Sleep related breathing disorders (SRBD) are among seven well-established major categories of sleep disorders defined in the third edition of The International Classification of Sleep Disorders (ICSD-3), and Obstructive Sleep Apnea (OSA) is the most common SRBD [1,2]. Several studies have demonstrated that obstructive sleep apnea treatment increases the quality of life in OSA patients [3-8]. Indeed, excessive daytime sleepiness (EDS), cognitive impairment (e.g., deficits in attention-concentration, memory, dexterity, and creativity), traffic accidents, and deterioration of social activities are frequently reported in untreated patients [9-11]. Furthermore, an increase in cardiovascular morbidities and mortality (systemic hypertension, stroke, cardiac arrhythmias, pulmonary arterial hypertension, heart failure) , metabolic dysfunction, cerebrovascular ischemic events and chemical/structural central nervous system cellular injuries (gray/white matter) has been reported in OSA patients [13-17].
Continuous positive airway pressure (CPAP) therapy is considered the gold standard for treatment of moderate-severe OSA, nevertheless there is an increasing body of evidence supporting the usefulness of mandibular advancement devices (MADs) for improving quality of life and respiratory parameters even among patients with a high severity of OSA burden [5,10,18,19]. According to the standard of care of the American Academy of Sleep Medicine (AASM), MADs are indicated for mild to moderate OSA particularly in the context of CPAP intolerance or refusal, surgical contraindication, or the need for a short-term substitute therapy [9,15,20-22]. In Cuba, CPAP machines are not readily available; they are expensive and the majority of OSA patients cannot obtain this mode of therapy. Taking into account this problem, our hypothesis was based in the scientific evidences of MAD effectiveness, considering that low cost MADs could offer a reasonable alternative treatment for patients with OSA where CPAP technology are not handy. In this way our purpose was to assess the efficacy of one of the most simple, low cost, manufactured monoblock MAD models (SAS de Zúrich) in terms of improvements in cerebral function, sleep quality and drowsiness reports in a group of Cuban OSA patients with mild to severe disease. Outcome measures included changes in the brain electrical activity, sleep quality, and respiratory parameters, measured by EEG recording with qEEG analysis and polysomnographic studies correspondingly, which were recorded before and during treatment with an MAD, as well as subjective/objective improvements in daytime alertness.
Background: Pathological and nighttime sleep deprivations have substantial adverse effects on regulation of weight, sugar and blood pressure because of endothelial dysfunction, sympathetic nervous system stimulation, regulation and activation of systemic inflammation. Thus, this study was aimed to assess quality of sleep among patients with chronic illness and its associated factors at South Wollo Zone Public Hospitals, Northeast Ethiopia.
Methods and Materials: The study was conducted at South Wollo Zone Public Hospitals, Northeast Ethiopia from February 15 2019 till April 15 2019. Institutional based cross sectional study design was employed. All patients with chronic illness who are on follow up in South Wollo Zone Public Hospitals were sources of population. Sample size was calculated by using EPI info version 7 and the total sample size was 344. The study employed stratified random sampling technique and study participants were selected by systematic sampling. After taking ethical approval from College of Medicine and Health Sciences Ethical Approval Committee, permission from selected Hospitals and informed verbal consent from patients, the data were collected by a tool which has 3 parts: Sociodemographic data, Pittsburgh Sleep Quality Index and factors affecting sleep quality. Data were entered in to Epi data version 4.1 and exported to Statistical Package for Service Product 25 for analysis. Different data presentation tools and binary logistic regression were enrolled by considering 95% confidence level and p value of 0.05.
Result: Among the total study participants, near to one third (31.7%) of them got sleep after 30 minutes. More than one fourth of them slept for less than 7 hours. Less than half of the study participants had habitual sleep efficiency of more than 85% however 296(86%) of them did not face day time dysfunction
Conclusion and recommendations: more than one third of patients with chronic illness had poor sleep quality. One third of study participants had sleep duration of less than the recommendations(less than 7 hours). Age, educational status, residence, and perception of prognosis of disease were factors that have associations with poor sleep quality among patients with chronic illness. Health care providers who are doing in chronic illness follow up clinic should be initiated to assess and screen those patients with poor sleep quality.
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