Berlin Questionnaire Calculator
Answer 10 sleep questions and see whether the Berlin Questionnaire puts the person at high risk for obstructive sleep apnea.
What it does
The Berlin Questionnaire is a short screen for obstructive sleep apnea. It asks about snoring, daytime sleepiness, body mass index, and blood pressure. The result is not a diagnosis and does not measure apnea severity. It flags people who should be offered a sleep study or a more detailed sleep evaluation.
The 10 questions fall into three categories. Category 1 covers snoring, loudness, frequency, whether snoring bothers others, and whether anyone has seen the person stop breathing. Category 2 covers tiredness after sleep, daytime fatigue, and falling asleep while driving. Category 3 covers BMI above 30 and high blood pressure.
A category is positive when enough of its questions are positive. Category 1 is positive with 2 or more positive answers out of 5. Category 2 is positive with 2 or more positive answers out of 3. Category 3 is positive when either BMI is above 30 or blood pressure is high. The overall screen is high risk when at least 2 of the 3 categories are positive.
The questionnaire is easy to give in a waiting room or during a clinic visit. It takes a few minutes and does not need a bed partner to be present, though a bed partner can answer the snoring questions more accurately. It is used in primary care, cardiology, bariatric surgery, and preoperative assessment.
The Berlin Questionnaire performs differently across populations. It tends to be sensitive but not specific, so many people who screen high risk do not have severe apnea on testing. It can also miss apnea in women, older adults, and people without loud snoring. A low risk result is not a guarantee, especially when symptoms are strong or the person has heart failure, atrial fibrillation, or resistant hypertension.
How to use
- Ask the 10 questions in the order shown. A bed partner can help with the snoring and witnessed apnea items.
- Count the positive answers in category 1: snoring, loud snoring, snoring nearly every day, snoring bothers others, and witnessed stopping of breathing.
- Mark category 1 positive when 2 or more of those 5 answers are yes.
- Count the positive answers in category 2: tired after sleep, daytime fatigue, and falling asleep while driving. Mark it positive when 2 or more of 3 are yes.
- Mark category 3 positive when BMI is above 30 or blood pressure is high. Either one is enough.
- Count the positive categories. Two or more positive categories means high risk. One or none means low risk.
Formula
- Category 1
- Five items about snoring, loudness, frequency, bother to others, and witnessed apnea. Positive with 2 or more yes answers.
- Category 2
- Three items about tiredness after sleep, daytime fatigue, and sleepiness while driving. Positive with 2 or more yes answers.
- Category 3
- BMI above 30 or high blood pressure. Positive when either is present.
- Overall
- High risk when 2 or more of the 3 categories are positive.
The BMI item uses above 30, not 25 or 30 or higher. The blood pressure item asks whether the person has high blood pressure, usually diagnosed by a clinician. The questionnaire does not ask about neck circumference, sex, age, or medication. It also does not grade severity. A high risk result should lead to a sleep study or a sleep medicine referral, not to a diagnosis by questionnaire alone.
Worked example
Example: 2 of 3 categories, high risk
A 52 year old patient snores loudly, feels tired after sleep, and has high blood pressure. The patient does not snore every night, has not been seen to stop breathing, does not fall asleep while driving, and has a BMI of 28.
- Category 1: snoring yes and loud snoring yes. The other three items are no, so the count is 2 of 5. Category 1 is positive.
- Category 2: tired after sleep yes, daytime fatigue no, falling asleep while driving no. The count is 1 of 3. Category 2 is negative.
- Category 3: BMI is 28, which is not above 30, but high blood pressure is yes. Category 3 is positive.
- Positive categories: category 1 and category 3, for a count of 2 of 3.
- Two or more categories are positive, so the overall result is high risk.
- Refer for a sleep study or sleep medicine evaluation.
Reference table
| Category | Items | Positive when | Example count |
|---|---|---|---|
| 1. Snoring and apnea | 5 questions | 2 or more yes answers | 2 of 5, positive |
| 2. Daytime sleepiness | 3 questions | 2 or more yes answers | 1 of 3, negative |
| 3. BMI or blood pressure | BMI above 30 or hypertension | Either one present | Hypertension yes, positive |
| Overall risk | All 3 categories | 2 or more categories positive | 2 of 3, high risk |
Limits
- The questionnaire screens for risk. It does not diagnose obstructive sleep apnea or measure the apnea hypopnea index.
- It can miss apnea in people who do not snore loudly, including some women and older adults.
- It can produce false positives in people with obesity, depression, or other causes of daytime fatigue.
- A low risk result does not rule out apnea when symptoms, heart disease, or witnessed apneas are present.
Common mistakes
- Treating one positive category as high risk. The cutoff is 2 or more categories.
- Using BMI 25 or 30 or higher for category 3. The item is BMI above 30.
- Counting snoring loudness as positive when the answer is only as loud as talking.
- Marking category 2 positive from a single yes answer. It needs 2 of 3.
- Using the questionnaire as a diagnosis instead of a reason to arrange sleep testing.
Try it yourself
Quick checks. Answers sit tucked under each question.
Category 1 has 2 yes answers, category 2 has 0, category 3 is negative. What is the result?
Only 1 category is positive, so the result is low risk.
Category 1 has 0 yes answers, category 2 has 2, and category 3 is positive. What is the result?
Two categories are positive, so the result is high risk.
All 10 answers are no. What is the result?
No category is positive, so the result is low risk.
Questions
What does a high risk Berlin result mean?
It means the person has positive answers in at least 2 of the 3 categories. The next step is a sleep study or a sleep medicine review.
Is the Berlin Questionnaire a diagnosis?
No. It estimates risk. Diagnosis needs sleep testing or a specialist assessment.
How is category 1 scored?
Add the yes answers to the 5 snoring questions. Two or more yes answers make the category positive.
How is category 2 scored?
Add the yes answers to the 3 sleepiness questions. Two or more yes answers make the category positive.
Does BMI 30 count as positive?
The item asks for BMI above 30. A BMI of exactly 30 is not above the threshold, so it does not count unless blood pressure is also high.
Can the Berlin Questionnaire be used for children?
No. It was developed for adults. Children need a pediatric sleep evaluation and different screening tools.
Sources
- American Thoracic Society: Berlin Questionnaire
- Validation of the modified Berlin Questionnaire for obstructive sleep apnea