Obstructive sleep apnea syndrome (OSAS) consists of episodes in which respiration ceases during sleep from the repeated collapse of the upper airway. The most common cause of this is the partial or complete stoppage of the flow of air due to the relaxation of the muscles which surround the throat and tongue. Although a detailed discussion of the pathophysiology of airflow obstruction in OSAS is outside the scope of this article, it is clear that upper airway collapse most often results from a combination of anatomic factors that predispose the airway to collapse during inspiration, plus neuromuscular compensation that is insufficient during sleep to maintain airway patency. The relative contribution of anatomic versus neuromuscular factors is likely to vary greatly among individuals and may vary considerably among groups defined on the basis of age, gender, body habits, race, ethnicity, and overweightness. The prevalence of OSAS is increasing among overweight and obese patients and it is well known that weight gain and obesity are important determinants in the progression of OSAS.1
Obesity is a growing health concern in the United Arab Emirates (UAE) with health officials stating that it is one of the leading causes of preventable deaths in the UAE and the UAE ranks 18th on a 2007 Forbes list of fattest countries with 68.3% of its citizens with an unhealthy weight.2
Obesity is 2.3-fold higher among UAE males and females at 14 years compared to international standards, and increases to 3.6 times at 18 years of age in males and to 1.9 times in females.3
This obesity in the UAE may be related to cultural influences. The traditional dress in the Middle East is a contributing factor of obesity due to the wearing of loose, flowing garments such as the dish-dash or abayas. Excess weight gained goes relatively unnoticed as people are not wearing close fitting garments, and due to extremely high temperatures up to 50°C for a large part of the year in the last 3 years, outdoor activities may be limited and therefore inactivity and boredom can lead to excessive calorie consumption resulting in weight gain.
Obstructive sleep apnea syndrome is a common medical condition with significant adverse medical and public health consequences. Primary care has a central role for recognizing cases of OSAS in the community.4
Patients attending primary care clinics tend to have a higher risk for OSAS because these patients often have chronic illnesses that are associated with OSAS. Population-based epidemiologic studies have uncovered the high prevalence and wide spectrum of severity of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity and mortality causing an additional burden on the public health service, and it is a potentially disabling condition. The community prevalence of symptoms and/or signs of OSAS varies by region and by country.5
In the United States, an estimated 9% and 24% of women and men, respectively, aged 30 to 60 years have at least mild OSAS.6
In other Western countries, the overall prevalence of mild and moderate OSAS is estimated at 20% and 7%, respectively.5
In New Delhi, a community-based study reported a prevalence of 14% for OSAS in middle-aged men.7
In the Middle East, one study was done in Jordan and it showed that the high risk of obstructive sleep apnea was present in 106/554 (19.1%) of men and in 96/651(14.7%) of women (P
No data on the prevalence of OSAS or the relationship between obesity and OSAS in the UAE or Dubai have been reported.
The practice of sleep medicine in Dubai began in the last 3 years and it is a relatively new specialty in the medical community. Since its inception, the specialty has grown, and now it is important to assess the prevalence of this disease in this community so this study performed a standardized survey of primary care outpatients from a diverse socioeconomic range to measure the prevalence of symptoms of obstructive sleep apnea among Dubai residents (UAE citizens and expatriates) of both genders. The data will demonstrate to the local authorities that public health initiatives with clinical support are warranted to reduce the burden of OSAS; and proper evaluation for OSAS by the health care workers is urgently needed; and expansion of sleep service in this community is needed for appropriate counseling for the high risk cases of OSAS.