Validity of the Pittsburgh sleep quality index in Indian university students

Despite the demonstrated utility of the Pittsburgh Sleep Quality Index [PSQI] in various demographic groups, it has never been validated in a sample of Indian subjects. To extend and confirm the PSQI's applicability for South Asian subjects, this preliminary study aimed to assess its psychometric and diagnostic validity in a sample of university students. Forty-seven male students were recruited from Jamia Millia Islamia, a public central university in New Delhi, India. The mean age of the students was 23.4 +/- 3.9 years, and they had a mean body mass index [BMI] of 23.3 +/- 3.3kg/m[2]. The PSQI was administered to all subjects and overnight polysomnographic testing was carried out as a concurrent validation measure. Cronbach's alpha for the questionnaire was found to be 0.736. Internal homogeneity was high, with the majority of correlations between questionnaire component scores and the summed global score being significant [p<0.010]. Criterion validity-correlations between the PSQI global score and polysomnography [PSG] measures were low. However, the questionnaire component scores and the related polysomnographic measures did show some significant relationships. The optimal cut-off scores for distinguishing students with/without sleep problems was >6 and was generated using receiver operating characteristic curve analysis. The area under the curve, sensitivity, specificity, positive and negative likelihood ratios at the cut-off score were 0.838 [p<0.0001], 75.0%, 88.9%, 6.75, and 0.280, respectively. The study found evidence that the PSQI had internal consistency, internal homogeneity, and diagnostic characteristics that compared well with PSG among a sample of young adult male students in India. This supports the applicability and certain aspects of the validity of the PSQI in the population

Prevalence, clinical characteristics, and predictors of obesity hypoventilation syndrome in a large sample of Saudi patients with obstructive sleep apnea

To assess the prevalence, clinical characteristics, and predictors of obesity hypoventilation syndrome [OHS] in a large sample of Saudi patients with obstructive sleep apnea [OSA]. This prospective observational study consisted of 1693 patients who were diagnosed to have sleep-disordered breathing using type I attended polysomnography [PSG] between January 2002 and December 2012 in the University Sleep Disorders Center [USDC] at King Saud University Hospital, Riyadh, Kingdom of Saudi Arabia. Out of 1693 OSA patients, OHS was identified in 144 [8.5%] [women 66.7%]. Compared with the pure OSA patients, the OHS patients were significantly older [57.4 +/- 13.4 years versus 46.8 +/- 13.7 years], had a higher body mass index [44.6 +/- 10.8 versus 35.7 +/- 9.2 kg/m[2]], a higher daytime partial pressure of carbon dioxide [PaCO[2]] [56.5 +/- 12.7 versus 41.6 +/-6.7 mmHg], a longer duration of nocturnal oxygen saturation [nSaO[2]] <90% [71.0 +/- 34.3 versus 10.5 +/- 20.5 minutes], and a higher apnea hypopnea index [68.2 +/- 47.1 versus 46.5 +/- 34.1 events/hour]. A multivariate logistic regression analysis showed that serum bicarbonate [odds ratio [OR]=1.17, p=0.0001, confidence interval [CI]=1.10-1.25], and duration of nSaO[2] <90% [OR=1.05, p=0.0001, CI=1.04-1.06] were predictors of OHS. Obesity hypoventilation syndrome is common among Saudi OSA patients referred to the Sleep Disorders Center. Serum bicarbonate and duration of nSaO[2] <90% are independent predictors of OHS among patients with OSA

Sleep medicine services in Saudi Arabia: The 2013 national survey

We conducted this national survey to quantitatively assess sleep medicine services in the Kingdom of Saudi Arabia [KSA] and to identify obstacles that specialists and hospitals face, precluding the establishment of this service. A self-administered questionnaire was designed to collect the following: General information regarding each hospital, information regarding sleep medicine facilities [SFs], the number of beds, the number of sleep studies performed and obstacles to the establishment of SFs. The questionnaire and a cover letter explaining the study objectives were mailed and distributed by respiratory care practitioners to 32 governmental hospitals and 18 private hospitals and medical centers in the KSA. The survey identified 18 SFs in the KSA. The estimated per capita number of beds/year/100,000 people was 0.11 and the per capita polysomnography [PSG] rate was 18.0 PSG/year/100,000 people. The most important obstacles to the progress of sleep medicine in the KSA were a lack of trained sleep technologists and a lack of sleep medicine specialists. The sleep medicine services provided in the KSA have improved since the 2005 survey; however, these services are still below the level of service provided in developed countries. Organized efforts are needed to overcome the identified obstacles and challenges to the progress of sleep medicine in the KSA

Sleep disorders as a cause of motor vehicle collisions

Studies have shown that a large proportion of traffic accidents around the world are related to inadequate or disordered sleep. Recent surveys have linked driver fatigue to 16% to 20% of serious highway accidents in the UK, Australia, and Brazil. Fatigue as a result of sleep disorders [especially obstructive sleep apnea], excessive workload and lack of physical and mental rest, have been shown to be major contributing factors in motor vehicle accidents. A number of behavioral, physiological, and psychometric tests are being used increasingly to evaluate the impact of fatigue on driver performance. These include the oculography, polysomnography, actigraphy, the maintenance of wakefulness test, and others. Various strategies have been proposed for preventing or reducing the impact of fatigue on motor vehicle accidents. These have included: Educational programs emphasizing the importance of restorative sleep and the need for drivers to recognize the presence of fatigue symptoms, and to determine when to stop to sleep; The use of exercise to increase alertness and to promote restorative sleep; The use of substances or drugs to promote sleep or alertness [i.e. caffeine, modafinil, melatonin and others], as well as specific sleep disorders treatment; The use of CPAP therapy for reducing excessive sleepiness among drivers who have been diagnosed with obstructive sleep apnea. The evidence cited in this review justifies the call for all efforts to be undertaken that may increase awareness of inadequate sleep as a cause of traffic accidents. It is strongly recommended that, for the purpose of promoting highway safety and saving lives, all disorders that cause excessive sleepiness should be investigated and monitored

Saudi regulations for the accreditation of sleep medicine physicians and technologists

The professional content of sleep medicine has grown significantly over the past few decades, warranting the recognition of sleep medicine as an independent specialty. Because the practice of sleep medicine has expanded in Saudi Arabia over the past few years, a national regulation system to license and ascertain the competence of sleep medicine physicians and technologists has become essential. Recently, the Saudi Commission for Health Specialties formed the National Committee for the Accreditation of Sleep Medicine Practice and developed national accreditation criteria. This paper presents the newly approved Saudi accreditation criteria for sleep medicine physicians and technologists

Sleep estimation using BodyMedia's Sense Wear armband in patients with obstructive sleep apnea

We aimed to evaluate the validity of the BodyMedia's SenseWear Armband [BSA] device in estimating total sleep time [1[st]] in patients with obstructive sleep apnea [OSA]. Simultaneous overnight recordings of in-laboratory polysomnography [PSG] and BSA were performed on [1] 107 OSA patients [mean age of 45.2 +/- 14.3 years, mean apnea hypopnea index of 43 +/- 35.7/hr and [2] 30 controls matched with OSA patients for age and body mass index. An agreement analysis between the PSG and BSA scoring results was performed using the Bland and Altman method. There was no significant difference in OSA patients between BSA and PSG with regard to TST, total wake time, and sleep efficiency. There was also no significant difference in the controls between BSA and PSG with regard to TST, total wake time, and sleep efficiency. Bland Altman plots showed strong agreement between TST, wake time, and sleep efficiency for both OSA and the controls. The intraclass correlation coefficients revealed perfect agreement between BSA and PSG in different levels of OSA severity and both genders. The current data suggest that BSA is a reliable method for determining sleep in patients with OSA when compared against the gold standard test [PSG]. BSA can be a useful tool in determining sleep in patients with OSA and can be combined with portable sleep studies to determine TST

Sleep architecture of consolidated and split sleep due to the dawn [Fajr] prayer among Muslims and its impact on daytime sleepiness

Muslims are required to wake up early to pray [Fajr] at dawn [approximately one and one-half hours before sunrise]. Some Muslims wake up to pray Fajr and then sleep until it is time to work [split sleep], whereas others sleep continuously [consolidated sleep] until work time and pray Fajr upon awakening. To objectively assess sleep architecture and daytime sleepiness in consolidated and split sleep due to the Fajr prayer. A cross-sectional, single-center observational study in eight healthy male subjects with a mean age of 32.0 +/- 2.4 years. The participants spent three nights in the Sleep Disorders Center [SDC] at King Khalid University Hospital, where they participated in the study, which included [1] a medical checkup and an adaptation night, [2] a consolidated sleep night, and [3] a split-sleep night. Polysomnography [PSG] was conducted in the SDC following the standard protocol. Participants went to bed at 11:30 PM and woke up at 7:00 AM in the consolidated sleep protocol. In the split-sleep protocol, participants went to bed at 11:30 PM, woke up at 3:30 AM for 45 minutes, went back to bed at 4:15 AM, and finally woke up at 7:45 AM. PSG was followed by a multiple sleep latency test to assess the daytime sleepiness of the participants. There were no differences in sleep efficiency, the distribution of sleep stages, or daytime sleepiness between the two protocols. No differences were detected in sleep architecture or daytime sleepiness in the consolidated and split-sleep schedules when the total sleep duration was maintained

Sleep medicine in Saudi Arabia: current problems and future challenges

Sleep medicine is a relatively new specialty in the medical community. The practice of sleep medicine in Saudi Arabia [KSA] began in the mid to late nineties. Since its inception, the specialty has grown, and the number of specialists has increased. Nevertheless, sleep medicine is still underdeveloped in the KSA, particularly in the areas of clinical service, education, training and research. Based on available data, it appears that sleep disorders are prevalent among Saudis, and the demand for sleep medicine service is expected to rise significantly in the near future. A number of obstacles have been defined that hinder the progress of the specialty, including a lack of trained technicians, specialists and funding. Awareness about sleep disorders and their serious consequences is low among health care workers, health care authorities, insurance companies and the general public. A major challenge for the future is penetrating the educational system at all levels to demonstrate the high prevalence and serious consequences of sleep disorders. To attain adequate numbers of staff and facilities, the education and training of health care professionals at the level of sleep medicine specialists and sleep technologists is another important challenge that faces the specialty. This review discusses the current position of sleep medicine as a specialty in the KSA and the expected challenges of the future. In addition, it will guide clinicians interested in setting up new sleep medicine services in the KSA or other developing countries through the potential obstacles that may face them in this endeavor

Distribution of chronotypes in a large sample of young adult Saudis

There are no published data on the chronotypes of young Saudi adults. This study assessed the distribution of chronotypes in college-aged Saudis. Cross-sectional survey of college students A validated abridged version of the original Horne and Ostberg morningness-eveningness questionnaire [MEQr] was used to assess the chronotype of 759 subjects. Of 540 [71.1%] males and 219 [28.9%] females participated in this study [age range, 18-32 years], 138 [18.2%] were "morning-types," 417 [54.9%] were "neither-types" and 204 [26.9%] were "evening-types." There was no significant gender difference in MEQr typology. In Saudis, particularly males, the frequency of morning typology was somewhat higher than that reported for individuals in similar age groups in some Western countries. Most Saudi college students had no preference for morningness or eveningness and were classified as "intermediate-types." Morningness appears to be slightly more common in Saudis, especially males, than in individuals of some Western societies

Obesity hypoventilation syndrome

Obesity is becoming a major medical concern in several parts of the world, with huge economic impacts on health- care systems, resulting mainly from increased cardiovascular risks. At the same time, obesity leads to a number of sleep-disordered breathing patterns like obstructive sleep apnea and obesity hypoventilation syndrome [OHS], leading to increased morbidity and mortality with reduced quality of life. OHS is distinct from other sleep- related breathing disorders although overlap may exist. OHS patients may have obstructive sleep apnea/hypopnea with hypercapnia and sleep hypoventilation, or an isolated sleep hypoventilation. Despite its major impact on health, this disorder is under-recognized and under-diagnosed. Available management options include aggressive weight reduction, oxygen therapy and using positive airway pressure techniques. In this review, we will go over the epidemiology, pathophysiology, presentation and diagnosis and management of OHS

Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi women in primary care

To assess the prevalence of symptoms and risks of obstructive sleep apnea [OSA] in a sample of middle-aged Saudi women in a primary care using a validated questionnaire. In this cross-sectional study, trained medical students administered the Berlin Questionnaire to a consecutive random sample of Saudi women in the age group 35-60 years, attending the primary health care center in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January and July 2007. Based on the questionnaire, individuals were classified into high-risk and low-risk groups for OSA. Four hundred women with a mean body mass index of 31.3+7.2 kg/m[2] were surveyed in this study. Among the study group, 40.8% reported snoring [everyday in 15%, 3-4 times a week in 7.5%, and one-2 times a week in 9.8%]. Breathing pauses more than 3 times per week was present in 22.5%. Hypertension was present in 24.8%. Based on the Berlin Questionnaire stratification for risk of OSA, 39% were considered as high-risk patients for OSA. In the primary care setting, the prevalence of symptoms of OSA among middle-aged Saudi women is very high. Almost 4 out of 10 middle-aged Saudi women are at risk for OSA, and may benefit from proper evaluation for OSA

Sleep medicine service in Saudi Arabia. a quantitative assessment

To assess quantitatively sleep medicine services in Saudi Arabia [KSA] and identify obstacles that face specialists and hospitals and preclude the establishment of this service. A self-administered questionnaire was mailed to 53 major governmental and private hospitals in KSA on September 2005. The response rate was 69.8%. Data were coded and analyzed. The survey identified 9 sleep disorders facilities in KSA; 7 were defined as sleep disorders centers and 2 as sleep laboratory using the American Academy of Sleep Medicine definitions. The per capita polysomnography [PSG] rate was 7.1 PSG/year/100,000 population, which was much lower than the reported rates in developed countries. The occupancy rate of sleep facilities was found to be low [45.7%]. The most important identified obstacles facing the progress of sleep medicine in KSA were lack of trained sleep technicians, shortage of sleep medicine specialists and the un-availability of fund or designated space for the facility. Sleep medicine seems to be underdeveloped in KSA compared to developed countries. Organized efforts are needed to overcome the identified obstacles and challenges facing the progress of sleep medicine in KSA

Narcolepsy in Saudi Arabia. demographic and clinical perspective of an under-recognized disorder

To assess the clinical and polysomnographic features of narcolepsy in Saudis. All patients diagnosed to have narcolepsy in the Sleep Disorders Center at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between March 1998 and December 2005 based on the International Classifications of Sleep Disorders Diagnostic and Coding Manual criteria were included. A data entry form collecting the demographic, clinical features, medications, referring specialty, prior diagnoses and daytime sleepiness was used. All patients underwent polysomnography followed by multiple sleep latency. Forty-seven patients with a mean age of 28.9 +/- 1.9 years were included. The mean age at onset of symptoms was 20.5 +/- 1.4 years. The interval between symptoms onset and diagnosis was 8.4 +/- 1.2 years. While 22 [46.8%] of the patients were referred to the sleep disorders clinic by different specialties, 25 [53.2%] patients sought an appointment in the sleep disorders clinic directly. Only 3 patients were referred with the correct diagnosis. Nocturnal sleep quality was worse in narcoleptics with cataplexy compared to those without cataplexy. Saudi patients with narcolepsy have the same clinical presentation as reported in the Western literature. Narcoleptics with cataplexy had disturbed quality compared to narcoleptics without cataplexy. A long time was reported between symptoms onset and diagnosis, which may reflect the under-recognition of the problem among physicians

Sleep habits and patterns among medical students

This study was designed to assess sleep patterns among male medical students at different academic levels. Participants in this study were healthy male medical students in the first [L1], second [L2] and third [L3] academic levels of the College of Medicine, King Saud University, Riyadh, Saudi Arabia. The study was conducted during November 2001. A self-administered questionnaire was distributed to students to assess age, academic level, registered credit hours, sleep-wake schedule, naps, quality of sleep, total sleep time at night, possible factors affecting bedtime, and daytime sleepiness using the Epworth Sleepiness Scale [ESS]. The final analysis included 129 students. Total sleep time at night + nap of the whole group was 5.9 ' 1.6 hours. Twenty-nine students [22.4%] were defined to have excessive daytime sleepiness [EDS] based on ESS score of >10. Also, 83.3% of students reported napping during the daytime more than twice per week. Analysis of the sleep pattern of male medical students revealed that this group is sleep deprived, which in turn may affect their academic performance

Acute Eosinophilic Pneumonia Simulating Severe Community Acquired Pneumonia

Idiopathic acute eosinophilic pneumonia is a recently described cause of acute respiratory failure. It usually affects young healthy individuals. Usually non-pulmonary organs are not involved. Bronchoalveolar lavage eosinophilia is required for diagnosis. This disease responds uniformly to a short course of corticosteroids and does not recur. We report a young man who presented with a 2-day history of acute respiratory failure simulating severe community acquired pneumonia and necessitating mechanical ventilation. The diagnosis was made based on the classical clinical presentation and bronchoalveolar lavage and peripheral blood eosinophilia. Acute eosinophilic pneumonia in our patient was associated with acute hepatitis and erythema multiforme. To our knowledge, this is the first time to report such an association. The case is reported with review of the literature