title: A pilot study to assess the possible methods of determining the burden of obstructive sleep apnoea syndrome in primary care.
abstract: BACKGROUND
  A significant minority of otherwise healthy adults may suffer from disordered breathing during sleep. The commonest problem, known as Obstructive Sleep Apnoea Syndrome (OSAS), results in poor quality sleep, daytime hypersomnolence and excess risk of road traffic crashes. It is also associated with occupational injuries. OSAS can be successfully treated, reducing costs of hospitalisation. There is a gap in the literature regarding the burden of patients with OSAS in primary care, particularly because there is no agreed method for screening.
  
  
  OBJECTIVE
  This pilot study was designed to determine the feasibility of screening for OSAS in a UK inner-city multi-ethnic primary care population, to investigate ways in which it might be detected, and to gain an awareness of the potential size of the burden of OSAS METHODS: We tested two methods of screening: firstly, postal questionnaires to a random sample of 240 patients from a subset of the population at highest risk of OSAS (men aged 35-65 years); and secondly, the same questionnaire plus two screening tools for detecting hypersomnolence, given to patients attending the practice for pre-registration health checks.
  
  
  RESULTS
  Despite reminders, only 40% of postal questionnaires were returned and there were only 67 (28%) usable responses. The prevalence of snoring was 55%. Almost half of those patients who responded (46%) had a Body Mass Index (BMI) associated with a high risk of OSAS. This was not a positive responder bias because there were no significant differences in BMI between responders and non-responders. 12% had a collar size of greater than 17.5, whilst 34% reported daytime sleepiness, and 24% reported witnessed apnoea. Screening during pre-registration health checks proved both feasible and productive with 38 patients of differing linguistic abilities completing the assessment.
  
  
  CONCLUSIONS
  Screening for OSAS in primary care by means of a postal questionnaire produced a low response. Whilst there was no evidence of a responder bias in terms of BMI, the numbers reporting large collar size, daytime sleepiness and witnessed apnoea suggest that a sizeable proportion of the population is at risk of OSAS. Questionnaires used in this study provide a means of identifying patients with symptoms suggestive of OSAS, although the sensitivity, specificity and positive predictive value of a self-administered instrument needs to be confirmed by a larger study incorporating ventilatory monitoring during sleep. The addition of screening to pre-registration health checks is feasible, but it would take a long time to screen all those at risk for OSAS by this route.
authors.affiliation: Faculty of Medicine, Imperial College London, NHLI at Charing Cross Hospital, St Dunstans Road, London W6 8RP, UK.
authors.forename: E L
authors.initials: EL
authors.lastname: Palmer
authors.forename: D
authors.initials: D
authors.lastname: Wingfield
authors.forename: K
authors.initials: K
authors.lastname: Jamrozik
authors.forename: M R
authors.initials: MR
authors.lastname: Partridge