Sleep disorders in Saudi health care workers

Sleepiness and Health-Related Quality of Life Among Kidney Transplant Recipients in a Low-Middle Income Country: A Cross-Sectional Study

This study aims to describe daytime sleepiness and health-related quality of life (HRQoL) among Lebanese kidney transplant (KT) recipients and to examine the medical, psychosocial and transplant factors related to them. It is a cross-sectional multi-center study involving KT recipients >18 years. Daytime sleepiness was assessed using ESS Questionnaire. HRQoL was measured using the SF-36 questionnaire. Social support was self-reported. A multivariable regression analysis evaluated factors associated with daytime sleepiness and HRQoL in our sample. 118 patients were recruited over a 2 years period. Excessive daytime sleepiness was prevalent in 12.7%. It was associated with Diabetes Mellitus (OR 3.97, 95% CI 0.94-16.81, p = 0.06) and obesity (OR 1.13, 95% CI 1.02, 1.27, p = 0.02). Social support and higher eGFR were associated with better scores on the MCS (β 24.13 p < 0.001 and β 0.26 p < 0.01) and the PCS (β 15.48 p < 0.01 and β 0.22 P 0.02). Conversely, depression and hospitalization were negatively associated with the MCS (β -27.44, p < 0.01 and β -9.87, p < 0.01) and the PCS (β -0.28.49, p < 0.01 and β -10.37, p < 0.01).

Assessment of Insomnia Among Emergency Department Physicians in the Western Region of Saudi Arabia, 2023

Background Sleep is essential for physical and mental health, and insomnia is the most common sleep disorder. Insomnia is associated with multiple health issues that may affect physicians' health and their decision-making, and subsequently affect patients in the emergency department (ED). This study aimed to assess insomnia and its associated factors among ED physicians in the western region of Saudi Arabia. Methods A cross-sectional study was conducted using a validated online questionnaire to collect data from the target population. The questionnaire included demographic characteristics, the nature of the job, shift characteristics, and the Insomnia Severity Index tool. Data were analyzed using the statistical package for the social sciences (SPSS, version 29.0), and the Chi-square test was used for bivariate analysis. Results The study involved 106 ED physicians, primarily from Saudi Arabia, who worked in government hospitals and were mostly aged from 20 to 29 years old. Of the participants, 35.8% had moderate to severe clinical insomnia, with younger physicians experiencing more severe insomnia than their older colleagues. This highlights the potential role of age in the development of insomnia. No significant associations were found between insomnia severity and other demographic or work-related factors. Conclusion This study found a high prevalence of insomnia among ED physicians in Saudi Arabia, emphasizing the need for further research and interventions to address this issue. Improving the sleep quality of ED physicians is crucial for their health and well-being, as well as for the safety and quality of care provided to their patients.

Joint consensus statement of the Saudi Public Health Authority on the recommended amount of physical activity, sedentary behavior, and sleep duration for healthy Saudis: Background, methodology, and discussion

The Saudi Public Health Authority recently prepared a Consensus Statement regarding how much time a person should spend engaged in physical activity, sedentary behavior, and sleep to promote optimal health across all age groups. This paper describes the background literature, methodology, and modified RAND Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach that guided the development process. A Leadership Group and Consensus Panels were formed, and credible existing guidelines were identified. The Panel identified clear criteria to choose the best practice guidelines for the set objectives after evaluation, based on GRADE table evidence, findings table summaries, and draft recommendations. Updating of the selected practice guidelines was performed, and the Consensus Panels separately reviewed the evidence for each behavior and decided to adopt or adapt the selected practice guideline recommendations or create de novo recommendations. Data related to cultural factors that may affect the studied behaviors, such as prayer times, midday napping or "Qailulah," and the holy month of Ramadan, were also reviewed. Two rounds of voting were conducted to reach a consensus for each behavior.

Prevalence of insomnia among university students in South Asian Region: a systematic review of studies

INTRODUCTION

Insomnia is a global health problem among university students which is associated with various psychiatric problems like depression and anxiety. While different developed and developing countries assessed the prevalence of insomnia in youth, currently there is hardly systematic review of studies found based on the prevalence of insomnia in South Asia.

AIMS

The aim of this study is to systematically review the evidence relating to the prevalence rate of insomnia in university students in South Asian countries.

METHODS

Electronic searches of three databases, PubMed, Cochrane library, and Worldwide science were performed from 2010 to 2020 before April. In total, seven studies were included for evaluating insomnia in South Asian region among university students.

RESULTS

The prevalence rates of insomnia of the seven studies ranged between 35.4% (95% CI: 32.4-38.5%) and 70% (95% CI: 65.7-74.1%). The pooled prevalence of insomnia among university students was 52.1% (95% CI: 41.1-63.1%).

CONCLUSIONS

This review emphasized that insomnia in university students might be a common health issue to give full concentration in their studies and academic performance. Thus, more attention should be given to the determinants of insomnia among university students, so that it could be helpful to identify the main causes of insomnia and effective measures could be taken.

Impact of shift work on sleep and daytime performance among health care professionals

OBJECTIVES

To evaluate sleep quality and daytime sleepiness in health care professionals who are performing shift work. Methods: This cross-sectional study was conducted on 510 health care professionals at Prince Sultan Military Medical City and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia between December 2015 and April 2016. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Participants were divided into 2 groups: shift workers and non-shift workers. Results: We compared both groups regarding the effect of shift work on the total score of PSQI and ESS. We found that the PSQI global score (p less than 0.001) and the total ESS score (p=0.003) were significantly higher in shift work health care professionals.  Conclusion: Shift work among health care professionals is associated with poor sleep quality but not excessive daytime sleepiness. Health care professionals performing shift work have PSQI and ESS scores slightly higher than non-shift work health professionals.

Risk of fatigue among anesthesia residents in Saudi Arabia

Objectives:

To quantify fatigue risk and sleepiness among anesthesia residents in Saudi Arabia (SA).

Methods:

Between April 2014 and April 2015, all anesthesia residents training in western, central, and eastern regions in SA were invited to fill a survey. We conducted a cross-sectional self-reporting survey that included demographic data, the Epworth sleepiness scale (ESS), and 2 other scales to assess fatigue risk: a Checklist for Individual Strength (CIS) and a predefined comprehensive fatigue risk assessment previously developed by the Australian Medical Association (AMA).

Results:

We received 102 responses, and more than half of the individuals in the sample were at elevated risk of fatigue according to both fatigue scales. Approximately 70% reported being excessively sleepy during the day.

Conclusion:

All 3 scales used in our survey suggested that local anesthesia residents in SA are sleepy and at risk of becoming fatigued. This could be multifactorial, explained by long shifts, or cultural and lifestyle habits.

The effects of age and gender on the prevalence of insomnia in a sample of the Saudi population

OBJECTIVES

The aim of this study was to determine the prevalence of insomnia among the Saudi adult population.

STUDY DESIGN

A cross-sectional insomnia survey was conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. The presence of insomnia was defined by difficulty initiating sleep, early morning awakening, or frequent awakening, in addition to the second-day effect in the form of fatigue, tiredness, or changes in the mode because of lack of sleep.

RESULTS

The crude prevalence of insomnia was 77.7% (95% CI = 75.9-79.5%). The gender-adjusted prevalence of insomnia was higher for females, 88.7% (95% CI = 86.4-90.7%) than for males, 70.4% (95% CI = 67.8-72.9%), p-value = .001. The age-adjusted prevalence of insomnia was higher for the elderly, 93.7% (95% CI = 90.6-96.0%) than for the middle aged, 79.8% (95% CI = 77.4-82.1%), or for the young group, 64.2% (95% CI = 59.9-68.4%), p-value = .001. The Chi-square analyses revealed that (1) being elderly, widowed/divorced, females, or housewives, (2) having a lack of education, and (3) excessive tea consumption were significantly associated with elevated risks for insomnia (p-values < .05).

CONCLUSIONS

Insomnia is most prevalent among Saudi females and the elderly Saudi population.

A systematic review of studies on the prevalence of insomnia in university students

OBJECTIVES

Many studies have shown that insomnia is a common problem among university students, but there are wide variations in the prevalence of insomnia. In this systematic review, we aimed to explore the prevalence of insomnia among university students using scientific and conclusive methods.

STUDY DESIGN

A systematic review is designed to analyze the studies reporting on prevalence of insomnia among university students.

METHODS

Systemic searches were conducted in PubMed, BioMed Central, EBSCO, ScienceDirect, Ovid LWW and Medline databases between January 2000 and July 2014, The Meta analyst software was used to calculate the prevalence rate of each study, the pooled means of prevalence rates and 95% CIs across studies were then calculated and presented.

RESULTS

Seven articles that met the inclusion and exclusion criteria were selected. The overall sample size in the current review was 16,478, with a minimum of 219 and a maximum of 10,322. The prevalence rates of the seven studies ranged between 9.4% (95%CI 8.8-10.0%) and 38.2% (95% CI 35.4-41.1%). Overall, the total students studied with a weighted mean prevalence of 18.5% (95% CI 11.2-28.8%), considerably higher than rates of 7.4% (95% CI 5.8-9.0%) reported in general population.

CONCLUSIONS

This review emphasized that insomnia prevalence in university students is considerably higher than that in general population, suggested that more attention should be paid to insomnia in university students.

Effect of age and gender in the prevalence of excessive daytime sleepiness among a sample of the Saudi population

The aim of this study is to assess whether the effect of gender on the excessive daytime sleepiness (EDS) is influenced by two confounders (age and hours of sleep per night). A cross-sectional study was conducted at King Abdulaziz Medical City-Riyadh (KAMC-R). A total of 2095 respondents answered a questionnaire that included questions regarding gender, age, hours of sleep per night, and daytime sleepiness using the Epworth Sleepiness Scale (ESS). The prevalence of EDS was 20.5% (females 22.2%, males 19.5%, p-value = 0.136). The EDS did not differ between genders, age groups, or hours of sleep per night (<6 vs. ⩾6 h). However, stratified statistical analysis shows that the prevalence of EDS did differ according to gender (25.3% in females, 19.0% in males, p-value = 0.036) in respondents with shorter hours of sleep per night. EDS was strongly related to female gender and young age (ages ⩽ 29 years) in respondents with short hours of sleep. This study reveals that one out of five of the general Saudi population has EDS. The effect of gender on EDS appeared to be influenced by hours of sleep per night. High EDS strongly related to female gender with short hours of sleep.

Validation of the Arabic version of the Epworth sleepiness scale

BACKGROUND

The Epworth Sleepiness Scale (ESS) is a questionnaire widely used in developed countries to measure daytime sleepiness and diagnose sleep disorders.

OBJECTIVE

This study aimed to develop an ESS questionnaire for the Arabic population (ArESS), to determine ArESS internal consistency, and to measure ArESS test-retest reproducibility. It also investigated whether the normal range of ESS scores of healthy people in different cultures are similar.

METHODS

The original ESS questionnaire was translated from English to Arabic and back-translated to English. In both the English and Arabic translations of the survey, ESS consists of eight different situations. The subject was asked to rate the chance of dozing in each situation on a scale of 0-3 with total scores ranging between 0 (normal sleep) and 24 (very sleepy). An Arabic translation of the ESS questionnaire was administered to 90 healthy subjects.

RESULTS

Item analysis revealed high internal consistency within ArESS questionnaire (Cronbach's alpha=0.86 in the initial test, and 0.89 in the retest). The test-retest intra-class correlation coefficient (ICC) shows that the test-retest reliability was substantially high: ICC=0.86 (95% confidence interval: 0.789-0.909, p-value<0.001). The difference in ArESS scores between the initial test and retest was not significantly different from zero (average difference=-0.19, t=-0.51, df=89, p-value=0.611). In this study, the averages of the ESS scores (6.3 ± 4.7, range 0-20 in the initial test and 6.5 ± 5.3, range 0-20 in the retest) are considered high in Western cultures.

CONCLUSIONS

The study shows that the ArESS is a valid and reliable tool that can be used in Arabic-speaking populations to measure daytime sleepiness. The current study has shown that the average ESS score of healthy Arabian subjects is significantly higher than in Western cultures.

Sleep complaints and daytime sleepiness among pharmaceutical students in Tripoli

Background

The effect of sleep difficulties has achieved a great deal of attention recently, with university students considered as a homogenized population, particularly affected by sleep habits.

Aim

The objective of this study was to investigate whether Libyan college students experience sleep disturbance during their academic programmes.

Methods

A cross-sectional survey was conducted in the college of Pharmacy, Tripoli University, during February 2010. A total of 201 students, including 179 females (89.05%) and 22 males (10.95%), were recruited from different academic levels. Data were collected using a structured questionnaire and included a number of life-style variables. Epworth Sleepiness Scale (ESS) was used for the assessment of daytime sleepiness.

Results

This study showed that the total sleep time (TST) on a weeknight was 6.40 h and 67 students reported napping during daytime. The TST plus naps totalled 7.39 h. Out of eight possible dozing situations, we found that the mean score for ESS was 8.78. In addition, 79 students showed an ESS score of >10. Furthermore, our results showed that the majority of students (>92%) reported poor sleep satisfaction with quality and duration of sleep hours. Thinking about difficulty of study but not increasing education programs or tea/coffee consumption is associated with sleep difficulties reported. Moreover, 77.6% of students reported an irregular sleep–wake schedule.

Conclusion

These findings indicate that students experienced excessive daytime sleepiness. The TST of pharmaceutical students in Libya, as in other developing countries, is less than those reported by Western students. Students experienced various environmental demands during their college years and, their quality of sleep was negatively affected.

Total sleep time in Muslim football players is reduced during Ramadan: a pilot study on the standardized assessment of subjective sleep-wake patterns in athletes

Ramadan is a period in which Muslims fast during daylight hours and is associated with disturbances in sleep-wake behaviour and adverse effects on physical and mental health in normal volunteers. Studies using athletes are rare and remain equivocal as to whether Ramadan influences sleep-wake patterns. Notably, the standardized assessment of subjective sleep quality and daytime sleepiness in athletes has not been established. This study employed the Arabic version of the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale in nine football players aged 20-35 years (mean ± s: 26 ± 4) one week before and during the last week of Ramadan. Compliance rates with self-administration were high (71%) and the results demonstrated a robust decline in total sleep time (before Ramadan: 6.6 ± 2 h; at the end of Ramadan: 5.3 ± 1 h; P < 0.05, effect size 0.81). Compared with previous research, the study questionnaires offer improved methodology, including less time constraints plus standardization in scoring. Thus, this study demonstrates a framework for greater reproducibility and reliability in the assessment of subjective sleep-wake patterns in athletes before and during Ramadan.

Qur'anic insights into sleep

Sleep has preoccupied and fascinated many civilizations since the dawn of mankind. Here, we critically review the various elements pertaining to sleep in the context of early Islamic religion and culture. The many principles of sleep hygiene, wellbeing and health associated with adequate sleep, and the understanding of sleep as a dynamic state are all apparent from such explorative process of Islamic tradition.

Sleep habits and sleep problems among Palestinian students

AIM

The aim of this study was to describe sleep habits and sleep problems in a population of undergraduates in Palestine. Association between self-reported sleep quality and self-reported academic achievement was also investigated.

METHODS

Sleep habits and problems were investigated using a convenience sample of students from An-Najah National University, Palestine. The study was carried out during spring semester, 2009. A self-administered questionnaire developed based on The Diagnostic and Statistical Manual of Mental Disorders IV criteria and Pittsburgh Sleep Quality Index was used.

RESULTS

400 students with a mean age of 20.2 ± 1.3 were studied. Reported mean duration of night sleep in the study sample was 6.4 ± 1.1 hours. The majority (58.3%) of students went to bed before midnight and 18% of the total sample woke up before 6 am. Sleep latency of more than one hour was present in 19.3% of the students. Two thirds (64.8%) of the students reported having at least one nocturnal awakening per night. Nightmares were the most common parasomnia reported by students. Daytime naps were common and reported in 74.5% of the study sample. Sleep quality was reported as "poor" in only 9.8% and was significantly associated with sleep latency, frequency of nocturnal awakenings, time of going to bed, nightmares but not with academic achievement.

CONCLUSION

Sleep habits among Palestinian undergraduates were comparable to those reported in European studies. Sleep problems were common and there was no significant association between sleep quality and academic achievement.

Translating the insomnia severity index into Arabic

PURPOSE

The purpose of this study was to translate the Insomnia Severity Index (ISI) into Arabic (Fusha dialect), and obtain preliminary reliability and validity estimates for the translated version.

BACKGROUND

Arabic populations experience sleep problems that interfere with their vitality and quality of life. The ISI was established to screen for insomnia in both clinical and research situations.

DESIGN

This study used a descriptive correlational design. The ISI was translated into Arabic using the back-translation method and compared with three other sleep measures: the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the Vitality Subscale from the Medical Outcomes Study Short Form-36. These measures were administered to 35 healthy Arabic bilingual participants from three community locations.

FINDINGS

The mean ISI score was 9.2 (SD = 5.8; range 0-20). Internal consistency reliability was 0.84. The correlations between the total ISI score and the single items ranged from 0.49 to 0.92 (p < .01). In terms of convergent validity, the total ISI score showed a strong positive correlation with the Pittsburgh Sleep Quality Index global score (r = 0.76, p < .001) and a moderate, negative correlation with vitality (r = -0.38, p =.026).

CONCLUSIONS

The translated ISI demonstrated adequate reliability and validity. The translated ISI needs further testing in a larger sample of both clinical and healthy Arabic populations in their own countries.

CLINICAL RELEVANCE

Preliminary psychometric estimates show that the translated ISI is reliable and valid in this community-dwelling Arabic sample. The translated ISI allows for Arabic researchers to screen for insomnia and plan for future intervention studies.

Translating the Pittsburgh Sleep Quality Index into Arabic

This descriptive correlational study describes the translation process and the psychometric testing of the Pittsburgh Sleep Quality Index (PSQI). The PSQI has been successfully translated into Arabic and back-translated into English by 10 Arabic bilingual translators. Then the PSQI is tested in a sample of 35 healthy Arabic bilinguals.The internal consistency reliability for the Global PSQI demonstrates borderline acceptability (Cronbach's alpha = .65). The reliability is further supported by moderate to high correlations between five PSQI components and the global PSQI score (r = .53 to .82, p < .01). Convergent validity is supported by the global PSQI correlating strongly with the Insomnia Severity Index (r = .76) and moderately with the related construct of the Medical Outcome Study Short Form-36 vitality subscale (r = -.33). Further testing of the PSQI is needed in a larger Arabic population, both clinical and healthy populations, living in their native countries.

Prevalence and associated risk factors of sleep-disordered breathing symptoms in young and middle-aged Pakistani employed adults

PURPOSE

The objective of this study was to evaluate the prevalence of self-reported sleep-disordered breathing (SDB symptoms and its associated risk factors in Pakistani employed adults.

METHODS

Full-time employees (n = 3470) of a medical university were evaluated. Self-administered questionnaire elicited information about demographic data, symptoms of SDB, smoking and alcohol use, presence of nasal congestion, family history of snoring, and included the Epworth Sleepiness Scale. Prevalence of self-reported snoring and of combined SDB symptoms (snoring plus at least one other SDB symptom) was evaluated. Regression analyses were used to assess risk factors associated with self-reported snoring and combined SDB symptoms.

RESULTS

Among the 2,497 (72%) responders, prevalence of self-reported snoring was 32%, and combined SDB symptoms 25%. A higher prevalence of snoring and combined SDB symptoms in male gender diminished with age. In univariate analysis, the odds of snoring was higher with age >or=35 yrs (odds ratio (OR) 2.6, confidence interval (CI) 2.2-3.2), body mass index >or=23 (OR 2.6, CI 2.2-3.1), and collar size above 40 cm (OR 2.7, CI 2.3-3.3). Self-reported nasal blockage (OR 1.9, CI 1.6-2.2) and family history of snoring (OR 2.9, 2.5-3.5) were other risk factors. In logistic regression analysis, significant risk factors for SDB symptoms were age, body mass index, collar size, nasal blockage, and family history of snoring. Male gender, smoking and alcohol were not significant risk factors for SDB symptoms.

CONCLUSION

The prevalence of SDB symptoms in Pakistani employed adults was comparable to Western populations. However, male gender and smoking were not significant risk factors for SDB symptoms.

Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients

We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 +/- 14) with disease from 0.4 to 23 years (6.7 +/- 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 +/- 2.0). RLS was detected in 12 cases (27%). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52%) and excessive daytime sleepiness in 3 cases (6.8%). Fatigue was present in 32 subjects (73%) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.

Prevalence of sleep problems and habits in a sample of Saudi primary school children

BACKGROUND

Sleep problems in children vary not only with age, but also with ethnic and sociocultural background. No research has been conducted to assess sleep problems in Saudi elementary school children. This study surveyed parents (or guardians) abouttheir elementary school children's sleep to assess the prevalence of certain sleep problems.

METHODS

The study population comprised boys and girls attending regular public elementary schools in all grades and was conducted during springtime of the year 1999. A questionnaire inquiring about demographic data, specific sleep problems and habits and home environment was distributed and completed bythe parents or guardians.

RESULTS

A total of 1012 complete questionnaires were included in the analysis. The sample comprised 511 boys (50.5%) and 501 girls (49.5%). The mean age was 9.5+/-1.9 years, ranging from 5 to 13 years. Daytime fatigue was the most prevalent sleep problem (37.5%) followed by bedtime resistance (26.2%), difficulty rising in the morning during weekdays (20.7%), and sleep-onset delay (11.8%). Cosleeping with parents was reported in 12.4% of children. The study revealed some differences between boys and girls. Napping during the daytime was reported in 40.8% of children.

CONCLUSION

The study showed that sleep problems are prevalent among Saudi elementary school children. Moreover, the study shed some light on sleep habits and practices in this age group in Saudi Arabia, like the high prevalence of daytime napping.