Sleep Medicine in Syria Facts, Problems and Solutions
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Transcript of Sleep Medicine in Syria Facts, Problems and Solutions
Naem Shahrour, MD, FCCPHead, Pulmonary Dept ,.
Alassad University HospitalDamascus University Medical School
Director, jisr Sleep Center
Sleep Medicine in SyriaFacts, Problems and Solutions
Thank YouAntalya, Turkey
Syria
Welcome to Syria
BOSRA HAS THE MOST FANTASTIC THEATRE
OMAYAD MOSQUE:&St. John’s Tomb
AZEM’S PALACE;an example of traditional Syrian Houses
RIVERS AND OUNTAINS
Basic Facts: Sleep Medicine in Syria
Sleep Medicine existed in Syria in 2000Teaching and awareness programs through
lectures at medical school, conferences, symposia and English medical cases started in 2001
Official acceptance as subspecialty by Gv 2002.Official teaching in Medical school in 2004First scientific study on sleep patients
presented in 2004 at Syrian American Medical society conference.
Current situation
2 officially specialized MD’s in sleep
Few MD’s are also interested in the field
There is only one private full PSG lab in the country
There are few portable sleep equipments
ProblemsProblem: we do not have official training in Sleep for MD’s or technicians
Problem: some of the MD’s do not have the appropriate background or expertise to do or interpret the test.
Problem: we do not have enough specialists
1st study
2008Naem Shahrour, MD
Emad Sibai, MD
Prevalence of OSA Ongoing study250 Bus drivers Questionnaires on sleepiness and other symptoms of sleep apnea
Epworth scale was used to estimate sleepiness
8% of drivers slept at least once during driving
Only 5% slept and had Epworth score above 10
Problems:Difficulty of making nation-wide screening:Due to fear of employees at riskLack financial support
We do not have regulation to report
No State or insurance support to diagnose or treat these patients
2nd studyNaem Shahrour, MD, FCCP
Head, Pulmonary Dept ,.Alassad University Hospital
Damascus University Medical SchoolDirector, jisr Sleep Center
MethodsThe study started from 2/2002-5/2004Ninety-seven patients were included. All
patients were subjected to standard polysomnography studies, and 2 had MSLT study for suspected narcolepsy.
Ages ranged from 10-78 yearsPatients were either self-referred, center-
referred or referred from other physicians.
MethodsPatients were monitored by a trained
physician or technician.
Auto and manual Scoring were performed by the observing technicians and reviewed the following day.
Split studies using CPAP were the rule for financial reasons.
Age distribution: No problem
0
5
10
15
20
25
number ofpatients
Demographic Data: Indicate Cultural Implications
0
10
20
30
40
50
60
70
80
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Married/single M/F
History of Smoking: same for general public
05
10
15
20
2530
35
40
45
Nargila passivesmoking
activesmoking
non-smokers
number of patients
Type of profession: could present an obstacle
professio
professio
profession44%
business22%
workers20%
housewivs 14
Problem: Presenting and Main Symptoms could be misleading
OVERALL SXPRESENTING
SX
0
20
40
60
80
100
GERD
CHEST P
NASAL SX
HEADACHE
D-T SLEEPINESS
FATIGUE
WITNESSED APNEA
DYSPNEA
SNORING
Problem of Centralized Information
0
10
20
30
40
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60
Residence site
Problem: Referral TypeIs it unawareness or ethical
0 10 20 30 40
percentage of Ptsreferred
Problem: Late presentationInitial Oxygen Desaturation
0
10
20
30
40
50
60
70
100-95 94-90 91-88 87-85 84-80 <80% Initialsat
Percentage ofpatients
With Complications and Associated Diseases
HTN39%DM
9%
Nasal Sx24%
CVA3%
Hypothyroid3%
hypercholest3%
Arthropathy12%
CAD7%
HTN
Nasal Sx
Arthropathy
DM
CAD
Hypothyroid
CVA
hypercholesterolemia
Medications
anti
acid
s
BD0
10
20
30
40
cardiac DM
tota
lBB
CC
BASA
DIU
RE
TIC
SA
CE
IO
TH
ER
S
totalBBCCBASADIURETICSACEIOTHERS
Overall Diagnosis
0
10
20
30
40
50
60
70
80
overallOSA
10-5/h 20-16/h
30-26/h
>35
Non-OSA:Problem with knwoledge
norm
al
Nar
co UA
RS
Dep
ress
ion
Oth
ers
0
2
4
6
8
10
12
normal RLS N-Rmyoclonus
N terror
N of Pts
Problems with CPAP during test:
0
5
10
15
20
25
30
RDI pre-CPAP
RDI post-CPAP
neverresponsive
partialresponsive
could nottolerate
RDIRDI
Pe
rce
nta
ge
of p
atie
nts
Pe
rce
nta
ge
of p
atie
nts
Mean apnea duration: 38 seconds
Mean CPAP of 6.8 cm H2O
Mean CPAP of 6.8 cm H2O
3RD STUDY
Follow-up Naem Shahrour, MD
86 patients2007-2008
Follow-Up up to 1 yearF/U: (41%)
Weight Stable (85%)
Still loosing (8.5%) Gain WT (6.5%) Sleepiness
same (55%) Better (45%)
CPAP
Bought by 85% Not tolerated by 15% Used by 83% Benefit by 92%
ProblemsWith poor Follow-up due to:
sending back pts to referring MD’s, Poverty incompliance
with ineffective weight loss programsAnd Ineffective Home Care FU for
CPAP use.Worst pts had highe RDI
Conclusion and SolutionsSleep 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 public through an organized awareness programs.
Physicians should be encouraged to recognize OSA early and refer patients for prompt treatments.
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.
Specialized sleep clinic and laboratories should be widely available and well staffed and equipped.
Supportive multidisciplinary programs for weight loss, home care, and CPAP training should be offered.
MD’s should be familiar with common symptoms and complications.
MD’s should screen all high risk patients especially with suggestive Sx, smoking, HTN, and obesity
Thank you FEMTOSAntalya, Turkey
D
Most pts are smokers or ex-smokers
Higher RDI associated with typical presenting SX
Treatment
The higher RDI requires more CPAP
Higher RDI requires higher CPAP
Higher RDI Increases SBP
Higher RDI Increases DBP
Weight increases RDI
Thank you FEMTOSAntalya, Turkey