Predicting sleep disordered breathing in outpatients with suspected OSA.

OBJECTIVE: To validate the utilities of Berlin, STOP and STOP-BANG Questionnaires, other patient characteristics, comorbidities, Epworth Sleepiness Scale (ESS), fractional exhaled nitric oxide (FENO) and blood markers for the prediction of sleep disordered breathing (SDB) on limited polygraphy. SETTING: North Glasgow Sleep Service (a tertiary referral centre). PARTICIPANTS: 129 consecutive patients, aged ≥16 years, referred to the sleep clinic for assessment of possible obstructive sleep apnoea. INTERVENTIONS: We selected cut-points of apnoea hypopnoea index (AHI) of ≥5 and ≥15/h from their home polygraphy and determined associations of these with individual symptoms, questionnaire scores and other results. Receiver operating characteristic analysis and univariate and multivariate logistic regression were used to explore these. PRIMARY AND SECONDARY OUTCOMES MEASURES: Primary: The utility of STOP, STOP-BANG and Berlin Questionnaires for prediction of SDB. Secondary: The utility of other measures for prediction of SDB. RESULTS: AHI was ≥5 in 97 patients and ≥15 in 56 patients. STOP and STOP-BANG scores were associated with both AHI cut-points but results with ESS and Berlin Questionnaire scores were negative. STOP-BANG had a negative predictive value 1.00 (0.77-1.00) for an AHI ≥15 with a score ≥3 predicting AHI ≥5 with sensitivity 0.93 (95% CI 0.84 to 0.98) and accuracy 79%, while a score ≥6 predicted AHI ≥15 with specificity 0.78 (0.65 to 0.88) and accuracy 72%. Neck circumference ≥17 inch and presence of witnessed apnoeas were independent predictors of SDB. CONCLUSIONS: STOP and STOP-BANG Questionnaires have utility for the prediction of SDB in the sleep clinic population. Modification of the STOP-BANG Questionnaire merits further study in this and other patient groups.

The role of the dentist in sleep disorders.

UNLABELLED: Snoring and sleep apnoea are common. The demand for sleep medicine services has increased exponentially since the recognition of sleep apnoea as a disease in the 1960s. The involvement of dentists in the treatment of sleep apnoea has increased. This article provides an overview of the disorders and options for management. CLINICAL RELEVANCE: It is important that dentists are aware of the problem of sleep disorders and the potential they have to help in their management.

Metacognitive beliefs in primary insomnia: developing and validating the Metacognitions Questionnaire--Insomnia (MCQ-I).

Patients with Primary insomnia often experience intrusive, worrisome cognitive activity in the pre-sleep period. Metacognitive beliefs may explain this yet no valid reliable scale exists. The present study, therefore, developed the Metacognitions Questionnaire--Insomnia (MCQ-I). Following initial metacognitive insomnia profiling interviews, item refinement produced a preliminary 60-item MCQ-I. This was administered to 34 primary insomniacs and 37 normal sleepers. Psychometric data indicate primary insomniac patients score significantly higher than normal sleepers on MCQ-I. Test-retest reliability is good. Face, concurrent, construct and discriminant validity, scale sensitivity and specificity are all acceptable. Further research with larger primary insomnia and normal sleeper samples is now required.

Ten-year follow-up of mandibular advancement devices for the management of snoring and sleep apnea.

STATEMENT OF PROBLEM: Intraoral mandibular advancement devices have become widely used in recent years for the management of snoring and sleep apnea, and short-term effectiveness has been demonstrated. However, there is a shortage of data regarding long-term compliance. PURPOSE: The purpose of this study was to investigate the long-term compliance of patients who were provided with a mandibular advancement device. MATERIAL AND METHODS: Records of 180 patients who were provided with a mandibular advancement device in 1996 were available for review. A questionnaire was sent to all of these patients inquiring about continued device usage, comfort, and effectiveness. Questions were also asked about smoking, alcohol consumption, height, and weight. Data were analyzed with chi-square tests for any association between these factors and success of the device (alpha=.05). RESULTS: The response rate was 40%, with 72 replies. Of this number, 34 patients were currently wearing the device every night, with a further 13 wearing the device for up to 6 nights per week. Thirty-one of the respondents who were wearing the device felt more refreshed on waking. The median body mass index (BMI) was 30, 8 were smokers, and 12 subjects drank more than 20 units of alcohol per week. Few adverse effects of the device were reported. CONCLUSIONS: The mandibular advancement device appears to be an effective long-term solution for a significant number of patients with problem snoring and also those with mild to moderate obstructive sleep apnea.