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Narcolepsy is an uncommon neurological disorder characterised by irresistible spells of sleep associated with abnormal rapid eye movement (REM) sleep. The association between narcolepsy and human leukocyte antigen HLA- DQB1*06:02 has been established elsewhere but remains to be investigated among Saudi Arabian patients with narcolepsy. A total of 29 Saudi patients with type I or type 2 narcolepsy comprising of 23 (79%) males and 6 (21%) females with a mean age of 17.2 ± 9.6 years were included in this study. Type 1 or type 2 narcolepsy was diagnosed by full polysomnography followed by a multiple sleep latency test in accordance with International Classifications of Sleep Disorders-3 criteria. HLA typing for DQB1 alleles was performed by polymerase chain reaction and hybridization with sequence-specific oligonucleotide probes. Differences in clinical and sleep parameters were compared by univariable analyses. HLA-DQB1*06:02 frequency was systematically compared with the published literature. Type 1 narcolepsy was diagnosed in 19/29 (65.5%) patients, whereas 10/29 (34.5%) patients had type 2 narcolepsy. DQB1*06:02 was present in 25/29 (86.2%) patients; 15/19 (78.9%) narcolepsy type 1 patients and 10/10 (100%) narcolepsy type 2 patients harboured the DQB1*06:02 allele. REM latency was significantly lower in DQB1*06:02-positive patients compared to DQB1*06:02-negative patients (17.6 ± 32.3 min vs. 106.0 ± 86.0 min; p = 0.025). Epworth Sleepiness Scale scores were significantly higher among type 1 than type 2 narcolepsy patients (19.7 ± 3.2 vs 15.3 ± 3.6; p = 0.02). DQB1*06:02 allele frequencies among Saudi patients with narcolepsy were consistent with previously published data.

International audience; Kleine-Levin syndrome (KLS) is a rare periodic hypersomnia with associated behavioural abnormalities but with often favourable prognosis. There is excess risk of KLS in first-degree relatives, suggesting a strong genetic contribution. So far, no mutation is identified in KLS and comprehensive genetic analysis of affected individuals is lacking. Here we performed whole genome single-nucleotide polymorphism (SNP) genotyping and exome sequencing in a large family with seven affected members. The identified gene with a mutation was resequenced in 38 sporadic KLS patients and the expression of the gene product was mapped in the mouse brain. Linkage analysis mapped the disease locus to chromosome 3 and exome analysis identified a heterozygous missense variant in LMOD3 (p.E142D) in the linkage interval. The variant was found to segregate in all affected and one presumably unaffected member of the family. Resequencing LMOD3 in 38 other KLS patients and their families revealed three other low frequency or rare missense variants in seven cases that were inherited with incomplete penetrance. LMOD3 is expressed in the brain and colocalized with major structures involved in the regulation of vigilance states. LMOD proteins are structural proteins and seem to be developmentally regulated. Our findings suggest that KLS might be a structural/neurodevelopmental brain disease.

Background Reductions in BDNF activity have shown associations with depressed mood. Other evidence has demonstrated that the BDNF Val66Met polymorphism (rs6265) appears to reduce neural plasticity. A limited number of studies have investigated the influence of these genetic polymorphisms in insomnia. The present study sought to confirm the presence of associations between BDNF Val66Met polymorphism (rs6265) occurrence in normal sleepers and those with insomnia. Method The study subjects consisted of a patient group (n = 199) complaining of insomnia and a control group (n = 51). Each subject was clinically interviewed using questions taken from the Brief Insomnia Questionnaire. After the interview, the subjects were asked to complete the Insomnia Severity Index, The Hamilton Depression Rating Scale, and the Montreal Cognitive Assessment Test. An overnight polysomnography test was also administered. Blood samples were collected for genetic study. Results The insomnia patients showed a greater prevalence of heterozygous (A/G) VAL/MET polymorphism than the normal controls (p = ≤ 0.0001). This finding confirmed that this genetic polymorphism, which impairs BDNF activity, is an important correlate of disturbed sleep. Further, the finding of significantly greater (p = ≤ 0.0001) depression scores among the insomnia group suggested that BDNF is an important factor in the development of depressive symptoms. Clinical Implications The results of the present study indicate that BDNF gene polymorphism plays a prominent role in the variation of symptoms among insomnia patients and, further, that this polymorphism is strongly related to the severity of depression.

Background Current evidence supports the applicability of the Leeds Sleep Evaluation Questionnaire (LSEQ) in screening for insomnia. The psychometric properties of the LSEQ have never been investigated in an African population. Therefore, this study aimed to validate the adapted version of the LSEQ-Mizan (LSEQ-M) in Ethiopian university students. Methods Of a preliminary sample of 750 (random sampling), 424 students (age = 21.87 ± 4.13 years and body mass index = 20.84 ± 3.18 kg/m2) from Mizan-Tepi University, Mizan-Aman, South-west Ethiopia completed the LSEQ-M, the General Anxiety Disorder Scale-7 and a semi-structured questionnaire for socio-demographics. Insomnia was screened in accordance with the International Classification of Sleep Disorders as a measure of concurrent validity. Results Although, individual items showed ceiling and floor effect, the LSEQ-M as a scale did not have these effects. Good internal consistency (Cronbach’s alpha of 0.84) and strong internal homogeneity as measured by the correlation coefficient between items scores and the LSEQ-M global score was found. The LSEQ-M showed excellent screening applicability for insomnia with optimal cut-off scores of 52.6 (sensitivity 94%, specificity 80%), and the area under the curve, 0.95 (p

Obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep is a special form of OSA that occurs predominantly during REM sleep. No study has assessed the long-term adherence to continuous positive airway pressure (CPAP) among patients with REM-only OSA. To objectively assess the long-term adherence to CPAP therapy among patients with REM-predominant (REM-only) OSA.This was a prospective observational cohort study that included consecutive patients who were diagnosed with OSA. Patients were divided into the following two groups: (I) REM-only OSA [an apnea hypopnea index (AHI) of ≥5, with a REM-AHI/NREM-AHI of2, an NREM-AHI of15, and a minimum of 15 min of REM-sleep duration], and (II) non-stage specific OSA. Follow-up was performed at 1, 6 and 12 months after the initiation of CPAP-therapy.The study included 175 patients; 30 met the criteria for REM-only OSA, and the remaining patients constituted the non-stage specific OSA group. The number of hours of CPAP use per day was significantly lower in the REM-only OSA group at 1, 6 and 12 months compared to the non-stage specific OSA group. At 12 months, the number of hours used per day was 3.8±1.8 and 5.1±2.1 hours in the REM-only and non-stage specific OSA groups, respectively (P=0.003). Approximately 80% of the enrolled participants in both groups were still using CPAP at the end of the study; 23.3% of REM-only OSA patients met the criteria for good adherence (4 hours/day), and 56.7% met the criteria for partial adherence.CPAP adherence is lower among patients with REM-only OSA compared to patients with non-stage specific OSA.

An accumulating amount of evidence has linked humoral mediators of inflammation with sleep measures. Nevertheless, important details of this association, in particular the role of the complement components in the context of chronic sleep attributes, have remained largely uncharacterized. Fifty university students (age, 23.3 ± 3.8 years; BMI, 23.7 ± 2.9 kg/m2) completed the study. Four dichotomized sleep measures assessed by the Pittsburgh Sleep Quality Index (PSQI) were used in association analysis using binary logistic regression with complement component 3, 4, and complement factor I (CFI). The sleep measures were defined as sleep quality (good sleep/poor sleep; PSQI ≤5/PSQI >5), bedtime (early/late; before 00:00 h/after 0:00 h), sleep duration (short/normal ≤6 h/>6 h), and sleep onset latency (normal/disturbed; 0–1 score/2–3 score on the PSQI component of sleep latency). The complement component 4 was associated with sleep quality (unadjusted, OR = 1.025, p

Objectives: To evaluate continuous positive airway pressure (CPAP) compliance and define predictors of CPAP compliance among Saudi patients with obstructive sleep apnea (OSA) after applying an educational program. Methods: This prospective cohort study included consecutive patients diagnosed to have OSA based on polysomnography between January 2012 and January 2014 in King Saud University, Riyadh, Kingdom of Saudi Arabia. All patients had educational sessions on OSA and CPAP therapy before sleep study, and formal hands-on training on CPAP machines on day one, day 7, and day 14 after diagnosis. The follow-up in the clinic was carried out at one, 4, and 10 months after initiating CPAP therapy. Continuous positive airway pressure compliance was assessed objectively. Logistic regression model was used to assess the predictors of CPAP adherence. Results: The study comprised 156 patients with a mean age of 51.9±12.1 years, body mass index of 38.4±10.6 kg/m 2 , and apnea hypopnea index of 63.7±39.3 events/hour. All patients were using CPAP at month one, 89.7% at month 4, and 83% at month 10. The persistence of CPAP-related side effects and comorbid bronchial asthma remained as independent predictors of CPAP compliance at the end of the study. Conclusion: With intensive education, support, and close monitoring, more than 80% of Saudi patients with OSA continued to use CPAP after 10 months of initiating CPAP therapy. Saudi Med J 2015; Vol. 36 (8): 911-919 doi: 10.15537/smj.2015.8.11716

Background:Obstructive sleep apnea (OSA) is a common, serious, under-recognized and under-diagnosed medical disorder. Polysomnography (PSG) is the gold standard diagnostic test for OSA; however, the cost of testing and the shortage of sleep disorders laboratories limit access to this tool. Therefore, there is a need for a simple and reliable diagnostic tool to screen patients at risk of OSA.Objective:This study was conducted to evaluate the validity and reliability of an Arabic version of the STOP-Bang questionnaire (SBQ) as a screening tool for OSA.Methods:This study was conducted in three steps, as follows: Step 1: the SBQ was translated from English to Arabic (examining both forward and backward translations); Step 2: the test-retest reliability of the questionnaire was investigated; and Step 3: the questionnaire was validated against PSG data prospectively on 100 patients attending a sleep disorders clinic who were subjected to a full-night PSG study after completing the translated version of the SBQ. The validity of the test was tested against the apnea-hypopnea index (AHI).Results:The study group had a mean age of 46.6 ± 14.0 years and a mean AHI of 50.0 ± 37.0/hour. The study demonstrated a high degree of internal consistency and stability over time for the translated SBQ. The Cronbach’s alpha coefficient for the 8-item tool was 0.7. Validation of the SBQ against the AHI at a cut-off of 5 revealed a sensitivity of 98% and positive and negative predictive values of 86% and 67%, respectively.Conclusion:The Arabic version of the SBQ is an easy-to-administer, simple, reliable and valid tool for the identification of OSA in the sleep disorders clinic setting.

Objectives: 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). Methods: 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. Results: 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 )

The obesity hypoventilation syndrome (OHS) is associated with significant morbidity and increased mortality compared with simple obesity and eucapnic obstructive sleep apnea. Accurate diagnosis and commencement of early and appropriate management is fundamental in reducing the significant personal and societal burdens this disorder poses. Sleep disordered breathing is a major contributor to the developmental of sleep and awake hypercapnia, which characterizes OHS, and is effectively addressed through the use of positive airway pressure (PAP) therapy. This article reviews the current evidence supporting different modes of PAP currently used in managing these individuals.

Noninvasive ventilation (NIV) is increasingly used in the treatment of acute respiratory failure (ARF). The success of NIV depends to a large extent on the selection of the proper interface. The choice and application of the interface in patients with ARF are a great challenge to the treating team. This chapter discusses the different types of masks that can be used in patients with ARF, the differences between nasal and oronasal masks, the impact of interface type on upper airway patency, mask fitting, and the relationship between ventilator type and interface choice.

Noninvasive ventilation (NIV) refers to providing ventilatory support without the use of invasive artificial airway. The use of NIV has markedly increased recently and is currently regarded essential in the management of acute respiratory failure and in particular acute hypercapnic respiratory failure (AHRF).

Fil: Almeneessier, Aljohara S. King Saud University. College of Medicine. Department of Family and Community Medicine; Arabia Saudita Fil: BaHammam, Ahmed S. King Saud University. College of Medicine. University Sleep Disorders Center; Arabia Saudita Fil: Sharif, Munir M. King Saud University. College of Medicine. University Sleep Disorders Center; Arabia Saudita Fil: Bahammam, Salman A. King Saud University. College of Medicine. Department of Medicine; Arabia Saudita Fil: Nashwan, Samar Z. King Saud University. College of Medicine. University Sleep Disorders Center; Arabia Saudita Fil: Pandi Perumal, Seithikurippu R. King Saud University. College of Medicine. University Sleep Disorders Center; Arabia Saudita Fil: Cardinali, Daniel P. Pontificia Universidad Católica Argentina. Facultad de Ciencias Médicas. Instituto de Investigaciones Biomédicas; Argentina Fil: Cardinali, Daniel P. Pontificia Universidad Católica Argentina. Facultad de Ciencias Médicas. Departamento de Docencia e Investigación; Argentina Fil: Alzoghaibi, Mohammad. King Saud University. Department of Physiology; Arabia Saudita Abstract: Aims: We hypothesized that if we control for food composition, caloric intake, light exposure, sleep schedule, and exercise, intermittent fasting would not influence the circadian pattern of melatonin. Therefore, we designed this study to assess the effect of intermittent fasting on the circadian pattern of melatonin. Methods: Eight healthy volunteers with a mean age of 26.6 ± 4.9 years and body mass index of 23.7 ± 3.5 kg/m2 reported to the Sleep Disorders Center (the laboratory) on four occasions: (1) adaptation, (2) 4 weeks before Ramadan while performing Islamic intermittent fasting for 1 week (fasting outside Ramadan [FOR]), (3) 1 week before Ramadan (nonfasting baseline [BL]), and (4) during the 2nd week of Ramadan while fasting (Ramadan). The plasma levels of melatonin were measured using enzyme-linked immunoassays at 22:00, 02:00, 04:00, 06:00, and 11:00 h. The light exposure, meal composition, energy expenditure, and sleep schedules remained the same while the participants stayed at the laboratory. Results: The melatonin levels followed the same circadian pattern during the three monitoring periods (BL, FOR, and Ramadan). The peak melatonin level was at 02:00 h and the trough level was at 11:00 h in all studied periods. Lower melatonin levels at 22:00 h were found during fasting compared to BL. Cosinor analysis revealed no significant changes in the acrophase of melatonin levels. Conclusions: In this preliminary report, under controlled conditions of light exposure, meal composition, energy expenditure, and sleep-wake schedules, intermittent fasting has no significant influence on the circadian pattern of melatonin.

Kleine-Levin syndrome (KLS) is a rare, homogeneous, debilitating sleep disorder characterized by episodic hypersomnia, cognitive impairment, and behavioral changes. The etiology, pathophysiology, and optimal management of KLS remain uncertain. We identify the 5 key areas requiring urgent attention: KLS immunopathogenesis studies, next-generation genetics, multimodal functional imaging, biomarker discovery, and clinical drug trials. A centralized registry of afflicted individuals must be established. Disease uniformity should make the identification of associated genetic or imaging biomarkers easier, but clinical efforts require laboratory-based research to model the disease and generate preclinical data for clinical translation.

One important cardiovascular morbidity that is associated with obesity hypoventilation syndrome (OHS) is the development of pulmonary hypertension (PH). However, few studies have assessed PH in OHS patients. Therefore, we prospectively assessed the prevalence of PH in a large sample of OHS patients.In this prospective observational study, all consecutive OHS patients referred to the sleep disorders clinic during the study period were included. All patients underwent overnight polysomnography (PSG), spirometry, arterial blood samples and thyroid tests. Transthoracic echocardiography was performed for patients who agreed to participate in the study. PH was defined as systolic pulmonary artery pressure (SPAP)40 mmHg.Echocardiographic data were available for 77 patients with a mean age of 60.5±11.7 years, a BMI of 43.2±10.4 kg/mPH is very common among patients with OHS who have been referred to sleep disorders clinics. PH should be considered in the regular clinical assessment of all patients with OHS.

The relationship between sleep disturbances and substance use can have harmful effects. Evidence shows widespread use of substances, including khat, in the Ethiopian population. However, to the best of our knowledge, no study has investigated the sleep correlates of substance use in community-dwelling Ethiopian adults. A cross-sectional study using simple random sampling was performed on community-dwelling adults (n = 371, age = 25.5 ± 5.7 years, body mass index = 22.0 ± 2.2 kg/m2) in Mizan-Aman, Ethiopia. Dichotomized sleep measures (sleep quality and sleep latency) assessed by the Pittsburgh Sleep Quality Index (PSQI) were used in association analysis using binary logistic regression with substance use (khat, smoking, and alcohol). Sleep latency was associated with khat chewing (adjusted odds ratio (AOR) = 2.8, 95% confidence interval (CI) 1.7–4.4) and tobacco smoking (AOR = 2.1, 95% CI 1.4–3.0). Sleep quality was associated with khat chewing (AOR = 3.1, 95% CI 1.8–5.2), tobacco smoking (AOR = 1.7, 95% CI 1.2–2.5), and alcohol intake (AOR = 1.9, 95% CI 1.1–3.1). Sleep correlates of substance use were found in community-dwelling Ethiopians. These findings may aid in the development of targeted strategies to manage substance use-related sleep disturbances.

Background The signal transducer and activator of transcription 6 (STAT6) transduces signals in response to IL-4 and IL-13 cytokine stimulations, resulting in many cell-specific responses. Some common STAT6 SNPs were associated with asthma predisposition and/or IgE levels, although discrepancies have also been reported. Objective To determine whether STAT6 rs324011 and rs324015 polymorphisms are associated with atopic asthma in Saudi Arabian patients. Methods A total of 536 Saudi individuals aged 11–70 years old (230 atopic asthmatics, 306 healthy subjects) were recruited. DNA was purified from peripheral blood and genotyping for rs324011 and rs324015 polymorphisms was performed by PCR amplification, followed by cycle sequencing of the purified PCR fragments using BigDye chain terminator and capillary electrophoresis. Results By the contrast of alleles tests, no significant differences between asthma and healthy groups were detected for both variants (rs324011: X 2 = 0.25, Pearson’s P -value = 0.617; rs324015: X 2 = 0.068, Pearson’s P = 0.814).When testing for genotypes, rs324011 homozygous T/T genotype was significantly associated with asthma, when the Recessive model is considered (T/T vs. C/C + C/T) (adjusted, OR = 2.49, 95% CI = 1.18–5.25, Pearson’s P = 0.014 ∗ , Yates’ P = 0.022 ∗ ). In contrast, rs324015 variant was not significantly associated with asthma. Conclusions Rs324011 homozygous T/T genotype was significantly associated with asthma risk whereas rs324015 genotypes were not in the Saudi population.

Migraine and restless legs syndrome (RLS) are common medical disorders that often co-occur. Various hypotheses have suggested that the co-occurrence of these distinct disorders could be related to shared genetic, neurobiological, or environmental factors. In this article, we review the available evidence regarding hypotheses concerning the possible causal roots of the frequently observed RLS/migraine association. We found only one study that implicated genetic mechanisms as potential causal factors. In addition, the dopamine theory appears to be overly simplistic. However, the roles of sleep disturbance and obesity have not been systematically investigated. Thus, it is suggested that these two factors be investigated further for a better understanding of their possible role in the pathophysiology of migraine and RLS. Elucidation of these issues would make an important contribution to methods of therapy and could potentially reduce the burden imposed by these disorders.

Summary Islamic intermittent fasting is distinct from regular voluntary or experimental fasting. We hypothesised that if a regimen of a fixed sleep–wake schedule and a fixed caloric intake is followed during intermittent fasting, the effects of fasting on sleep architecture and daytime sleepiness will be minimal. Therefore, we designed this study to objectively assess the effects of Islamic intermittent fasting on sleep architecture and daytime sleepiness. Eight healthy volunteers reported to the Sleep Disorders Centre on five occasions for polysomnography and multiple sleep latency tests: (1) during adaptation; (2) 3 weeks before Ramadan, after having performed Islamic fasting for 1 week (baseline fasting); (3) 1 week before Ramadan (non-fasting baseline); (4) 2 weeks into Ramadan (Ramadan); and (5) 2 weeks after Ramadan (non-fasting; Recovery). Daytime sleepiness was assessed using the Epworth Sleepiness Scale and the multiple sleep latency test. The participants had a mean age of 26.6 ± 4.9 years, a body mass index of 23.7 ± 3.5 kg m−2 and an Epworth Sleepiness Scale score of 7.3 ± 2.7. There was no change in weight or the Epworth Sleepiness Scale in the four study periods. The rapid eye movement sleep percentage was significantly lower during fasting. There was no difference in sleep latency, non-rapid eye movement sleep percentage, arousal index and sleep efficiency. The multiple sleep latency test analysis revealed no difference in the sleep latency between the ‘non-fasting baseline’, ‘baseline fasting’, ‘Ramadan’ and ‘Recovery’ time points. Under conditions of a fixed sleep–wake schedule and a fixed caloric intake, Islamic intermittent fasting results in decreased rapid eye movement sleep with no impact on other sleep stages, the arousal index or daytime sleepiness.

Summary Non-invasive ventilation (NIV) has become a common treatment for acute and chronic respiratory failure. In comparison with conventional invasive mechanical ventilation, NIV has the advantages of reducing patient discomfort, procedural complications, and mortality. However, NIV is associated with frequent uncomfortable or even life-threatening adverse effects, and patients should be thoroughly screened beforehand to reduce potential severe complications. We performed a detailed review of the relevant medical literature for NIV complications. All major NIV complications are potentially life-threatening and can occur in any patient, but are strongly correlated with the degree of pulmonary and cardiovascular involvement. Minor complications can be related to specific structural features of NIV interfaces or to variable airflow patterns. This extensive review of the literature shows that careful selection of patients and interfaces, proper setting of ventilator modalities, and close monitoring of patients from the start can greatly reduce NIV complications.

To the Editor: Although humidifiers have demonstrated beneficial therapeutic effects during noninvasive ventilation (NIV), there is still controversy over the selection of the best humidifier to improve patient-ventilator interaction and gas exchange.[1][1] We read with interest the recently

Objective To assess the characteristics of obstructive sleep apnea (OSA) patients with nightmares and the effects of continuous positive airway pressure (CPAP) therapy on nightmares. Methods Consecutive patients referred with a clinical suspicion of OSA underwent attended overnight sleep studies. OSA and nightmares were diagnosed according to the American Academy of Sleep Medicine (AASM) criteria, and CPAP titration was performed in accordance with the AASM guidelines. A follow-up visit was performed 3 months later, and the patients with nightmares were divided into two groups: group 1 used CPAP with good compliance, whereas group 2 refused CPAP treatment and did not use other alternative treatments for OSA. Results The study included 99 patients who had been diagnosed with OSA with nightmares. Their mean age was 47.2 ± 11.2 years, and they had a mean apnea–hypopnea index (AHI) of 36.5 ± 34.3/h. Also included were 124 patients with OSA without nightmares. The mean age of these patients was 45.4 ± 13.9 years, and they had a mean AHI of 40.2 ± 35/h. The patients with nightmares had a significantly higher AHI during rapid eye movement sleep (REM) compared with the patients without nightmares (51.7 ± 28.1 vs 39.8 ± 31.9/h). Logistic regression analysis revealed that the REM-AHI and interrupted sleep at night were independent predictors of nightmares in the OSA patients. Nightmares disappeared in 91% of the patients who used CPAP compared with 36% of patients who refused to use CPAP (p Conclusion Nightmares in OSA patients are associated with a higher REM-AHI. CPAP therapy results in a significant improvement in nightmare occurrence.

Objectives: We aimed to evaluate the validity of the BodyMedia's SenseWear ™ Armband (BSA) device in estimating total sleep time (TST) in patients with obstructive sleep apnea (OSA). Methods: 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. Results: 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. Conclusion: 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.

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.

To explore and validate the factor structure of the Pittsburgh Sleep Quality Index (PSQI) in young collegiate adults. Six hundred university students were initially contacted and invited to participate in a survey of their sleep experience and history. Of this preliminary sample 418 of the students (age = 20.92 ± 1.81 years, BMI = 23.30 ± 2.57 kg/m2) fulfilled the screening criteria and ultimately completed the Pittsburgh Sleep Quality Index (PSQI), a self-report survey of respondents’ sleep habits and sleep quality. The students were enrolled in various undergraduate and postgraduate programs at Jamia Millia Islamia, New Delhi, India. Exploratory factor analysis (EFA) investigated the latent factor structure of the scale. Confirmatory factor analysis evaluated both of the models found by EFA. The Kaiser’s criteria, the Scree test, and the cumulative variance rule revealed that a 2-factor model accounted for most of the variability in the data. However, a follow up Parallel Analysis found a 1-factor model. The high correlation coefficient (r = 0.91) between the two factors of the 2-factor model and almost similar values of the fit indices supports the inference that the PSQI is a unidimensional scale. The findings validate the 1-factor model of the PSQI in young collegiate adults.

Purpose To explore and validate the factor structure of the Pittsburgh Sleep Quality Index (PSQI) in young collegiate adults. Methods Six hundred university students were initially contacted and invited to participate in a survey of their sleep experience and history. Of this preliminary sample 418 of the students (age = 20.92 ± 1.81 years, BMI = 23.30 ± 2.57 kg/m2) fulfilled the screening criteria and ultimately completed the Pittsburgh Sleep Quality Index (PSQI), a self-report survey of respondents’ sleep habits and sleep quality. The students were enrolled in various undergraduate and postgraduate programs at Jamia Millia Islamia, New Delhi, India. Exploratory factor analysis (EFA) investigated the latent factor structure of the scale. Confirmatory factor analysis evaluated both of the models found by EFA. Results The Kaiser’s criteria, the Scree test, and the cumulative variance rule revealed that a 2-factor model accounted for most of the variability in the data. However, a follow up Parallel Analysis found a 1-factor model. The high correlation coefficient (r = 0.91) between the two factors of the 2-factor model and almost similar values of the fit indices supports the inference that the PSQI is a unidimensional scale. Conclusions The findings validate the 1-factor model of the PSQI in young collegiate adults.

Purpose To study spontaneous K-complex (KC) densities during slow-wave sleep. The secondary objective was to estimate intra-non-rapid eye movement (NREM) sleep differences in KC density. Materials and Methods It is a retrospective study using EEG data included in polysomnographic records from the archive at the sleep research laboratory of the Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, India. The EEG records of 4459 minutes were used. The study presents a manual identification investigation of KCs in 17 healthy young adult male volunteers (age = 23.82±3.40 years and BMI = 23.42±4.18 kg/m2). Results N3 had a higher KC density than N2 (Z = -2.485, p = 0.013) for all of the probes taken together. Four EEG probes had a higher probe-specific KC density during N3. The inter-probe KC density differed significantly during N2 (χ2 = 67.91, p < .001), N3 (χ2 = 70.62, p < .001) and NREM (χ2 = 68.50, p < .001). The percent distribution of KC decreased uniformly with sleep cycles. Conclusion The inter-probe differences during N3 establish the fronto-central dominance of the KC density regardless of sleep stage. This finding supports one local theory of KC generation. The significantly higher KC density during N3 may imply that the neuro-anatomical origin of slow-wave activity and KC is the same. This temporal alignment with slow-wave activity supports the sleep-promoting function of the KC.

Obstructive sleep apnea (OSA) is a common medical problem with serious medical consequences if left untreated. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for OSA. However, compliance with CPAP therapy remains a major challenge for patients and practitioners. Therefore, close monitoring and follow-up, support, education, and behavioral therapy are needed to improve CPAP adherence among patients.

Introduction: Egyptian medical education system awards students the bachelor degree of medicine after six academic years and a rotating house-officer year. There are no structured sleep educative programs in Egypt. Aim of work: This study aimed to assess the knowledge of Egyptian final year medical students and houseofficers about normal sleep and sleep disorders. Subjects and methods: Medical schools distributed throughout Egypt were surveyed asking sixth year medical students (males and females) and house-officers to participate. Seven faculties of medicine were selected. To screen for knowledge on normal sleep and sleep disorders, the Assessment of Sleep Knowledge in Medical Education Survey was used; the participants were classified to low scorers versus high scorers depending upon their ability to answer 60% of the questions correctly. The participants were separated into comparative groups (males vs. females). 6th year students vs. house officers and according to their faculty location. Results: A total of 726 participants completed the survey (52.8% males, 78.9% were 6th year medical students and 21.1% were house-officers). There was a statistically significant difference in the scores of the participants with regard to their Faculty location and gender, while no statistically significant difference was found with regards to the study year. Conclusion and recommendation:Medical students in the screened Egyptian faculties possess poor knowledge about sleep medicine, which reflects the deficient educative processes in this field of medicine. Medical faculties should provide better sleep medicine education through a formal sleep medicine degree-awarding program.

Asthma is characterized by eosinophilic airway inflammation and remodeling of the airway wall. Features of airway remodeling include increased airway smooth muscle (ASM) mass. However, little is known about the interaction between inflammatory eosinophils and ASM cells. In this study, we investigated the effect of eosinophils on ASM cell proliferation. Eosinophils were isolated from peripheral blood of mild asthmatics and non-asthmatic subjects and co-cultured with human primary ASM cells. ASM proliferation was estimated using Ki-67 expression assay. The expression of extracellular matrix (ECM) mRNA in ASM cells was measured using quantitative real-time PCR. The role of eosinophil derived Cysteinyl Leukotrienes (CysLTs) in enhancing ASM proliferation was estimated by measuring the release of leukotrienes from eosinophils upon their direct contact with ASM cells using ELISA. This role was confirmed either by blocking eosinophil-ASM contact or co-culturing them in the presence of leukotrienes antagonist. ASM cells co-cultured with eosinophils, isolated from asthmatics, but not non-asthmatics, had a significantly higher rate of proliferation compared to controls. This increase in ASM proliferation was independent of their release of ECM proteins but dependent upon eosinophils release of CysLTs. Eosinophil-ASM cell to cell contact was required for CysLTs release. Preventing eosinophil contact with ASM cells using anti-adhesion molecules antibodies, or blocking the activity of eosinophil derived CysLTs using montelukast inhibited ASM proliferation. Our results indicated that eosinophils contribute to airway remodeling during asthma by enhancing ASM cell proliferation and hence increasing ASM mass. Direct contact of eosinophils with ASM cells triggers their release of CysLTs which enhance ASM proliferation. Eosinophils, and their binding to ASM cells, constitute a potential therapeutic target to interfere with the series of biological events leading to airway remodeling and Asthma.