Sleep Apnea Screening Tests Explained

Sleep Apnea Screening Tests

Do you snore loudly, wake up feeling exhausted, or has someone noticed you stop breathing during sleep? Three clinically validated questionnaires can help you assess your risk of obstructive sleep apnea: the Berlin Questionnaire, the Epworth Sleepiness Scale (ESS), and the STOP-BANG score. This page explains how each test works, how to interpret your results, and what steps to take if your score is high.

Why Take a Screening Test?

Obstructive sleep apnea (OSA) affects around 4 to 6% of the adult population, yet the vast majority of cases remain undiagnosed. Symptoms - snoring, chronic fatigue, daytime sleepiness, frequent night-time awakenings - are often dismissed or attributed to stress or an unhealthy lifestyle. Screening questionnaires allow at-risk individuals to be identified within minutes, helping them decide whether to consult a doctor for a sleep study.

These tools are widely used in general practice, before surgical procedures and in sleep medicine centres. They do not replace a diagnosis, but serve as a useful first step in determining whether a specialist assessment is needed.

Test 1 - The Berlin Questionnaire

Developed in 1996 at an international conference on sleep apnea in Berlin, Germany, the Berlin Questionnaire is one of the most comprehensive screening tools available. It is structured into 3 categories of questions covering the main dimensions of sleep apnea:

How to Interpret Your Berlin Score

Each category is assessed independently: it is either positive (a risk indicator) or negative. A patient is considered at high risk of obstructive sleep apnea if they score positive in at least 2 out of 3 categories.

• 0 or 1 positive category → Low to moderate risk. Monitor your symptoms.
• 2 or 3 positive categories → High risk. Medical consultation with a sleep study is strongly recommended.

The Berlin Questionnaire has a sensitivity of 86% and a specificity of 77% for moderate to severe sleep apnea (AHI ≥ 15). It is particularly well suited for screening in general practice as it explores several dimensions of the syndrome.

The full interactive test (with automatic scoring) is available on associationapnee.be:
Take the Berlin test →

Test 2 - The Epworth Sleepiness Scale (ESS)

The Epworth Sleepiness Scale (ESS) was developed in 1991 by Dr Murray Johns at Epworth Hospital in Melbourne, Australia. It is now one of the most widely used tools in the world for measuring excessive daytime sleepiness, one of the cardinal symptoms of sleep apnea.

The test consists of 8 everyday situations. For each, you must rate your likelihood of dozing off, on a scale from 0 to 3:

• 0 = No chance of dozing off
• 1 = Slight chance of dozing off
• 2 = Moderate chance of dozing off
• 3 = High chance of dozing off

The 8 situations assessed are: sitting and reading, watching television, sitting inactive in a public place, as a car passenger for an hour, lying down to rest in the afternoon, sitting and talking to someone, sitting quietly after lunch without alcohol, and in a car stopped in traffic.

How to Interpret Your Epworth Score

A score of 10 or above indicates excessive daytime sleepiness and warrants medical consultation. From 16 onwards, sleepiness is severe and may pose a safety risk (driving, working at height). Note: the ESS measures sleepiness in general - it is not specific to sleep apnea. Other conditions such as narcolepsy, restless legs syndrome or chronic sleep deprivation can also produce high scores.

The interactive test with automatic scoring is available on associationapnee.be:
Take the Epworth test →

Test 3 - The STOP-BANG Score

The STOP-BANG questionnaire was developed in 2008 by Chung et al. at the University of Toronto and validated on more than 2,000 patients. It is now the most widely used screening test in clinical settings, particularly before surgical procedures. Validated by the European Respiratory Society, it stands out for its speed (around 2 minutes) and simplicity.

STOP-BANG is an acronym covering the 8 criteria assessed:

• S - Snoring: Loud snoring (heard through a closed door?)
• T - Tired: Frequent fatigue or daytime sleepiness
• O - Observed: Breathing pauses witnessed by someone else
• P - Pressure: High blood pressure, treated or untreated
• B - BMI: Body mass index greater than 35
• A - Age: Over 50 years of age
• N - Neck: Neck circumference greater than 40 cm
• G - Gender: Male gender

Each criterion scores 1 point (Yes) or 0 points (No). The total score ranges from 0 to 8.

How to Interpret Your STOP-BANG Score

A score of 3 or more warrants medical consultation. A score of 5 or more indicates high risk and requires a sleep study. Clinical note: for women, a STOP-BANG score ≥ 2 combined with other criteria (BMI > 35 or age > 50) significantly increases the specificity of the test.

The full interactive test is available on associationapnee.be:
Take the STOP-BANG test →

After the Tests: What Steps to Take

A high score on one or more of these questionnaires is not a diagnosis. It indicates an increased risk and justifies a medical consultation, but only a sleep study can confirm or rule out sleep apnea.

The two reference examinations are:

• Ambulatory respiratory polygraph (home sleep test): performed at home with a portable device. It measures airflow, blood oxygen saturation, chest movements and heart rate. It is sufficient in the vast majority of cases.
• Polysomnography (PSG): performed at an accredited sleep centre, with one night of hospitalisation. It additionally records brain activity (EEG), eye movements and muscle tone. This is the gold standard examination for complex cases.

To learn more about these examinations and the diagnostic pathway in Belgium, visit our page on home sleep apnea testing.

If a High AHI Is Confirmed: Your Options

If your sleep study reveals an apnea-hypopnea index (AHI) of 15 or more, you may be eligible for the INAMI CPAP convention in Belgium. In this case, an accredited sleep centre will provide you with a device and manage your medical follow-up for a co-payment of €7.50/month (or free if you benefit from BIM status).

However, some patients prefer to purchase their own device, particularly those who:

• Have an AHI below 15 (convention threshold not reached) but whose quality of life is impacted
• Wish to freely choose their model and own their device
• Want to start treatment immediately without waiting 4 to 8 weeks
• Travel frequently and need a second compact device

VivaRespire offers a selection of the latest-generation automatic CPAP devices:

• ResMed AirSense 11 AutoSet - connected, quiet, with integrated humidifier
• Philips DreamStation 2 Auto - compact and lightweight, ideal for travel
• Löwenstein Prisma Smart Auto - German engineering with advanced auto-adjustment

Browse our full auto CPAP catalogue or our complete sleep apnea guide to better understand your options.