- Email: [email protected]
SLEEP APNOEA
873 HYPNOTIC USE BEFORE ADMISSION, IN HOSPITAL, AND ON DISCHARGE
unpublished survey of a general population sample, 6% were taking a benzodiazepine or other sedative drug chronically and a "substantial proportion" of these claimed that they were started on these drugs when they were in hospital for an acute emergency or for an operation. We have investigated prescribing of hypnotics in hospital wards to find out what proportion of patients were kept on these drugs for three or more nights and how many of those started on hypnotics were discharged home on them. 155 patients, mean age 48 (range 14-86), on medical, surgical, and obstetric wards were interviewed by one of us (S.H.) using a semistructured questionnaire. Patients were asked about current and previous use of hypnotics and answers were checked against case notes and prescription charts. Medication on discharge was obtained later from routine discharge summaries sent out to general practitioners. A patient was defined as a "regular user" ofhypnotics if he or she had been taking them for more than three nights per week at home or, in hospital, for more than three consecutive nights since admission. Medical patients received most new prescriptions for hypnotics prescribed for three or more nights (see table). Hospital admission increased the proportion of "regular users" from 17% at home to 51% in hospital. Of the medical patients started on hypnotics in hospital half were discharged with a further prescription-i.e., the number of patients taking hypnotics at home had doubled. There was no increase in the proportion of regular users among surgical and obstetric patients: more of these patients received hypnotics for one or two nights, as expected, but the temptation to continue prescribing seems to have been avoided. Hypnotics will continue to play an important role in the care of hospital inpatients but they should be prescribed in short courses. Ideally, the doctor who starts them should be the doctor who stops them. Our findings underline the contribution that hospital doctors can still make to reduce the incidence of chronic sleeping pill ’
ingestion. Department of Mental Health, University of Bristol,
SUSANNA HILL G. L. HARRISON
Bristol BS2 8DZ
sleep apnoea syndrome-namely, 30 or more apnoeic episodes lasting at least 10 s observed in both REM and non-REM overnight sleep.3The apnoeic episodes in these three patients were also predominantly central in type. This study will be reported in full elsewhere. In contrast to these patients with metabolic and endocrine disorders we have found only one case of the sleep apnoea syndrome among seven patients referred to us this year from other centres because of suspected sleep disorders. Two of these patients had chronic obstructive airways disease, one was obese, one had systemic hypertension, one had had a pneumonectomy for bronchiectasis, and the sixth was found to have temporal lobe epilepsy. The patient with the sleep apnoea syndrome had treated myxoedema and mitral valve disease but was euthyroid at the time of study. Although only a small series as yet, we have found the sleep apnoea syndrome in a much higher proportion of patients than in the large Edinburgh series. It may well be relevant that our patients had different underlying medical conditions than those studied by Shapiro et al., but we feel it may be premature to suggest at this stage that the syndrome is uncommon in Britain. Our work is currently directed towards investigating the incidence and mechanism of this interesting syndrome. the criteria for the
’
Departments of Clinical Neurophysiology, Respiratory Medicine, and Endocrinology, North Staffordshire Hospital Centre, Stoke-on-Trent ST4 7LN
PHYSICAL ILLNESS IN THE MENTALLY ILL
SIR,-I was glad to read Dr Peet’s letter (Sept. 5, p. 529) and would
psychiatrists to examine inpatients and outpatients very thoroughly for conditions other than the psychiatric disease they are known to have. Psychiatric patients often look physically very ill. Hall and his colleagues, from the department of psychiatry, University of Texas Medical Branch, have evaluated in a clinical research ward the medical state of 100 consecutively admitted psychiatric patients.’ "46% of the patients were thought to have medical illnesses that directly caused or greatly exacerbated their symptoms and were consequently responsible for their admission, while an additional 34% of patients were found to be suffering from a medical illness requiring treatment. A diagnostic battery of physical, psychiatric and neurological examinations coupled with a 34 panel automated blood analysis, complete blood cell count, urine analysis, ECG and sleep-depiived EEG established the presence urge all
and nature of more than 90% of the illnesses detected." Dr Hall will be speaking at this Association’s next conference, to be held in London in April, 1982, and we hope that many of your readers working in psychiatry will come to hear more of this work.
SLEEP APNOEA Tyr Twr,
SiR,-Dr Shapiro and colleagues (Sept. 5, p. 523) suggest that the sleep apnoea syndrome may be uncommon in Britain in the absence of some other medical disorder. However, there are in Britain very few sleep laboratories in which this syndrome can be studied and it may easily be missed. The common presenting features-snoring and daytime somnolence-may not attract much attention in a busy clinic or surgery. In addition to the occurrence of the sleep apnoea syndrome in acromegaly and in Scheie’s syndrome which we have reported elsewhere, 1,2 we have recently studied eight patients with myxoedema. Two patients, one male and one female, had the sleep apnoea syndrome, the apnoea being predominantly central in type. Three other female patients had 28, 25, and 22 apnoeic episodes during rapid eye movement (REM) and non-REM sleep, well outside the normal range of less than 5 in females,3but not fulfilling 1 Perks
WH, Horrocks PM, Cooper RA, Bradbury S, Allen A, Baldock N, Prowse K, van’t Hoff W. Sleep apnoea in acromegaly. Br Med J 1980; 280: 894-97. 2 Perks WH, Cooper RA, Bradbury S, Horrocks PM, Baldock N, Allen A, van’t Hoff W, Weidman G, Prowse K. Sleep apnoea in Scheie’s syndrome. Thorax 1980; 35: 85-91. 3 Guilleminault C, van der Hoed J, Mitler MM. In Guilleminault C, Dement WC, eds. Sleep apnea syndromes. New York: Alan R Liss, 1978: 1-12.
ROSEMARY COOPER DAVID MACKAY KEITH PROWSE WALTER VAN’T HOFF
Llanfair Hall, Caernarvon LL55 ITT
GWYNNETH HEMMINGS, Hon. Secretary, Schizophrenia Association of Great Britain
PRIVATE PRACTICE AND THE MEDICAL DIRECTORY
SIR,-A change in editorial policy that has accompanied a change in the editorial team at the Medical Directory has resulted in an invitation to doctors to indicate whether they take private patients. The Medical Directory already allows for a modest catalogue of achievements which, with other data, is quite sufficient to enable any would-be private patient to make intelligent and relevant inquiries. Since I am not in sympathy with this new policy I have requested that my entry be deleted. I suggest that others of like mind should take the same action. 35 Knatchbull Road, London SE5 9QR
MURIEL E. PURKISS
ER, Stickney SK, Lecann AF, Popkin MK. Physical illness manifesting as psychiatric disease II: Analysis of a State hospital inpatient population. Arch Gen Psychiat 1980, 37: 989.
1. Hall RCW, Gardner
unpublished survey of a general population sample, 6% were taking a benzodiazepine or other sedative drug chronically and a "substantial proportion" of these claimed that they were started on these drugs when they were in hospital for an acute emergency or for an operation. We have investigated prescribing of hypnotics in hospital wards to find out what proportion of patients were kept on these drugs for three or more nights and how many of those started on hypnotics were discharged home on them. 155 patients, mean age 48 (range 14-86), on medical, surgical, and obstetric wards were interviewed by one of us (S.H.) using a semistructured questionnaire. Patients were asked about current and previous use of hypnotics and answers were checked against case notes and prescription charts. Medication on discharge was obtained later from routine discharge summaries sent out to general practitioners. A patient was defined as a "regular user" ofhypnotics if he or she had been taking them for more than three nights per week at home or, in hospital, for more than three consecutive nights since admission. Medical patients received most new prescriptions for hypnotics prescribed for three or more nights (see table). Hospital admission increased the proportion of "regular users" from 17% at home to 51% in hospital. Of the medical patients started on hypnotics in hospital half were discharged with a further prescription-i.e., the number of patients taking hypnotics at home had doubled. There was no increase in the proportion of regular users among surgical and obstetric patients: more of these patients received hypnotics for one or two nights, as expected, but the temptation to continue prescribing seems to have been avoided. Hypnotics will continue to play an important role in the care of hospital inpatients but they should be prescribed in short courses. Ideally, the doctor who starts them should be the doctor who stops them. Our findings underline the contribution that hospital doctors can still make to reduce the incidence of chronic sleeping pill ’
ingestion. Department of Mental Health, University of Bristol,
SUSANNA HILL G. L. HARRISON
Bristol BS2 8DZ
sleep apnoea syndrome-namely, 30 or more apnoeic episodes lasting at least 10 s observed in both REM and non-REM overnight sleep.3The apnoeic episodes in these three patients were also predominantly central in type. This study will be reported in full elsewhere. In contrast to these patients with metabolic and endocrine disorders we have found only one case of the sleep apnoea syndrome among seven patients referred to us this year from other centres because of suspected sleep disorders. Two of these patients had chronic obstructive airways disease, one was obese, one had systemic hypertension, one had had a pneumonectomy for bronchiectasis, and the sixth was found to have temporal lobe epilepsy. The patient with the sleep apnoea syndrome had treated myxoedema and mitral valve disease but was euthyroid at the time of study. Although only a small series as yet, we have found the sleep apnoea syndrome in a much higher proportion of patients than in the large Edinburgh series. It may well be relevant that our patients had different underlying medical conditions than those studied by Shapiro et al., but we feel it may be premature to suggest at this stage that the syndrome is uncommon in Britain. Our work is currently directed towards investigating the incidence and mechanism of this interesting syndrome. the criteria for the
’
Departments of Clinical Neurophysiology, Respiratory Medicine, and Endocrinology, North Staffordshire Hospital Centre, Stoke-on-Trent ST4 7LN
PHYSICAL ILLNESS IN THE MENTALLY ILL
SIR,-I was glad to read Dr Peet’s letter (Sept. 5, p. 529) and would
psychiatrists to examine inpatients and outpatients very thoroughly for conditions other than the psychiatric disease they are known to have. Psychiatric patients often look physically very ill. Hall and his colleagues, from the department of psychiatry, University of Texas Medical Branch, have evaluated in a clinical research ward the medical state of 100 consecutively admitted psychiatric patients.’ "46% of the patients were thought to have medical illnesses that directly caused or greatly exacerbated their symptoms and were consequently responsible for their admission, while an additional 34% of patients were found to be suffering from a medical illness requiring treatment. A diagnostic battery of physical, psychiatric and neurological examinations coupled with a 34 panel automated blood analysis, complete blood cell count, urine analysis, ECG and sleep-depiived EEG established the presence urge all
and nature of more than 90% of the illnesses detected." Dr Hall will be speaking at this Association’s next conference, to be held in London in April, 1982, and we hope that many of your readers working in psychiatry will come to hear more of this work.
SLEEP APNOEA Tyr Twr,
SiR,-Dr Shapiro and colleagues (Sept. 5, p. 523) suggest that the sleep apnoea syndrome may be uncommon in Britain in the absence of some other medical disorder. However, there are in Britain very few sleep laboratories in which this syndrome can be studied and it may easily be missed. The common presenting features-snoring and daytime somnolence-may not attract much attention in a busy clinic or surgery. In addition to the occurrence of the sleep apnoea syndrome in acromegaly and in Scheie’s syndrome which we have reported elsewhere, 1,2 we have recently studied eight patients with myxoedema. Two patients, one male and one female, had the sleep apnoea syndrome, the apnoea being predominantly central in type. Three other female patients had 28, 25, and 22 apnoeic episodes during rapid eye movement (REM) and non-REM sleep, well outside the normal range of less than 5 in females,3but not fulfilling 1 Perks
WH, Horrocks PM, Cooper RA, Bradbury S, Allen A, Baldock N, Prowse K, van’t Hoff W. Sleep apnoea in acromegaly. Br Med J 1980; 280: 894-97. 2 Perks WH, Cooper RA, Bradbury S, Horrocks PM, Baldock N, Allen A, van’t Hoff W, Weidman G, Prowse K. Sleep apnoea in Scheie’s syndrome. Thorax 1980; 35: 85-91. 3 Guilleminault C, van der Hoed J, Mitler MM. In Guilleminault C, Dement WC, eds. Sleep apnea syndromes. New York: Alan R Liss, 1978: 1-12.
ROSEMARY COOPER DAVID MACKAY KEITH PROWSE WALTER VAN’T HOFF
Llanfair Hall, Caernarvon LL55 ITT
GWYNNETH HEMMINGS, Hon. Secretary, Schizophrenia Association of Great Britain
PRIVATE PRACTICE AND THE MEDICAL DIRECTORY
SIR,-A change in editorial policy that has accompanied a change in the editorial team at the Medical Directory has resulted in an invitation to doctors to indicate whether they take private patients. The Medical Directory already allows for a modest catalogue of achievements which, with other data, is quite sufficient to enable any would-be private patient to make intelligent and relevant inquiries. Since I am not in sympathy with this new policy I have requested that my entry be deleted. I suggest that others of like mind should take the same action. 35 Knatchbull Road, London SE5 9QR
MURIEL E. PURKISS
ER, Stickney SK, Lecann AF, Popkin MK. Physical illness manifesting as psychiatric disease II: Analysis of a State hospital inpatient population. Arch Gen Psychiat 1980, 37: 989.
1. Hall RCW, Gardner