JC-Dr.Adnan-SNORING

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Presented byDr. Adnan AhmedPost Graduate MPH Fellow

Department of Community Medicine

DMC, DUHS


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TITLE AND AUTHORSleep disordered breathing

(SDB) experinces associatedwith snoring in adult Nigerians.

Sogebi OA, Oywwole EA, Olusoga-Peters OOAfrican Health Sciences Vol 11 No 3

September 2011

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ROAD MAPBackground (Sleep disordered breathing)Article

Introduction (Rationale and Objectives)

Methodology (Setting, duration, sample size,sampling technique, inclusion/exclusioncriteria, study tool, statistical analysis)

Results

Discussion

Crtitique

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Background

Sleep-disordered breathing is an umbrella term for severalchronic conditions in which partial or complete cessation ofbreathing occurs many times throughout the night, resulting indaytime sleepiness or fatigue that interferes with a persons ability to

function and reduces quality of life. Symptoms may include snoring, pauses in breathing described

by bed partners, and disturbed sleep.

Obstructive sleep apnea (OSA), which is by far the most common

form of sleep-disordered breathing, is associated with many otheradverse health consequences, including an increased risk of death.

Snoring is the vibratory sound generated from the upper airwaysdue to partial upper airway obstruction from narrowing that occursduring sleep.

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Background

A breathingpause of 10 seconds or more is termed an apnea. Polysomnogram (sleep test) is required for the diagnosis. Risk Factors of developing sleep apnea include obesity, male

gender, and some ethnic groups (African American, Asian, and

Native American), nasal obstruction; large tonsils (particularly inchildren); an underactive thyroid gland; the use of alcohol, tobacco,and sedatives; menopause in women; and

higher levels of testosterone. 4 percent of men, 2 percent of women, and 2 percent of children

ages 8 to 11 in the United States have sleep-disorderedbreathing.Other surveys estimate that between 5 and 10 percent of the U.S.adult population have OSA (57); 7 percent have breathing pausesduring sleep that put them at risk

for more severe sleep events, and 23 to 59 percent snore (710).

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Background

A breathingpause of 10 seconds or more is termed an apnea. Polysomnogram (sleep test) is required for the diagnosis. Risk Factors of developing sleep apnea include obesity, male

gender, and some ethnic groups (African American, Asian, and

Native American), nasal obstruction; large tonsils (particularly inchildren); an underactive thyroid gland; the use of alcohol,tobacco, and sedatives; menopause in women; and

higher levels of testosterone. 4 percent of men, 2 percent of women, and 2 percent of children

ages 8 to 11 in the United States have sleep-disorderedbreathing. Other surveys estimate that between 5 and 10 percentof the U.S. adult population have OSA (57); 7 percent havebreathing pauses during sleep that put them at risk

for more severe sleep events, and 23 to 59 percent snore (710).

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Background

The OSAS prevalence data from Asia is scarce,however, it is reported that prevalence ranges from 2.1

to 7.5%; with a male-to-female ratio of 2:1. In India theprevalence of obstructive sleep apnea syndrome hasbeen reported to be 7.5%

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Relavent literature in Pakistan

A study done by Haqqee et al, showed a highprevalence of snoring (46%); frequency of snoringwith apnea was reported to be 7% and; snoring withapnea and excessive daytime sleepiness was 3%.

Another study recently done on seminar participantsby the authors, Taj et al, reports that significant

proportion of population is at risk for OSAS. Ironically,

most physicians in Pakistan are unaware of the clinicalfeatures and common associations of OSAS with 18%physicians treating sleep disturbances with sedativesonly.

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Nigeria

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Population 155,215,573

Population growth rate1.935%

Birth rate35.51 births/1,000 pop

Death rate16.06 deaths/1,000 pop

Infant Mortality Rate91.54deaths/1,000 live births

Total Fertility Rate 4.73 childrenborn/woman

Maternal mortality Rate840deaths/100,000 live births

Health Expenditure5.8% of GDP


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SAGAMU COUNTRY : NIGERIA

STATE : OGUN

TOWN : Sagamu

Population : 2,53,412 in 2006

University : Olabisi Onabanjo

University, College of

MedicineSgamu

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Sgamu


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INTRODUCTIONPrevalence of snoring in general adult population has been

found to be in range of 19.3-52.3% while the risk of OSASranges between 16.8-33.3.

Snoring should not be ignored since there is stongassociation with the cardiovascular, endocrine,gastrointestine, neurological & anatomical conditions.

Habitual snoring has been associated with increased rate

of motor vehicle & ouucpational accidents.

Studies on sleep disordered breathing experinces, snoringhave been done since 1980 & are well characterised in manycountries.

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ObjectiveTo compare the experiences of day time &

night time symptoms of Sleep disordered

breathing of habitual snorers with non-habitual snoring adult in a tertiary health

facitlity in Nigeria

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METHODOLOGY

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Study site: ENT Clinic ,OOUTH, Sagamu, NigeriaStudy design: Cross sectional studyStudy duration: Feb-May 2010Sampling Technique: ConsecutiveSample Size: 195Ethical approval obtained from Olabisi, Onabanjo

University Teaching Hospital, OOUTH,Sagamu, Nigeria


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METHODOLOGY-Study Tool

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Berlin Structured questionnaire with validated questionsfrom previous studies

Pretested and administered by trained resident doctors Socio-demographics Snoring experience, apnea experience, day time sleepiness, and

self reported history f hypertension,. Physical examination of the nose and throat, height, weight and

BMI.Subject were categorized into habitual and non-habitual snorers.


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METHODOLOGY-

Inclusion/Exclusion Criteria

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All consenting adults were included.

Excluded were those patients who have pathologies

and tumors in the nose and pharynx.


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METHODOLOGY-Statistical

Analysis

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Simple descriptive (frequencies and cross tabulation)Chi square and Students t test. Bivariate Logistic regression.Dependent variable: Symptoms of sleep disorder

breathing

Independent Variables: Snoring statusData were analyzed using SPSS version 17.


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RESULT

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Table 4 shows. Statisticaly increased odds ratio for eachsymptom in presence of habitual snoring. Night time

symptoms, highest odds ratio of 18.0 (C.I=5.1-63.2) wasfound fatigue after sleep while for daytime symptoms

highest odds ratio is 10.1 (C.I=2.2-45.6) found in fallingasleep while driving.

Table3 shows prevalence of symptoms significantly higher

in habitual snorers as compared non habitual snorers. Alsodaytime symptoms more common in habitual snorers.

Table 2 shows statistical significant differences inage, marital status and BMI of habitual snorerscompared to non habitual snorers.


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DiscussionPrevalence of snoring of 37.9% and that of habitual snoringof 18.5% found in this study is marginally higher than 31.6%and 14% respectively reported earlier in Nigeria.

Some studies have shown high prevalence of snoringranging from 25.6% to 52.3% conducted at Jordan and Saudi

Arab while those of Australia and Singapore were relativelylow.

Night time symptoms like Restlessness during sleep, mouthbreathing, frequent awakening similar to that found among

adults in Sweden.Day time symptoms like morning headache, daytime

sleepiness, fatigue and poor concentration at work were alsofound in Sweden.

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LimitationLack of sleep study laboratory

Hospital based study with small sample size.

Findings are not generalisable.

Day time symptoms like morning headache, daytimesleepiness, fatigue and poor concentration at workwere also found in Sweden.

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Critique

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StrengthValidated, Pretested Questionnaire

Ethical Consideration

Convincing write up

WeaknessSample size not calculate

Non probability sampling


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Thank you

JC-Dr.Adnan-SNORING

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