# Cross-Cultural Adaptation and Validation of the Modern Standard Arabic Versions of the Berlin Questionnaire and Epworth Sleepiness Scale

## TL;DR

This study adapted and validated two sleep assessment tools for use in Arabic-speaking populations, showing they are reliable and effective for diagnosing sleep apnea.

## Contribution

The study provides the first validated Modern Standard Arabic versions of the Berlin Questionnaire and Epworth Sleepiness Scale for use in Moroccan clinical settings.

## Key findings

- The MSA versions of the BQ and ESS showed strong reliability with Kappa indices of 0.98-1.00 and an ICC of 0.99.
- High-risk OSAS identification was significantly associated with obesity and menopause.
- Excessive daytime sleepiness was reported by 61.9% of high-risk OSAS participants.

## Abstract

Background

The Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS) have been validated in various studies across diverse sociocultural contexts. Despite their significant impact, there is a lack of standardized assessment tools for obstructive sleep apnea syndrome (OSAS) in Arabic-speaking populations. This study aimed to adapt the BQ and the ESS to Modern Standard Arabic (MSA) for use in Moroccan clinical settings and assess their psychometric properties.

Methodology

The BQ and ESS were translated into MSA using a standardized process involving forward and backward translation. The psychometric properties of the Arabic versions of the BQ and ESS were assessed in 125 Moroccan patients recruited from the University Dental Clinic Ibn Rochd in Casablanca at two time points (T1 and T2). Reliability was assessed using Cohen’s kappa index, and internal consistency was measured using Cronbach’s alpha. Associations between variables were analyzed using Pearson’s chi-square and Fisher’s exact tests, with statistical significance set at p-values <0.05.

Results

The BQ identified 50.4% (63 out of 125) of participants as being at high risk for OSAS (95% confidence interval (CI) = 41.8-59.0), while 38.4% (48 out of 125) had a positive ESS score (95% CI = 30.4-47.2). Kappa indices for the BQ ranged from 0.98 to 1.00, while the intraclass correlation coefficient for the ESS was 0.99. Cronbach’s alpha values for the three categories were 0.58, 0.67, and 0.74, respectively. Statistically significant associations were observed between the risk of OSAS and obesity (p = 0.002) and menopause (p = 0.023). Additionally, 61.9% of participants identified as high-risk for OSAS reported experiencing excessive daytime sleepiness (p < 0.001).

Conclusions

The MSA versions of the BQ and ESS demonstrated strong validity and reliability for assessing and diagnosing OSAS in Arabic-speaking populations. These scales represent valuable resources for enhancing clinical practice in settings where Arabic is the primary language.