Ayman Krayem

Sleep disorders in Saudi health care workers.

BACKGROUND The objective of the study was to screen for sleep habits and various sleep disorders, using a standard questionnaire. PATIENTS AND METHODS The questionnaire was designed to assess sleep habits, the degree of daytime sleepiness using the Epworth Sleepiness Scale (ESS), and specific sleep problems. A random sample of Saudi employees working as medical or paramedical personnel was selected. RESULTS There were 163 respondents (65%) comprising 33 females and 130 males. The mean ESS score was 9.4. Sixty-four respondents (39.3%) had an ESS score of more than 10, i.e., excessive daytime sleepiness (EDS). When subjects with poor sleep habits and/or sleep problems were excluded, there were 65 ânormalâ sleepers, with a mean ESS score of 8.9+/-3.6. This did not differ from the rest of the sample population, who had a score of 9.8+/-3.7 (P=0.15). Subjects with inadequate sleep or insomnia consisted of 17 females (51.5%) and 45 males (34.6%). There were seven subjects, all males (5.4%), with habitual snoring. Ten males (7.7%) and two females (6.1%) reported having breathing pauses while asleep. Symptoms of restless leg syndrome, sleep paralysis, and cataplexy were reported by 21 (12.9%), 26 (16.0%) and two (1.2%) subjects, respectively. CONCLUSION The prevalence of EDS in the Saudi population is higher compared to that reported from other populations when a Western ESS normal range is used. Nevertheless, the range of normal score of ESS is probably broader for Saudis compared to other populations. In general, sleep disorders are common but unrecognized in our community.

Effect of on-call-related sleep deprivation on physicians' mood and alertness.

BACKGROUND AND OBJECTIVE: Physicians may experience periods of acute sleep deprivation while on-call, in addition to baseline chronic sleep deprivation which may affect physicians’ performance and patients’ safety. The purpose of this study was to determine the effect of acute sleep deprivation due to working long on-call shifts on mood and alertness, both of which may impair physicians’ performance. METHODS: Eighty-eight junior physicians working in one university hospital completed a questionnaire, before and after completion of a shift, that collected data regarding socio-demographic factors, patterns of work and sleep, Profile of Mood States (POMS), and Stanford Sleepiness Scale. Based on duration of sleep the physicians had during on-call in comparison to their usual average sleep, the participants were categorized into group 1 (those who slept many fewer hours), group 2 (those who slept fewer hours), or group 3 (those who slept the same number of hours). RESULTS: More than 87% of the participant slept 5 or fewer hours while working an on-call shift. Among all participants, the percentage of physicians who were alert post-on-call was significantly reduced compared to the percentage pre-on-call (P = 0.001). The post-on-call total POMS scores of groups 1 and 2 were significantly worse than their pre-on-call scores (P = 0.001 and 0.038, respectively), while there was no significant difference between the pre- and post-on-call POMS scores of group 3 (P = 0.165). CONCLUSION: Acute sleep loss due to working long on-call shifts significantly decreases daytime alertness and negatively affects the mood state of junior physicians.

The presence of atypical mycobacteria in the mouthwashes of normal subjects: Role of tap water and oral hygiene

BACKGROUND: The nontuberculous mycobacteria (NTM) have been found in different environmental sources. They tend to colonize different body surfaces and secretions. The purpose of this study is to evaluate the presence of NTM in the oral cavity of healthy individuals and its relationship to tap water or oral hygiene. MATERIALS AND METHODS: One hundred sixty-seven healthy subjects were recruited. Three consecutive early morning mouthwashes using tap water were performed and examined for the presence of Mycobacterium tuberculosis (MTB) and NTM. In addition we obtained mouthwashes from 30 control healthy individuals with good oral hygiene using sterile water and examined these for the presence of MTB and NTM. RESULTS: NTM was isolated from the mouthwash of 44 (26.3%) subjects that used tap water. On the other hand, NTM was isolated from the mouthwash of 10 (33%) subjects that used sterile water. Age, gender, social class oral hygiene and the regular use of toothbrush made no statistically significant differences in the isolation rate of NTM. CONCLUSION: The rate of isolation of NTM from mouthwash is high in normal subjects. It is independent of oral hygiene, the use of tap water or teeth brushing. Smear-positive sputum could be NTM rather than M. tuberculosis. Tuberculosis polymerase chain reaction or culture confirmation is essential in developing countries to avoid the unnecessary use of antituberculosis therapy when the clinical suspicion is very low.

Unplanned extubation in the ICU: Impact on outcome and nursing workload

PURPOSE: To determine the incidence and factors associated with unplanned extubation (UE) in the intensive care unit (ICU) and its relationship with nursing workload. MATERIALS AND METHODS: A retrospective case-control study was carried out within a cohort of ventilated patients in two teaching hospital medical-surgical ICUs. A total of 50 adult patients with UE were studied. Controls were subjects without UE who were matched to the cases on the following Five factors: age, gender, admission diagnostic category, admission date (within 3 months) and duration of mechanical ventilation. Other data including patient demographics, comorbid conditions, APACHE III score, ventilation parameters, use of sedation, re-intubation, mortality rate and ICU/hospital length of stay were collected. Nine equivalents of nursing manpower use score (NEMS) and multiple organ dysfunction score (MODS) were calculated in both, cases and controls, 24 h before and after the event. RESULTS: Sixty-eight episodes of UE occurred in 66 patients during the 24-month study period (1.1%). Patients with UE were more agitated ( P 0.05). The mean NEMS were not significantly different between the two groups 24 h before ( P =0.69) and after ( P =0.99) the extubation event. Also, the mean MODS were similar between both groups 24 h before ( P =0.69) and after ( P =0.74) extubation. CONCLUSION: In this study, agitation and greater use of benzodiazepines were frequently associated with UE and potentially can be used as risk factors for UE. We have found no significant impact of UE on increasing mortality and, in a manner not shown before, nursing workload.

The diagnostic challenge of pulmonary Kaposi's sarcoma with pulmonary tuberculosis in a renal transplant recipient: a case report.

Wereport a case of a 39-year-old, HIV-negative, post renal transplant patientwho developed mucocutaneous Kaposi’s sarcoma with lung parenchymalinvolvement and concurrently culture proven pulmonary tuberculosis. To thebest of our knowledge, this is the first case report of this combination,which presented with cavitating lung nodules and responded well to withdrawalof immunosuppressive drugs beside antituberculoustreatment.

Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis.

Aim: The prevalence of obstructive sleep apnea (OSA) in end-stage renal disease (ESRD) patients was reported to be 10-fold that in the general population. OSA can worsen the clinical symptoms and cardiovascular complications of ESRD. We aimed to investigate the prevalence of symptoms and risk of OSA among Saudi patients with ESRD. Settings And Design: This multi-center, cross-sectional study was conducted in Jeddah, Saudi Arabia, between June 2012 and September 2013. Methods: The prevalence of OSA was assessed using the Berlin questionnaire. The presence of daytime sleepiness was evaluated using the Epworth sleepiness scale. Data were also collected on the medical history, clinical, and laboratory findings of participants. Results: In all, 355 patients (61% male) were enrolled (mean age: 45.5 ± 15.4 years). The overall prevalence of high-risk of OSA was 44.2% (males, 47.3%; females, 44.8%; P = 0.65). The prevalence of excessive daytime sleepiness (EDS) was 74%. Controlling for age, gender and body mass index, multivariate analysis revealed that hypertension and hepatitis C infection were the only comorbidities significantly associated with OSA (odds ratio [OR]: 3.827 and 0.559; confidence interval [CI]: 2.120-6.906 and 0.324-0.964; P < 0.0001 and 0.036, respectively). OSA was also strongly associated with EDS (OR: 3.054; CI: 1.676-5.565; P < 0.0001). Conclusions: In Saudi Arabia, the risk of OSA is more common in ESRD patients than in the general population. OSA is strongly associated with EDS. Interestingly, a significant negative correlation between OSA and hepatitis C infection was noted, which warrants further investigation.

Pulmonary embolism: A diagnostic approach

Despite the availability of many diagnostic modalities and the advent of new tests, the diagnosis of pulmonary embolism (PE) remains a challenge. Clinical manifestations can be notoriously deceptive and there is not a single test, that can be relied on solely, to exclude PE. Although it has been regarded as the gold standard test, pulmonary angiography has not been tested against a reference standard and thromboembolic events have been reported after a normal study. Therefore the diagnosis of PE depends on judicious utilization of the available tests in the right clinical setting, as the accuracy of the results of the investigations, depends largely on the pretest clinical probability. Simple investigations such as chest radiograph, electrocardiogram and arterial blood gas, are used to enhance the clinical probabilities, rather than confirming or refuting the diagnosis of PE. On the other hand, Perfusion ventilation (VQ) scan and computerized tomographic pulmonary angiography (CTPA), are the main screening tests used for patients with suspected PE. Recently CTPA has largely replaced VQ scan, in many centres. As both VQ scan and CTPA have their limitations, other diagnostic modalities, such as D-dimer and Compression ultrasound of the legs (CUS), are used as adjunctive diagnostic investigations. High probability and normal VQ scan, especially when combined with the concordant clinical probability, has a high positive and negative predicative value, respectively. On the other hand, CTPA is more sensitive and specific than VQ scan, though it has to be combined with CUS and clinical probability, to reduce the chance of missing PE. Although many diagnostic algorithms have been advocated, the discretion of the clinician and clinical experience, still has a major role to play in the diagnosis of PE. In this article, we try to come with a plausible approach to the diagnosis of PE, based on the current literature.

Prevalence and risk factors of obstructive sleep apnea syndrome in a Saudi Arabian population

Background: Obstructive sleep apnea (OSA) is a common disorder worldwide; however, epidemiological studies on its prevalence lack in Saudi Arabia. This study aimed to determine the prevalence and risk factors of OSA in Saudi Arabia. Methods: The study was performed from 2013 to 2015 in two stages. The screening stage was first; a random sample of Saudi employees (n = 2682) 30–60 years of age completed a survey that included the Wisconsin questionnaire. According to these data, the subjects were categorized as habitual, moderate, or nonsnorers (NSs). The confirmatory second stage was a case–control study conducted on 346 individuals selected from each group using polysomnography (PSG). Results: In the first stage, the prevalence of habitual snoring was 23.5%, moderate snoring was16.6%, while 59.9% of the sample was NSs. Among the 346 individuals who underwent PSG, a total of 235 (67.9%) subjects had OSA with an apnea-hypopnea index (AHI) of ≥5; 76 (22.0%) had OSA syndrome (OSAS), defined by an AHI of ≥5 plus daytime sleepiness; and 227 (65.6%) had clinically diagnosed OSA syndrome (COSAS), as defined by the American Academy of Sleep Medicine. A conservative estimate of at least 8.8% (12.8% in men and 5.1% in women) was calculated for the overall prevalence of OSA. Similarly, the overall estimated prevalence of OSAS and COSAS was 2.8% (4.0% in men and 1.8% in women) and 8.5% (12.4% in men and 4.8% in women), respectively. A multivariate analysis revealed age, gender, obesity, and hypertension as independent risk factors of OSA. Conclusions: Our study demonstrated that the rate and risk factors of OSA in the Saudi population are similar to those observed in Western studies.

Erratum to: The effect of vitamin D supplements on the severity of restless legs syndrome

1 Sleep Medicine and Research Center, King Abdulaziz University, Jeddah, Saudi Arabia 2 Sleep Disorders Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia 3 Associate Professor of Medicine College of Medicine, King Abdulaziz University Sleep Medicine and Research Center King Abdulaziz University Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia Sleep Breath (2015) 19:1483 DOI 10.1007/s11325-015-1264-1