Introduction: A number of screening questionnaires and clinical screening models have been developed to identify patients with obstructive sleep apnea syndrome (OSAS). These questionnaires lack reliability, and their predictability varies. Hence, it is difficult to predict or rule out OSAS on one questionnaire alone. The combination of two or more questionnaires might be helpful in ruling out OSAS. Objectives: (1) To determine the sensitivity, specificity, and predictive values of combination of two or more sleep questionnaires out of three established sleep questionnaires, i.e., Epworth sleepiness scale (ESS), perioperative sleep apnea prediction score (PSAP), STOP-Bang, in predicting OSAS and correlation with severity of OSAS. (2) To compare and correlate ESS, PSAP, and STOP-Bang individually with apnea–hypopnea index (AHI) obtained by polysomnography (PSG). Materials and methods: It was a prospective observational study conducted in a tertiary care center from January 2018 to August 2019 involving 250 cases of suspected OSAS. All the participants were interviewed for the three questionnaires followed by diagnostic type I PSG. Results: Comparing the individual questionnaires, ESS had higher sensitivity but low specificity, whereas PSAP had higher specificity. Perioperative sleep apnea prediction [area under curve (AUC) = 0.743 for any OSAS and 0.722 for moderate-to-severe OSAS] had a better prediction for OSAS. For predicting any OSAS, the combination of STOP-Bang + ESS + PSAP had a sensitivity of 95.76, specificity of 24.59%, and high negative predictive value (NPV) of 65.22%. For predicting moderate-to-severe OSAS, the combination of STOP-Bang + ESS + PSAP had a sensitivity of 92.59, specificity of 36.06%, and high NPV of 61.11%. Conclusion: The combination of questionnaires especially STOP-Bang, ESS, and PSAP improves the sensitivity of detection up to 95%, and when all of them are negative, OSAS is ruled out with around 65% confidence. So, using this combination can help us to identify high-risk patients and prioritize them for PSG so that they can get early treatment.

Obstructive sleep apnea (OSA) is a heterogeneous disease with a wide spectrum and diversity. Impact of OSA is multi-systemic with predisposition to cardiac, neurological, metabolic, endocrinological, neurocognitive, and psychiatric disorders. The continuous positive airway pressure (CPAP) device has a strong recommendation in treatment of OSA. Of the patients prescribed CPAP, 5–50% are nonadherent. Various patient-, clinician-, and therapy-related barriers affect CPAP adherence. Continuous positive airway pressure adherence can be improved by focusing on the multidisciplinary aspects like (1) education and counseling, (2) intensive patient support, (3) behavioral interventions, (4) spousal collaboration, (5) machine- and interface-related issues, (6) conservative measures, (7) and newer adherence monitors. Thus providing holistic management in OSA.

Heart failure (HF) shares a bidirectional cause and effect relationship with sleep-disordered breathing (SDB). This review aims to address the epidemiology, etiopathogenesis, and treatment for such patients as early suspicion, and treatment is the key to improved morbidity and mortality.

Late-onset congenital central hypoventilation syndrome (LO-CCHS) is a rare entity, with scant literature. In view of low prevalence and poor awareness in both patients and doctors, it is often diagnosed late or, worse, misdiagnosed as an obstructive airway disease. Timely diagnosis of central hypoventilation is necessary to prevent hypercapnia, acidosis, and hypoxemia, which can adversely affect the cardiovascular and neurocognitive function. Here we report an interesting case of a young nonobese female who had history of multiple intensive care unit (ICU) admissions for her hypercapnic respiratory failure.