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Sleep Medicine in Syria Facts, Problems and Solutions

Naem Shahrour, MD, FCCP Head, Pulmonary Dept., Alassad University Hospital Damascus University Medical School Director, jisr Sleep Center. Sleep Medicine in Syria Facts, Problems and Solutions. Thank You Antalya, Turkey. Syria. Welcome to Syria. BOSRA HAS THE MOST FANTASTIC THEATRE.

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Sleep Medicine in Syria Facts, Problems and Solutions

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  1. Naem Shahrour, MD, FCCP Head, Pulmonary Dept., Alassad University Hospital Damascus University Medical School Director, jisr Sleep Center Sleep Medicine in SyriaFacts, Problems and Solutions

  2. Thank YouAntalya, Turkey

  3. Syria

  4. Welcome to Syria

  5. BOSRA HAS THE MOST FANTASTIC THEATRE

  6. OMAYAD MOSQUE:&St. John’s Tomb

  7. AZEM’S PALACE;an example of traditional Syrian Houses

  8. RIVERS AND OUNTAINS

  9. Basic Facts: Sleep Medicine in Syria • Sleep Medicine existed in Syria in 2000 • Teaching 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 2004 • First scientific study on sleep patients presented in 2004 at Syrian American Medical society conference.

  10. 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

  11. Problems • Problem: 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

  12. 1st study2008Naem Shahrour, MDEmad Sibai, MD

  13. Prevalence of OSA • Ongoing study • 250 Bus drivers • Questionnaires on sleepiness and other symptoms of sleep apnea • Epworth scale was used to estimate sleepiness

  14. 8% of drivers slept at least once during driving • Only 5% slept and had Epworth score above 10

  15. Problems: • Difficulty of making nation-wide screening: • Due to fear of employees at risk • Lack financial support • We do not have regulation to report • No State or insurance support to diagnose or treat these patients

  16. Initial Syrian Experience in Sleep Disorders 2nd study Naem Shahrour, MD, FCCP Head, Pulmonary Dept., Alassad University Hospital Damascus University Medical School Director, jisr Sleep Center

  17. Methods • The study started from 2/2002-5/2004 • Ninety-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 years • Patients were either self-referred, center-referred or referred from other physicians.

  18. Methods • Patients 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.

  19. Results

  20. Age distribution: No problem

  21. Demographic Data: Indicate Cultural Implications

  22. History of Smoking: same for general public

  23. Type of profession: could present an obstacle professio

  24. Problem: Presenting and Main Symptoms could be misleading

  25. Problem of Centralized Information

  26. Problem: Referral TypeIs it unawareness or ethical

  27. Problem: Late presentationInitial Oxygen Desaturation

  28. With Complications and Associated Diseases

  29. Medications

  30. Overall Diagnosis

  31. Non-OSA:Problem with knwoledge

  32. Problems with CPAP during test: RDI Mean apnea duration: 38 seconds Percentage of patients Mean CPAP of 6.8 cm H2O

  33. Follow-up Naem Shahrour, MD 86 patients 2007-2008 3RD STUDY

  34. Follow-Up up to 1 year F/U: (41%) Weight Stable (85%) Still loosing (8.5%) Gain WT (6.5%) Sleepiness same (55%) Better (45%)

  35. CPAP Bought by 85% Not tolerated by 15% Used by 83% Benefit by 92%

  36. Problems • With poor Follow-up due to: • sending back pts to referring MD’s, • Poverty • incompliance • with ineffective weight loss programs • And Ineffective Home Care FU for CPAP use. • Worst pts had highe RDI

  37. Conclusion and Solutions • Sleep 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.

  38. 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

  39. Thank you FEMTOSAntalya, Turkey

  40. D

  41. Most pts are smokers or ex-smokers

  42. Higher RDI associated with typical presenting SX

  43. Treatment

  44. The higher RDI requires more CPAP

  45. Higher RDI requires higher CPAP

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