Aim:The aim of this study was to develop and validate a Japanese version of the Athens Insomnia Scale (AIS-J).Methods: The AIS-J was created using a backtranslation design. A total of 477 outpatients with chronic insomnia and 163 individuals from the general community were recruited. Participants were asked to complete the AIS-J along with two other insomnia scales -Japanese versions of the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. Results:The AIS-J consisted of a two-factor structure: 'nocturnal sleep problem' (items 1-5) and 'daytime dysfunction' (items 6-8). Internal consistency coefficients ranged from 0.78 to 0.88. Correlations between the AIS-J and the aforementioned authorized scales were 0.81 and 0.85, respectively. Scores on the AIS-J were significantly higher for the insomnia group than for the control group. The AIS-J cut-off value for identifying pathological insomnia was estimated at 6 points or more, and the AIS-J-nocturnal cut-off value was estimated at 4 points or more. Conclusions:The AIS-J has sufficient validity and diagnostic utility.

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Patients with less severe obstructive sleep apnoea (OSA) are usually prescribed oral appliances and/or smaller optimal nasal continuous positive airway pressure (PnCPAP) in nCPAP therapy. We hypothesised that OSA patients with greater PnCPAP would not respond favourably to oral appliances.Oral appliances were inserted in nCPAP users after washing-out the nCPAP effect. Follow-up polysomnography was undertaken with the adjusted oral appliance in place. The predictability of PnCPAP was evaluated with receiver-operating characteristic (ROC) curves.The median baseline apnoea/hypopnoea index (AHI) was reduced with the oral appliance from 36 to 12 events?h -1 in 35 patients. When responders were defined as patients showing a follow-up AHI of ,5 events?h -1 with .50% reduction in baseline AHI, the area under the ROC curve for PnCPAP was 0.76. The best cut-off value of PnCPAP turned out to be 10.5 cmH 2 O with a high negative predictive value (0.93) and a low negative likelihood ratio (0.18). OSA patients with a PnCPAP of .10.5 cmH 2 O are unlikely to respond to oral appliance therapy. This prediction is clinically helpful to both OSA patients and medical personnel in discussing oral appliances as a temporary substitute and/or alternative for nCPAP.

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