When evaluating the risk of obstructive sleep apnea (OSA), healthcare providers rely on simple tools to screen patients before ordering formal diagnostic tests. Two of the most common options are the STOP-Bang questionnaire and the Berlin Questionnaire.
Although both aim to assess sleep apnea risk, they use different criteria, scoring systems, and approaches. Understanding the differences can help you—and your provider—choose the most appropriate path forward.
In this blog, we break down how each tool works, compare their accuracy, and explain when each is most useful.
What Is the STOP-Bang Questionnaire?
The STOP-Bang tool consists of 8 yes/no questions. Each letter in “STOP-Bang” stands for a risk factor:
- Snoring
- Tiredness
- Observed apnea
- Pressure (high blood pressure)
- Body Mass Index (BMI >35)
- Age (≥50)
- Neck circumference
- Gender (male or assigned male at birth)
Each “yes” answer scores 1 point. A score of:
- 0–2 suggests low risk
- 3–4 suggests intermediate risk
- 5–8 suggests high risk
The STOP-Bang is fast, objective, and widely validated in clinical settings—especially for identifying moderate to severe OSA.
What Is the Berlin Questionnaire?
The Berlin Questionnaire was introduced earlier and uses a more subjective, category-based approach. It has 10 questions split into three sections:
- Snoring & Observed Apnea
- Daytime Sleepiness
- High Blood Pressure or BMI
Instead of yes/no answers, it uses frequency-based responses like “3–4 times a week.” Scoring places you into either a “high risk” or “low risk” category based on how many sections you qualify in.
A patient is labeled “high risk” if they score positive in two or more sections.
Key Differences at a Glance
| Feature | STOP-Bang | Berlin Questionnaire |
| Format | 8 yes/no questions | 10 frequency-based questions |
| Scoring | 0–8 total score | Risk level based on 3 category scores |
| Focus Areas | Symptoms + anatomical risk factors | Symptoms + hypertension + BMI |
| Output | Low, Intermediate, or High Risk | Low Risk or High Risk |
| Strength | Easy to score, more objective | Captures symptom frequency |
| Weakness | Doesn’t track frequency or insomnia | More subjective, longer to complete |
Which One Is More Accurate?
In general, STOP-Bang is more sensitive, meaning it catches more people with moderate to severe sleep apnea—especially when scores are high.
The Berlin Questionnaire may be better at identifying individuals with milder symptoms or where snoring and daytime fatigue are the main complaints, even without obvious risk factors.
A 2021 review comparing both found that:
- STOP-Bang had better sensitivity
- Berlin had slightly better specificity
(Source: Sleep Review Journal)
This means STOP-Bang is more likely to flag people who truly have OSA, while the Berlin Questionnaire is better at filtering out those who don’t.
When to Use STOP-Bang
STOP-Bang is often preferred in:
- Surgical screening settings
- Primary care offices
- Pre-test evaluations for high-risk individuals
Its scoring is quick, requires no calculations, and incorporates risk factors like age, neck circumference, and gender, which have strong correlations with airway collapse during sleep.
It also aligns well with AI facial scanning, which considers many of the same physical risk markers.
When to Use the Berlin Questionnaire
The Berlin tool may be more helpful when:
- Patients report vague fatigue or daytime sleepiness without clear physical risk factors
- Providers want to assess snoring frequency and its impact
- There is a need to explore habitual symptoms in greater detail
It’s more nuanced when it comes to behavioral symptoms, like how often someone falls asleep while driving or sitting still.
However, it’s more subjective and takes slightly longer to score.
Can You Use Both?
Yes. In fact, some sleep clinics use both tools together for a broader picture—especially when one gives a borderline result.
Pairing these with home sleep tests or facial scan-based risk assessments can further improve accuracy.
For example:
- A STOP-Bang score of 3 (intermediate risk) + a “high risk” Berlin result = high priority for testing
- A STOP-Bang score of 2 + a “low risk” Berlin = low likelihood of OSA, monitor only
What If I Score High on Either Tool?
High risk scores on either tool mean it’s time to explore further testing. Options include:
- Home sleep apnea test (HSAT) – ideal for most people with moderate symptoms
- Polysomnography – full lab study recommended for complex or unclear cases
- AI facial scanning – fast, contact-free method that analyzes structural airway risks
The tools themselves don’t diagnose sleep apnea. They’re a guide—to help determine who should be tested and who might not need it right away.
Bottom Line
Both the STOP-Bang and Berlin Questionnaire are useful tools for spotting sleep apnea risk. While STOP-Bang is quicker and more data-driven, the Berlin method gives deeper insight into symptom frequency.
Choosing the right one depends on:
- Your symptoms
- Time available for screening
- Whether physical traits like BMI and neck size are already apparent risks
In many cases, using both—alongside tools like facial scans or oximetry—can give the clearest picture of your sleep health.
If your score from either tool is concerning, don’t wait. Take the next step and speak with a sleep provider, order a home test, or try a facial risk scan to confirm what your body may already be telling you.
