Respiratory Health - Philips



Studies show significant number of adults at high risk of sleep apnea in UAE and KSA


Studies show that a significant number of adults in the UAE and Saudi Arabia are at high risk of Obstructive Sleep Apnea. Although obesity is a risk factor it is not the only cause of this sleep disorder which can have detrimental effects on an individual’s general health and wellbeing.

What is Obstructive Sleep Apnea?
Obstructive Sleep Apnea (OSA) is the most common type of sleep apnea and is caused by complete or partial obstructions of the upper airway. It is characterized by repetitive episodes of shallow or paused breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. These episodes of decreased or paused breathing, called gapneash (apnea means ewithout breathf), typically last 20 to 40 seconds. The most common cause of this is the partial or complete stoppage of the flow of air due to the relaxation of the muscles which surround the throat and tongue.

Individuals with OSA are rarely aware of difficulty breathing, even upon awakening. It is often recognized as a problem by others who observe the individual struggling to breathe while sleeping or is suspected because of its effects on the body. OSA is commonly accompanied with snoring.

OSA affects approximately 4% of the adult population. If OSA left is untreated, it can contribute to the development of high blood pressure, diabetes, heart attacks, and strokes. According to the World Health Organization (WHO), it is estimated that approximately 100 million people worldwide suffer from the condition.

Symptoms
One of the most noticeable symptoms of OSA is unexplained daytime sleepiness. Other common symptoms include, restless sleep, and loud snoring (with periods of silence followed by gasps). Less common symptoms are morning headaches; insomnia; trouble concentrating; mood changes such as irritability, anxiety and depression; forgetfulness; increased heart rate and/or blood pressure; decreased sex drive; unexplained weight gain; increased urination and/or nocturia; frequent heartburn or gastroesophageal reflux disease; and heavy night sweats.

Causes
One of the main causes of OSA is obesity, which can increase the soft tissue around the airway, leading to airway obstruction during sleep. However, obesity is not always present in individuals with OSA. Old age and individuals with decreased muscle tone can also suffer from airway collapse and sleep apnea.

Prevalence of OSA in KSA
According to the current evidence, sleep disorders are prevalent among the Saudi population.(1, 2) Two previous studies used the Berlin questionnaire to assess the prevalence of obstructive sleep apnea (OSA) risk and symptoms among middle-aged Saudi men and women and found that 3 of every 10 Saudi men and 4 of every 10 Saudi women are at high risk for OSA.(3, 4) A recent study that used polysomnography (PSG) to assess OSA in a random sample of Saudi school employees aged 30 to 60 years (n=346) revealed that the rates of OSA (an apnea-hypopnea index (AHI) of >5) were 11.2% and 4.0% in men and women, respectively, and the rates of obstructive sleep apnea syndrome (OSAS) (an AHI of >5 plus daytime sleepiness) were 2.8% (4.0% in men and 1.8% in women).(5) In the Western countries, the prevalence of OSAS is 3% to 7% in men and 2% to 5% in women.(6, 7) Parent-reported snoring has been described in 17.9% of elementary school children.(8) A metaanalysis that included studies from all continents estimated the prevalence of parent-reported snoring in children to be 7.45% (95% confidence interval, 5.75.9.61).(9) The estimated prevalence of narcolepsy with cataplexy in Saudis is 40/100,000 people,(10, 11) which is within the range reported in other studies that showed the prevalence of narcolepsy with cataplexy to fall between 25 and 50 per 100,000 people.(12) A national study reported the prevalence of restless leg syndrome as 5.2%.(13)

Prevalence of OSA in the UAE
A study in the United Arab Emirates (doi: 10.2147/IJGM.S40001) published in the International Journal of General Medicine in 2013 showed that in a primary health care setting, the prevalence of symptoms of OSA among adult UAE citizens is very high. The authors note that UAE patients are at risk for OSA and may benefit from proper evaluation for OSA.

Based on the responses and measurement of the Berlin Questionnaire of 1214 subjects studied, 58% of the respondents were female and 42% were male. Two-hundred-fifty-four respondents met the criteria for high-risk scoring. This gives a prevalence of 20.9% (out of which 22.9% of the male respondents were high risk for OSA, while 19.5% of the females were high risk for OSA), while the remainder of the participants were classified as low risk. The highest prevalence was observed between age 51 to 60 in both genders. Seventy percent of the high-risk group were obese with a body mass index (BMI) >30 kg/m2 and nearly 75% of the low risk group had a BMI < 30 kg/m2.

The authors of the study note that community-based studies from Western countries have reported OSA is more common in males compared with females, and in Jordan, the high risk of obstructive sleep apnea was present in 19.1% of men and in 14.7% of women. The authors also pointed out that a population-based study in the United States revealed that obesity was a strong predictor of OSA risk. Among obese subjects (BMI > 30 kg/m2), 59% of subjects were at high risk of OSA. They add that their study shows a close association between high BMI and the risk of OSA in the population of Dubai.

Speaking about the disorder at a medical conference in Dubai, Professor Ahmed BaHammam, Consultant of Pulmonary and Sleep Medicine and Director of Sleep Disorders Center at King Saud University in Riyadh, said: "Considering the high prevalence and the serious consequences of OSA, efforts are needed to build up and advance this specialty in the Middle East. It is very important for physicians in the primary healthcare sector to be fully educated and trained on the diagnosis and treatment of OSA to help improve the detection and make sure they are tackled and detected earlier. This will definitely help in preventing complications for patients."

Treatment
Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA specially for moderate and severe cases. Other treatment options are considered for milder cases such as (but not limited to); Avoiding alcohol and smoking, avoiding medications that relax the central nervous system, such as muscle relaxants and weightloss in those who are overweight. Surgical procedures and oral appliances are being considered for some cases as well.

As a global leader in the management of sleep disorders, Philips Respironics has developed an extensive range of products and solutions, from diagnostics tools through patient-centred sleep therapy devices, to help enhance the quality of sleep and improve peoplesf health. Philips is a pioneer in science-based sleep solutions, which forms a strategic element of the companyfs commitment to provide innovative solutions for the home.

Philips latest innovation was the introduction of Dream Family Sleep Therapy Platform in 2016.

The Dream Family offers innovative, comprehensive sleep therapy technology with sleek, patient-driven design, and personalized tools to keep patients engaged and compliant to therapy.

DreamStation positive airway pressure (PAP) sleep therapy devices are designed to be as comfortable and easy to experience as sleep is intended to be. Connecting patients and care teams, DreamStation devices empower users to embrace their care with confidence, and enable care teams to practice efficient and effective patient management.

SleepApnea.com
Philips Respironics hosts and operates an online resource for sleep apnea patients and healthcare professionals – SleepApnea.com. With Philips’ understanding of the challenges faced by sleep apnea patients, this site is a comprehensive online resource designed to provide sleep apnea patients and healthcare professionals with the information they need to recognise, diagnose and treat the disorder.


References:

1. Bahammam AS, Alsaeed M, Alahmari M, Albalawi I, Sharif MM. Sleep medicine services in Saudi Arabia: The 2013 national survey. Ann Thorac Med. 2014;9(1):45-7. Epub 2014/02/20.

2. Bahammam AS, Aljafen B. Sleep medicine service in Saudi Arabia. A quantitative assessment. Saudi Med J. 2007;28(6):917-21.

3. Bahammam AS, Al-Rajeh MS, Al-Ibrahim FS, Arafah MA, Sharif MM. Prevalence of symptoms and risk of sleep apnea in middleaged Saudi women in primary care. Saudi Med J. 2009;30(12):1572-6. Epub 2009/11/26.

4. BaHammam AS, Alrajeh MS, Al-Jahdali HH, BinSaeed AA. Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi males in primary care. Saudi Med J. 2008;29(3):423- 6. Epub 2008/03/11.

5. Wali SO, Abalkhail B, Alotaibi M, Krayem A. Prevalence Of Sleep Disordered Breathing In A Saudi Population. ATS 20162016. p. A2555.

6. Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311-22. Epub 2015/09/19.

7. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136-43. Epub 2008/02/06.

8. BaHammam A, AlFaris E, Shaikh S, Bin Saeed A. Prevalence of sleep problems and habits in a sample of Saudi primary school children. Ann Saudi Med. 2006;26(1):7-13. Epub 2006/03/09.

9. Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):242-52. Epub 2008/02/06.

10. BaHammam AS, Alenezi AM. Narcolepsy in Saudi Arabia. Demographic and clinical perspective of an under-recognized disorder. Saudi Med J. 2006;27(9):1352-7. Epub 2006/09/05.

11. Al Rajeh S, Bademosi O, Ismail H, Awada A, Dawodu A, al-Freihi H, et al. A community survey of neurological disorders in Saudi Arabia: the Thugbah study. Neuroepidemiology. 1993;12(3):164-78. Epub 1993/01/01.

12. Longstreth WT, Jr., Koepsell TD, Ton TG, Hendrickson AF, van Belle G. The epidemiology of narcolepsy. Sleep. 2007;30(1):13-26. Epub 2007/02/22.

13. BaHammam A, Al-shahrani K, Al-zahrani S, Al-shammari A, Al-amri N, Sharif M. The prevalence of restless legs syndrome in adult Saudis attending primary health care. Gen Hosp Psychiatry. 2011;33(2):102-6. Epub 2011/05/21.

 

 

Date of upload: 20th Jan 2017

                                  
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