18 - Pilot study on sleep disorders in syria - 31/03/08

Introduction: Sleep disorders are fairly common worldwide. Snoring and obstructive sleep apnea (OSA) are prototypes of these disorders. We started evaluating sleep patients in 2001 in Damascus.

The purpose: to evaluate the initial experience of sleep related disorders and related practice in Syria. Setting: a single-bed sleep laboratory.

Patients and methods: 197 sleep studies with standard full 32-channel polysomnography program with 4 EEG channels, 2 EOG, 1 EKG, 2 EMG, 1 chin, 2 chest and abdominal, 1 saturation, 1 position, 1 flow, and 1 snoring were evaluated between 2002-2005. The lab is also equipped with real time camera for direct observation and recording. Nasal or esophageal probes were not included. Patients were referred to the lab by pulmonologists, neurologists, otolaryngologists from all over the country. Some were self-referred. Most referrals were to evaluate for sleep apnea. Patients were advised on the day of the test not to take naps, cafeinated beverages, or drugs that might affect sleep unless they are regular medicines. Patients were monitored by a trained physician or technician. Auto and manual scoring were performed by the observing technicians and reviewed by the specialist on the following day. Split studies using CPAP at the same night were the rule in order to cut cost. Further testing includimg thyroid evaluation, ENT evaluation, MRI of the upper airways and others were obtained as needed to complete the investigation. Family history, medications, pulmonary function testing were also studied.

Results: Number of the tests increased dramatically in the last 2 years after many campaigns of awareness. Total number of patients was 197 patients. Mean age was 45.6 0years (singles12%, married: 88%). Male/ female ratio was 86/14%. There was no correlation between OSA and type of profession, socioeconomic status, smoking status, and residence. Mean BMI was 35.5 kg/m2. For patients 40-50 years, the mean BMI was 43.6 kg/m2Mean BP was 132/84. Most common associated diseases were HTN (39%), Nasal pathology (24%), arthropathy (12%), DM (9%), CAD (7%), hypothyroidism (3%), CVA (3%), Hypercholesterolemia (3%). Mean TST (total sleep time was 5.6 hours. Mean REM periods was 44.1 minutes, mean REM/TST was 0.13. Snoring was clearly detected in 88% of patients and in all OSA pts. OSA was dominant diagnosis, accounting for 72% of patients. Respiratory disturbance index (RDI) ranged from mild (5-10/h) to very high (>35/h). Mean time of deasaturation below 90% was 49 min, and below 80% was 16 minutes. Non OSA included, normal (11%), upper airway resistance syndrome (4%). Mean CPAP pressure needed to alleviate snoring and apnea was 6.8 cm H₂O, and correlated to BMI, and and OSA RDI.

Conclusion: Sleep disorders, as in the rest of the world, are expected to be common in Syria. Concept of Sleep Medicine and sleep disorders should be further clarified and well presented to physicians and the public. CPAP and BIPAP should be readily available, and affordable to patients. Further and larger scale studies on the epidemiology and impact of sleep disorders in Syria should be conducted.