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Sleep Med Res > Volume 15(2); 2024 > Article
Bashir and Khalid: Sleep Medicine Clinics: A Solution for Obstructive Sleep Apnea and Sleep Disorders in Pakistan
Sleep medicine is a type of medicine that helps people with sleep problems. It is a field that works with experts from different areas, such as lung, brain, and mental health. Sleep medicine has improved a lot in the last few decades, with new ways like using a machine to help people breathe when they sleep. Sleep medicine faces some challenges in getting recognized and educated, especially in developing countries like Saudi Arabia. But sleep health is very important and sleep problems can affect public health a lot. Sleep problems are very common and different, with more than 90 kinds. The field of sleep medicine keeps growing, with more research and better ways to find and treat sleep problems [1-4]. Sleep medicine is important for public health. It is a leading part of medical knowledge and is part of the health programs of many countries, including big and developed countries like the United States, Europe, and China. Promoting sleep health is a good public health chance that can help with various important health outcomes, such as heart disease, weight, mood, and brain [4,5]. The field of sleep medicine has grown a lot as a specialty in recent years. This growth is because of various reasons such as the rise in sleep problems, the awareness of the value of sleep for health, and the improvement in finding and treating sleep problems. Sleep medicine has become its own specialty, and there is a high need for sleep medicine doctors and services [6-8].
Sleep problems that affect breathing, such as obstructive sleep apnea (OSA), are also common, especially in men, older people, and fat people [9]. The number of people with OSA is increasing over time, and some things like neck size, where you come from, head shape, and genes can make people more likely to have this problem [10]. Other sleep problems include snoring, restless legs, and sleep paralysis [11]. The number of people with sleep problems varies among different groups of people, and some studies have reported different rates of breathing problems and short sleep [12].
OSA is a common sleep problem in Pakistan, and many studies show that it affects a significant portion of the population. One study conducted in a village in Punjab found that more than 40% of the people were at high risk of OSA [13]. Another study in the same area found that older women were more likely to have OSA than younger women [14]. A study in Chitral found that about 13% of the people there had a high risk of OSA and that OSA was related to other health problems like being overweight, having heart disease, high cholesterol, and high blood pressure [15]. Additionally, a study in Karachi found that people with larger neck circumferences had more severe OSA, especially men [16]. The number of people with OSA varies between countries, and some estimates range from 4% to 22.8% in different regions [12]. Sleep problems can cause many health issues. They can damage your heart, blood pressure, and chance of survival [17]. They can also cause a condition called obstructive sleep apnea syndrome (OSAS), which makes you stop breathing while sleeping. This can lead to many other problems, such as stroke, diabetes, liver disease, kidney disease, mental problems, and road traffic accidents [18]. Your eyes can also suffer from sleep problems, especially from OSAS. You may have eye problems like floppy eyelid syndrome, optic nerve damage, swelling in the retina, changes in the blood vessels of the eye, and maybe glaucoma [19]. Not sleeping enough or having poor quality sleep can also make you feel sleepy, moody, tired, angry, anxious, depressed, forgetful, and less focused. You may also get sick more often, gain weight, and have higher blood sugar and blood pressure [20]. Moreover, sleep problems can harm your metabolism, which is how your body uses energy. You may become obese, resistant to insulin, and have type 2 diabetes. This can raise your risk of heart disease and death [21]. OSA treatment in Pakistan is not good and more people need to know about it and learn how to treat it. Studies have shown that OSA is not taken seriously in most parts of the country, and there is not much information on the problem [22]. A survey done among medical and dental professionals in Karachi showed that only a few of them knew enough about OSA and how it affects daily life [23]. Another study done in a rural area of Punjab found a lot of people with OSA, especially men, older people, and those with less education [24].
In the past decades, countries like India and Bangladesh have taken steps to create awareness and treat sleep problems by creating sleep medicine centers and labs, even though OSA is the cause behind stroke and heart diseases that often happen in people with high blood pressure, diabetes, high cholesterol, and smoking, which are common risk factors. Surprisingly, even though these conditions are likely to happen together, doctors often miss screening for OSA in these patients. This leads to the possible underdiagnosis of OSA, as doctors usually focus on high blood pressure, diabetes, high cholesterol, and heart problems, and forget to check for OSA symptoms.
This problem is worse because Pakistan does not have a good sleep service or specialty, and there is no formal training program for sleep problems. Creating such programs would not only increase the number of trained professionals but also increase research activity in the field, and make young doctors more aware. Also, there is a lack of trained people who can provide cognitive behavioral therapies for people who have trouble sleeping. It is important to address the importance of sleep at the school level, promote healthy sleep habits, screen for sleep-related symptoms in medical schools and colleges, do awareness programs for the public and doctors, and start formal training programs to improve sleep health and research in Pakistan. Also, a collaborative approach involving public-private health industry partnerships and working together with different experts is important. Cooperation is needed to increase awareness, create comprehensive training programs, and provide high-quality care to patients who struggle with sleep problems. By working together, Pakistan can improve its efforts to improve sleep health and deal with the challenges of sleep problems.

NOTES

Author Contributions
Conceptualization: Muhammad Arsalan Bashir, Aashar Khalid. Supervision: Muhammad Arsalan Bashir. Validation: Muhammad Arsalan Bashir. Writing—original draft: Muhammad Arsalan Bashir, Aashar Khalid. Writing—review & editing: Muhammad Arsalan Bashir, Aashar Khalid.
Conflicts of Interest
The authors have no potential conflicts of interest to disclose.
Funding Statement
None

ACKNOWLEDGEMENTS

None

REFERENCES

1. Shneerson JM. Sleep medicine: a guide to sleep and its disorders. 2nd ed. Hoboken: Blackwell Publishing 2005.

2. Bahammam AS. Sleep medicine: present and future. Ann Thorac Med 2012;7:113-4.
crossref pmid pmc
3. Parrino L, Halasz P, Szucs A, Thomas RJ, Azzi N, Rausa F, et al. Sleep medicine: practice, challenges and new frontiers. Front Neurol 2022;13:966659.
crossref
4. Sadeghniiat-Haghighi KH, Akbarpour S, Forouzan N, Amirifard H, Najafi A. Importance of sleep health in the non-communicable diseases and its outcomes on the health care system. Occup Med Q J 2023;15:1-6.
crossref
5. Hale L, Troxel W, Buysse DJ. Sleep health: an opportunity for public health to address health equity. Annu Rev Public Health 2020;41:81-99.
crossref pmid pmc
6. Dang T, Taype-Roberts C. Current practice of sleep medicine in the USA. In Attarian HP, Coussa-Koniski MLM, Sabri AM (eds.), The practice of sleep medicine around the world: challenges, knowledge gaps and unique needs. Singapore: Bentham Science Publishers; 2023. 1-17.

7. McNicholas WT. Sleep medicine in Europe: 50 years of evolution. Breathe (Sheff) 2022;18:220206.
crossref
8. Beauchamp W, Bibbs MB, Ventimiglia D. Sleep technologist requirements. In: Kushida CA. Encyclopedia of sleep and circadian rhythms 2nd ed. Amsterdam: Elsevier; 2023;568-71.

9. Most JF. Epidemiology of sleep related breathing disorders. In: Kushida CA. Encyclopedia of sleep and circadian rhythms 2nd ed. Amsterdam: Elsevier; 2023;12-8.

10. Babicki M, Piotrowski P, Mastalerz-Migas A. Insomnia, daytime sleepiness, and quality of life among 20,139 college students in 60 countries around the world—A 2016–2021 study. J Clin Med 2023;12:692.
crossref
11. Matsumoto T, Chin K. Prevalence of sleep disturbances: sleep disordered breathing, short sleep duration, and non-restorative sleep. Respir Investig 2019;57:227-37.
crossref
12. McNamara P. Sleep disorders. In: McNamara P. The neuroscience of sleep and dreams 2nd ed. Cambridge: Cambridge University Press; 2023;85-102.

13. Khan TM, Jamil M, Dhillon AI, Umer MJ, Ahmed MMH, Arsh L, et al. Prevalence of obstructive sleep apnea and factors affecting it among old age population of rural area of Pakistan. Eur J Med Health Sci 2021;3:95-8.
crossref
14. Khan TM, Mumtaz M, Naseer M, Saher S, Shabbir F, Kaleem M, et al. Prevalence of obstructive sleep apnea and impact of menopause on it among women of rural area of Pakistan. Eur J Med Health Sci 2021;3:99-102.
crossref
15. Moin M, Asad F, Saif-Ur-Rehman U. Continuous positive airway pressure therapy improves the quality of life among obstructive sleep apnea individuals in Pakistani population. Pak J Med Health Sci 2022;16:105.
crossref
16. Subhani F, Ali U, Advani R, Hussain M, Qidwai W. Prevalence of symptoms and risk of sleep apnea in the northern population of Pakistan. Middle East J Fam Med 2020;18:25-32.
crossref
17. Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Cardiovascular complications of sleep disorders: a better night’s sleep for a healthier heart/from bench to bedside. Curr Vasc Pharmacol 2021;19:210-32.
crossref pmid
18. Sircu V, Colesnic SI, Covantsev S, Corlateanu O, Sukhotko A, Popovici C, et al. The burden of comorbidities in obstructive sleep apnea and the pathophysiologic mechanisms and effects of CPAP. Clocks Sleep 2023;5:333-49.
crossref pmid pmc
19. Lee SSY, Nilagiri VK, Mackey DA. Sleep and eye disease: a review. Clin Exp Ophthalmol 2022;50:334-44.
crossref pmid pmc
20. Jha VM, Jha SK. Sleep: disorders and clinical implications. In: Jha VM, Jha SK. Sleep: evolution and functions Singapore: Springer; 2020;101-18.

21. Романенко І, Третяк OE. Metabolic consequences of sleep disorders. Review. Clin Endocrinol Endocrin Surg 2022;2:39-46.

22. Outlook Web Desk. India’s first sleep lab [Internet]. New Delhi: Outlook Publishing India; 2022 [accessed 2022 February 6]. Available from: https://www.outlookindia.com/society/indias-first-sleep-labnews-201449.

23. Sultan N, Ajmal M, Saqib IU, Mobeen A, Iqbal M, Mateen F, et al. Obstructive sleep apnoea in Pakistan: a single tertiary care center experience. Cureus 2019;11:e6459.
crossref pmid pmc
24. Sohail R, Hayat S, Tariq J, Ashraf D, Karim M, Rizvi BE, et al. Awareness of obstructive sleep apnea and its effects on daily life among health professionals from Karachi, Pakistan. Work 2020;67:619-23.
crossref pmid