CDE Detailed Report

Disease: Spinal Cord Injury
Sub-Domain: Sleep
CRF: Berlin Questionnaire

Displaying 1 - 10 of 10
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C09565 Berlin Questionnaire (BQ) - snore indicator BQSnoreInd Whether patient/subject snores as part of BQ form Whether patient/subject snores as part of BQ form Do you snore? Yes;No;Don't know Yes;No;Don't know Alphanumeric

No instructions available

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf<br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09566 Berlin Questionnaire (BQ) - snore volume type BQSnoreVolTyp Description of participant/subject snoring volume level as part of BQ form Description of participant/subject snoring volume level as part of BQ form Your snoring is: Slightly louder than breathing;As loud as talking;Louder than talking;Very loud - can be heard in adjacent rooms Slightly louder than breathing;As loud as talking;Louder than talking;Very loud - can be heard in adjacent rooms Alphanumeric

Answer only if Question #1 was answered Yes

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf <br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09567 Berlin Questionnaire (BQ) - snore frequency BQSnoreFreq Frequency of participant/subject snoring as part of BQ form Frequency of participant/subject snoring as part of BQ form How often do you snore? Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Alphanumeric

Answer only if Question #1 was answered Yes

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf <br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09568 Berlin Questionnaire (BQ) - snore bother other indicator BQSnoreBthrOthrInd Whether participant/subject snoring has ever bothered other people as part of BQ form Whether participant/subject snoring has ever bothered other people as part of BQ form Has your snoring ever bothered other people? Yes;No;Don't know Yes;No;Don't know Alphanumeric

Answer only if Question #1 was answered Yes

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf<br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09569 Berlin Questionnaire (BQ) - stop breathe sleep status BQStopBreathSleepStatus Whether anyone has noticed that participant/subject stops breathing during sleep as part of BQ form Whether anyone has noticed that participant/subject stops breathing during sleep as part of BQ form Has anyone noticed that you quit breathing during your sleep? Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Alphanumeric

Answer only if Question #1 was answered Yes

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf <br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09570 Berlin Questionnaire (BQ) - feel tired often after sleep status BQFeelTrdOftAftrSleepStatus How often patient/subject feels tired or fatigued after sleeping as part of BQ form How often patient/subject feels tired or fatigued after sleeping as part of BQ form How often do you feel tired or fatigued after your sleep? Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Alphanumeric

No instructions available

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf <br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09571 Berlin Questionnaire (BQ) - feel tired waking time status BQFeelTrdWakeTImeStatus How often does patient/subject feel tired, fatigued or not up to par during waking time as part of BQ form How often does patient/subject feel tired, fatigued or not up to par during waking time as part of BQ form During your waking time, do you feel tired, fatigued or not up to par? Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Alphanumeric

No instructions available

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf<br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09572 Berlin Questionnaire (BQ) - sleep drive indicator BQSleepDriveInd Whether patient/subject has ever nodded off or fallen asleep while driving a vehicle as part of BQ form Whether patient/subject has ever nodded off or fallen asleep while driving a vehicle Have you ever nodded off or fallen asleep while driving a vehicle? No;Yes No;Yes Alphanumeric

No instructions available

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf<br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09573 Berlin Questionnaire (BQ) - sleep drive frequency BQSleepDriveFreq How often has patient/subject nodded off or fallen asleep while driving a vehicle as part of BQ form How often has patient/subject nodded off or fallen asleep while driving a vehicle as part of BQ form How often does this occur? Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Nearly every day;3-4 times a week;1-2 times a week;1-2 times a month;Never or nearly never Alphanumeric

Answered only if Question #8 was answered Yes

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf<br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

C09574 Berlin Questionnaire (BQ) - high blood pressure indicator BQHiBldPrssrInd Whether patient/subject has high blood pressure as part of BQ form Whether patient/subject has high blood pressure as part of BQ form Do you have high blood pressure? Yes;No;Never exposed Yes;No;Never exposed Alphanumeric

No instructions available

http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf<br />Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91 Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822-830. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Berlin Questionnaire Sleep Outcomes and End Points

Single Pre-Defined Value Selected

CSV