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From 70 patients who had uvulopalatopharyngoplasty (UPPP) operation and a pre- and postoperative sleep registration, we could retrospectively determine the failures and the correlation between variables such as age, gender, body mass index (BMI), earlier or concomitant tonsillectomy, unilevel (uvula-palate-tonsil) or multilevel (base of tongue as well) obstruction during sleep endoscopy and treatment outcome. From 70 patients, the preoperative sleep registration classified 15 social unacceptable snorers and 55 obstructive sleep apnoea syndrome (OSAS) patients. In this study we focused on the OSAS patients. From the 55 OSAS patients, 32 were classified as successful after UPPP, because they had a decreased apnoea-hypopnoea index (AHI) after surgery ( 0.56) as between the level of obstruction(s) (P > 0.24). For earlier or concomitant tonsillectomy we found a statistically difference (P > 0.039), but a very small number in the high failure group (n = 8). We conclude that although sleep endoscopy adds to better patient selection and better results, paradoxically, the finding of obstruction on palate-uvula level during sleep endoscopy can still give UPPP failures.

In the diagnostic work-up of socially unacceptable snoring (SUS) with or without a history suggestive of obstructive sleep apnoea syndrome (OSAS), information on the severity of the pathology as well as on local and general causative factors is needed. In part I of this study, we reported on the findings recorded in 380 patients by means of sleep registration. In this part, our emphasis is on analysis of the local contributing factors. In 340 of the 380 patients sleep endoscopy was performed to establish the level(s) of obstruction as accurately as possible. Sleep endoscopy was performed following artificial induction of sleep with midazolam and consisted in endoscopy and flexible nasopharyngoscopy and laryngoscopy. Although obstruction at the oropharyngeal level was often present, obstructions at lower levels or at multiple levels were also frequently found. In many cases sleep endoscopy showed obstruction at different level(s) than had been suspected on the grounds of ear nose and throat (ENT) investigation only. An obstruction at only one level was recorded in 35% of the patients (119), while 65% of patients (221) had multiple-level obstruction. The level(s) of obstruction could be well established by sleep endoscopy. We conclude that a diagnostic work-up involving a combination of sleep registration, sleep endoscopy, and analysis of general factors is worthwhile. Combining the results of these tests makes it possible to give individually tailored advice on treatment.

and KENTMARQUIS United States Census Bureau, Washington, D.C. QUAID (question-understanding aid) is a software tool that assists survey methodologists, social scientists , and designers of questionnaires in improving the wording, syntax, and semantics of questions. The tool identifies potential problems that respondents might have in comprehending the meaning of questions on questionnaires. These problems can be scrutinized by researchers when they revise questions to improve question comprehension and, thereby, enhance the reliability and validity of answers. QUAID was designed to identify nine classes of problems, but only five of these problems are addressed in this article: unfamiliar technical term, vague or imprecise relative term, vague or ambiguous noun phrase, complex syntax, and working memory overload. Wecompared the output of QUAID with ratings of language experts who evaluated a corpus of questions on the five classes of problems. The corpus consisted of 505 questions on 11 surveys developed by the U.S. Census Bureau. Analyses of hit rates, false alarm rates, d' scores, recall scores, and precision scores revealed that QUAID was able to identify these five problems with questions, although improvements in QUAID's performance are anticipated in future research and development. A good surveyor questionnaire contains questions that elicit valid and reliable answers from respondents in a short amount oftime. One of the challenges to survey researchers and social scientists is to design questions that achieve these general objectives. Researchers in the field ofsurvey methodology have proposed models that dissect the many stages of question answering (Cannell, Miller,

Introduction. The objective was to determine the value of (hetero‐) anamnestic apnoea and hypersomnia in relation to the outcome of sleep registration, in patients with socially unacceptable snoring. Methods. Retrospectively, 337 patients with socially unacceptable snoring who underwent sleep registration were evaluated to determine the predictive value of apnoea and hypersomnia using 2 × 2 tables. Results. Eighty per cent of patients reported having at least incidental complaints of apnoea. Sensitivity was 0.92228 and the predictive value for obstructive sleep apnoea syndrome (OSAS) was 0.58746. Two hundred and eighty patients also reported hypersomnia during the day. The sensitivity was 0.29032 and the predictive value for obstructive sleep apnoea syndrome was 0.56250. Conclusion. These data confirm that apnoea and hypersomnia in the history do not have a reliable predictive value for obstructive sleep apnoea syndrome. We conclude that, in all patients with socially unacceptable snoring, sleep registration is indicated to rule out or confirm the presence of OSAS.

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