The Danish translation and validation of the Berlin Questionnaire for sleep apnoea.

INTRODUCTION: Obstructive sleep apnoea (OSA) is an increasing health problem related to cardiovascular disease, poor quality of life, daytime sleepiness and un-restorative sleep with an estimated prevalence up to 20% in the adult population. Approximately 82% of men and 93% of women with moderate to severe OSA remain undiagnosed. Relevant, fast, accurate and cost-effective screening methods are essential. The aim of this study was to translate and validate the Danish version of the Berlin Questionnaire (BQ), and to investigate if the questionnaire can be used for screening of OSA in a Danish population. METHODS: The BQ was translated into Danish according to guidelines producing the Danish Berlin Questionnaire (DBQ). The study population included 206 adult patients referred to the Sleep Clinic of Zealand University Hospital, Denmark, on suspicion of OSA. RESULTS: 69.4% were males, 53.3% were obese (BMI > 30), the mean BMI was 32.01. A total of 135 patients had hypertension (65.5%). Apnoea/hypopnoea Index (AHI) ≥ 15 was present in 141 of 206 patients (68.4%). We observed a sensitivity of the DBQ of 84% and a positive predictive value of 69%. CONCLUSIONS: We have successfully translated and partially validated the DBQ for OSA. Our study showed that the DBQ is useful for screening of Danish patients suspected of OSA. Further studies with improved screening methods and further development of questionnaires are recommended. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency.

Risk of childhood otitis media with focus on potentially modifiable factors: A Danish follow-up cohort study.

INTRODUCTION: Otitis media is the primary cause of antibiotic prescription in children. Two-thirds of all children experience at least one episode of otitis media before the age of 7 years. The aim of this study was to characterise the attributable effect of several modifiable risk exposures on the risk of >3 episodes of otitis media at age 18 months and 7 years within a large prospective national birth cohort. METHODS: The study used the Danish National Birth Cohort comprising information about otitis media and risk exposures from more than 50,000 mother-child pairs from the period 1996-2002. Logistic regression models were used to estimate odds ratios for the risk factors and to calculate the population attributable fraction. RESULTS: Short time with breastfeeding, early introduction to daycare, cesarean section, and low compliance to the national vaccination program were all associated with an increased risk of >3 episodes of otitis media at 18 months of age and at 7 years of age. The fraction of children with otitis media attributed from breastfeeding lasting for less than 6 months was 10%. Introduction to daycare before the age of 12 months attributed with 20% of the cases of >3 episodes of otitis media. CONCLUSIONS: Short duration of breastfeeding, early introduction into daycare, cesarean section, and low compliance with the national vaccination program increased the risk of experiencing >3 episodes of otitis media at 18 months, and at 7 years of age. These are factors that all can be modulated.

Validation of the Danish STOP-Bang obstructive sleep apnoea questionnaire in a public sleep clinic.

INTRODUCTION: Obstructive sleep apnoea is common; a prevalence of 1-5% was previously reported. However, only few cases are diagnosed and receive treatment. The aim of this study was to validate the Danish translated version of the STOP-Bang screening tool for obstructive sleep apnoea (OSA) in a public sleep clinic. 
 METHODS: A study population of 208 patients who were referred to a public sleep clinic on suspicion of OSA were assessed with the STOP-Bang questionnaire and at-home cardiorespiratory monitoring in order to assess the quality of the questionnaire as an OSA screening tool. 
RESULTS: In the study population, 73% were males, and 51% of the population had an Apnoea-Hypopnoea Index (AHI) ≥ 15. The STOP-Bang screening tool had a sensitivity of 0.98 for detection of OSA with AHI ≥ 15 and a corresponding specificity of 0.09. Hence, the questionnaire is able to detect almost all patients suffering from OSA. However, using the tool will cause many healthy subjects to be falsely classified as having OSA. 
 CONCLUSIONS: The Danish version of the STOP-Bang screening tool does not seem useful for OSA screening of patients in a sleep clinic setup, but it may be useful in primary care. 
 FUNDING: The Zealand Research Foundation. 
 TRIAL REGISTRATION: not relevant.

The Effect of Breastfeeding on Childhood Otitis Media.

PURPOSE OF REVIEW: The purpose of this review is to summarize the literature regarding the association between breastfeeding and childhood otitis media (OM), with focus on the literature published within the past 5 years. The review comprises original articles and recent reviews. RECENT FINDINGS: The effect of a protective effect of breastfeeding on the risk of OM is still being discussed. Within the past 5 years, 6 reviews and 15 original articles have been published. No randomized controlled trials have been published, and the diversity of exposure and outcome measures in the studies was significant. Also, we provide a summary of the recent literature on cost-benefit of breastfeeding and believed mechanism of protection against OM. Breastfeeding for more than 6 months seems to protect against OM during the first 6 years of life. Exclusive breastfeeding may have a more protective effect than non-exclusive breastfeeding. Introduction of formula feeding before the age of 6 months increased the risk of OM.

Correction: Risk Factors of Early Otitis Media in the Danish National Birth Cohort.

[This corrects the article DOI: 10.1371/journal.pone.0166465.].

Early childhood otitis media and later school performance - A prospective cohort study of associations.

INTRODUCTION: Otitis media (OM) is a common disease in childhood and hearing loss (HL) is the most common complication. Prolonged HL may lead to language delay and cognitive difficulties. However, the consequences of HL due to OM are not fully understood. The aim of this study was to determine the possible association between number of OM episodes in childhood and self-rated school performance controlling for potential confounders. METHODS: Prospectively gathered systematic interview data on OM episodes in early childhood and school performance at 11 years of age were obtained from The Danish National Birth Cohort, involving >100,000 individual pregnancies and their offspring. We defined four exposure groups (0, 1-3, 4-6 and ≥7 OM episodes) and assessed general school performance, mathematics and literacy. Possible confounders were recognized à priori and associations were determined using proportional odds regression. RESULTS: Out of 94,745 successful pregnancies, 35,946 children without malformations and their parents completed a questionnaire at age 11 years. No associations were observed between number of OM episodes and school performance, even in children with ≥7 OM episodes. CONCLUSION: This national birth-cohort study did not support the hypothesis that the number of OM episodes in childhood is associated with reduced self-reported school performance in children at 11 years of age.

Risk Factors of Early Otitis Media in the Danish National Birth Cohort.

OBJECTIVE: To assess risk factors of otitis media (OM) in six-months-old children. METHOD: The sample consisted of 69,105 mothers and their children from the Danish National Birth Cohort. The women were interviewed twice during pregnancy and again 6 months after birth. The outcome "one or more" maternal reported episodes of OM at age six months. In total 37 factors were assessed, covering prenatal, maternal, perinatal and postnatal factors. RESULTS: At age six months 5.3% (95% CI 5.1-5.5) of the children had experienced one or more episodes of OM. From the regression analysis, 11 variables were associated with a risk of OM. When a Bonferroni correction was introduced, gender, prematurity, parity, maternal age, maternal self-estimated health, taking penicillin during pregnancy, and terminating breastfeeding before age six months, was associated with a risk of early OM. The adjusted ORs of OM for boys versus girls was 1.30 (95% CI 1.18-1.44). The OR having one sibling versus no siblings was 3.0 (95% CI 2.64-3.41). If the woman had been taking penicillin during pregnancy, the OR was 1.35 (95% CI 1.15-1.58). Children born before 38th gestational week had an increased OR for early OM of 1.49 (95% CI 1.21-1.82). Children of young women had an increased OR of early OM compared to children of older women. Additionally, children of women who rated their own health low compared to those rating their health as high, had an increased OR of 1.38 (95% CI 1.10-1.74). Finally, children being breastfeed less than 6 months, had an increased OR of 1.42 (95% CI 1.28-1.58) compared to children being breastfeed beyond 6 months. CONCLUSION: These findings indicate that prenatal factors are of less importance regarding early OM before the age of six months. Postnatal risk factors seem to pose the main risk of early OM.