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      The symptoms and risk of sleep apnea among adults in the United Arab Emirates

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          Abstract

          INTRODUCTION:

          Recently, sleeping disorders and snoring are being recognized as a public health concern with various risk factors and health consequences. The main objective of the present study was to determine the prevalence of snoring and sleep apnea among adults (20–60 years) in Sharjah (United Arab Emirates, UAE) and assess the major risk factors as well as the general knowledge among the population.

          METHODS:

          A self-administrated Questionnaire of five sections including both Berlin questionnaire (BQ) and the Epworth Sleepiness Scales (ESS) were given to a randomly selected population in Sharjah between the ages of 20–60 years. Data were analyzed using SPSS software version 22.0.

          RESULTS:

          Nearly 34.2% of the study population reported to be snorers, and 43.2% of snorers were at high risk of sleep apnea based on the BQ. Gender was significantly associated with snoring ( P = 0.038), as 40.8% of males reported snoring compared to 28.7% of females. Elderlies (50–60 years) were at a higher risk, and obesity (body mass index >30) was considered to be a powerful risk factor as 46.8% of the obese participants reported snoring. Those who scored higher on the ESS were more likely to be snorers ( P = 0.001) and were likely to fall into the high-risk category in the BQ ( P = 0.007). In addition, smoking ( P = 0.005), hypertension ( P = 0.005), and nasal septal deviation ( P = 0.024) were also considered as risk factors.

          CONCLUSION:

          Prevalence and major risk factors within the UAE are similar to those in other countries. Sleeping disorders and snoring campaigns and management facilities should be considered to raise the awareness about these issues and manage their risk factors.

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          Most cited references22

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          Reliability and factor analysis of the Epworth Sleepiness Scale.

          The Epworth Sleepiness Scale (ESS) is a self-administered eight-item questionnaire that has been proposed as a simple method for measuring daytime sleepiness in adults. This investigation was concerned with the reliability and internal consistency of the ESS. When 87 healthy medical students were tested and retested 5 months later, their paired ESS scores did not change significantly and were highly correlated (r = 0.82). By contrast, ESS scores that were initially high in 54 patients suffering from obstructive sleep apnea syndrome returned to more normal levels, as expected, after 3-9 months' treatment with nasal continuous positive airway pressure. The questionnaire had a high level of internal consistency as measured by Cronbach's alpha (0.88). Factor analysis of item scores showed that the ESS had only one factor for 104 medical students and for 150 patients with various sleep disorders. The ESS is a simple and reliable method for measuring persistent daytime sleepiness in adults.
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            Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial.

            More than 70% of patients with resistant hypertension have obstructive sleep apnea (OSA). However, there is little evidence about the effect of continuous positive airway pressure (CPAP) treatment on blood pressure in patients with resistant hypertension. To assess the effect of CPAP treatment on blood pressure values and nocturnal blood pressure patterns in patients with resistant hypertension and OSA. Open-label, randomized, multicenter clinical trial of parallel groups with blinded end point design conducted in 24 teaching hospitals in Spain involving 194 patients with resistant hypertension and an apnea-hypopnea index (AHI) of 15 or higher. Data were collected from June 2009 to October 2011. CPAP or no therapy while maintaining usual blood pressure control medication. The primary end point was the change in 24-hour mean blood pressure after 12 weeks. Secondary end points included changes in other blood pressure values and changes in nocturnal blood pressure patterns. Both intention-to-treat (ITT) and per-protocol analyses were performed. A total of 194 patients were randomly assigned to receive CPAP (n = 98) or no CPAP (control; n = 96). The mean AHI was 40.4 (SD, 18.9) and an average of 3.8 antihypertensive drugs were taken per patient. Baseline 24-hour mean blood pressure was 103.4 mm Hg; systolic blood pressure (SBP), 144.2 mm Hg; and diastolic blood pressure (DBP), 83 mm Hg. At baseline, 25.8% of patients displayed a dipper pattern (a decrease of at least 10% in the average nighttime blood pressure compared with the average daytime blood pressure). The percentage of patients using CPAP for 4 or more hours per day was 72.4%. When the changes in blood pressure over the study period were compared between groups by ITT, the CPAP group achieved a greater decrease in 24-hour mean blood pressure (3.1 mm Hg [95% CI, 0.6 to 5.6]; P = .02) and 24-hour DBP (3.2 mm Hg [95% CI, 1.0 to 5.4]; P = .005), but not in 24-hour SBP (3.1 mm Hg [95% CI, -0.6 to 6.7]; P = .10) compared with the control group. Moreover, the percentage of patients displaying a nocturnal blood pressure dipper pattern at the 12-week follow-up was greater in the CPAP group than in the control group (35.9% vs 21.6%; adjusted odds ratio [OR], 2.4 [95% CI, 1.2 to 5.1]; P = .02). There was a significant positive correlation between hours of CPAP use and the decrease in 24-hour mean blood pressure (r = 0.29, P = .006), SBP (r = 0.25; P = .02), and DBP (r = 0.30, P = .005). Among patients with OSA and resistant hypertension, CPAP treatment for 12 weeks compared with control resulted in a decrease in 24-hour mean and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern. Further research is warranted to assess longer-term health outcomes. clinicaltrials.gov Identifier: NCT00616265.
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              Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta-analysis.

              We aimed to systematically review the Berlin questionnaire as a screening tool for obstructive sleep apnea. We systematically searched PubMed, Embase, and Scopus databases, reviewed articles reporting the Berlin questionnaire's diagnostic utility as measured against type-1 polysomnography, and performed meta-analyses where possible. Thirty five eligible articles showed that the Berlin questionnaire's diagnostic utility varied by study population, definition of hypopnea used, and apnea-hypopnea index threshold used. It had good sensitivity and specificity for detecting clinically relevant obstructive sleep apnea as well as any obstructive sleep apnea in the sleep clinic population. Despite limited evidence, it showed modest to high sensitivity for detecting clinically relevant obstructive sleep apnea or any obstructive sleep apnea in other clinical and general population subgroups. Its specificity was relatively low. Possible reasons for variability in reported diagnostic utility of the Berlin questionnaire are multifaceted. We conclude that the Berlin questionnaire is useful as a clinical screening test and epidemiological tool in the sleep clinic population. Despite limited evidence, it likely has potential clinical and research utility in other populations. Adopting more consistent methodological definitions and focussing more on the general population and specific clinical populations to determine its usefulness as a clinical or epidemiological screening tool are recommended.
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                Author and article information

                Journal
                Ann Thorac Med
                Ann Thorac Med
                ATM
                Annals of Thoracic Medicine
                Medknow Publications & Media Pvt Ltd (India )
                1817-1737
                1998-3557
                Jul-Sep 2018
                : 13
                : 3
                : 168-174
                Affiliations
                [1] Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
                Author notes
                Address for correspondence: Yazan Ghazi Al Shaikh, College of Medicine, University of Sharjah, Post Box No. 27272, Sharjah, United Arab Emirates. E-mail: yazanchaikh95@ 123456outlook.com
                Article
                ATM-13-168
                10.4103/atm.ATM_245_17
                6073781
                3ca40df8-80ea-49ae-b9d5-627bd402b094
                Copyright: © 2018 Annals of Thoracic Medicine

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 23 July 2017
                : 14 February 2018
                Categories
                Original Article

                Respiratory medicine
                berlin questionnaire,epworth sleepiness scale,sleep apnoea,sleeping disorders,snoring

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