The Validation of an Existing Sleep Apnea Questionnaire and its Application to Clinical Orthodontics
The purpose of this study was to validate a sleep apnea questionnaire from the Loma Linda University Sleep Disorders Center, and then to utilize the questionnaire in order to identify potential sleep apnea patients from a pre-orthodontic patient sample. Study patients were selected from the Loma Linda University Sleep Disorders Center and the Loma Linda University Orthodontics Clinic, both in Loma Linda, California, USA. Methods: The study sample represented all of the patients initially examined from 1996 through 1998 who were age 8-15 years old at the time of the initial exam. Validation of the questionnaire was based on responses to questions of these 90 patients from the sleep center, irregardless of the diagnosis, whose parents responded to the questionnaire. To assess potential sleep apnea patients, 65 patients, age 8-15, were selected from the Sleep Center archives, all of whom completed the Loma Linda Sleep Disorders Center Questionnaire (LLUSDCQ). Their responses on the LLUSDCQ, were compared to 65 patients, ages 8-15, from the Loma Linda Orthodontic Clinic, who were under orthodontic evaluation. From the LLSDCQ, questions of clinical utility were then identified as significant in their ability to predict sleep apnea correctly. These questions were then analyzed statistically for their sensitivity and specificity at uniquely predicting sleep apnea. Pretreatment orthodontic patients with a strong indication for sleep apnea were also identified and orthodontic records were then assessed, on the basis of the results from the questionnaire. Results indicated that, neither gender nor age, predicted sleep apnea when using the Normal Approximation to Binomial statistical test. A Logistics Regression Model found that a combination of questions 2 (Snoring or noisy breathing), 3 (Observed times with no breathing), and 8 (Mouth breathes while awake) resulted in a statistically significant ability to predict sleep apnea correctly. (R2=56.5 ; p < .05). The incidence of sleep apnea predicted by the questionnaire in the pre-treatment orthodontic patients was 4.6%, an incidence roughly double that expected in this age group. Similarities in orthodontic patient records were examined in those patients identified, particularly the dolichofacial pattern characteristics, suggesting an aggregation of craniofacial characteristics which may additionally be important in the identification of sleep apnea patients. In summary, the LLUSDCQ may assist in the identification of sleep apnea patients in the orthodontic population age range examined. Evaluation of orthodontic records may be coordinated with the LLUSDCQ to help clinicians and other health professionals to make an appropriate referral to sleep centers with confidence.
Orthodontics and Orthodontology, Sleep Medicine, Sleep Apnea Syndromes -- etiology; Sleep Apnea Syndromes -- therapy; Sleep Disorders; Orthodontics.
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