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1.  Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients 
Annals of Thoracic Medicine  2011;6(4):212-216.
Obstructive sleep apnea (OSA) is a common, under-recognized, under diagnosed, under treated, and serious medical condition in adults. Polysomnography (PSG) is the gold standard for diagnosis of OSA; however, prohibitive cost of the test and rarity of sleep laboratory in the Arabic nations limit its access. So, searching for another simple, economical, reliable, and valid tool for identification of OSA at risk patients is of special public concern.
This study was conducted to evaluate the reliability and validity of Arabic version of Berlin questionnaire (ABQ) in detection of OSA at risk patients.
After hospital ethics approval and formal patients consent, 100 patients were subjected to full night PSG study after their response to the developed ABQ. The patients were classified into both low (30) and high risk (70) for OSA using ABQ and validated against apnea hypopnea index (AHI). Reliability was assessed by internal consistency using Cronbach's alpha test and consistency over time using test retest correlation.
The study demonstrated a high degree of internal consistency and stability over time for the developed ABQ. The Cronbach's alpha coefficient for the 10-item tool was 0.92. Validation of ABQ against AHI at cutoff >5 revealed a sensitivity of 97%, specificity of 90%, positive and negative predictive values of 96% and 93%, respectively.
The ABQ is reliable and valid scale in screening patients for the risk of OSA among Arabic-speaking nations, especially in resource-limited settings.
PMCID: PMC3183638  PMID: 21977066
Apnea hypopnea index; Arabic version of Berlin questionnaire; Berlin questionnaire; obstructive sleep apnea; reliability and validity
2.  Sleep apnea in children with refractory monosymptomatic nocturnal enuresis 
Children with nocturnal enuresis (NE) are believed to have deep sleep with high arousal threshold. Studies suggest that obstructive sleep apnea–hypopnea syndrome (OSAHS) and NE are common problems during childhood. We sought to assess the prevalence of OSAHS in children with refractory NE and whether its severity is associated with the frequency of bedwetting.
The study group comprised 43 children with refractory monosymptomatic NE and a control group of 30 children, both aged 6–12 years. All subjects underwent thorough neurological examination, one night of polysomnography only for the patient group, and a lumbosacral plain X-ray to exclude spina bifida.
The groups were well matched. Two subjects of the control group had mild OSAHS. The mean age of the patients was (9.19±2.4 years), 26 were boys, and 67% showed frequent NE (>3 days bedwetting/week). Patients with NE had significantly higher rates of OSAHS (P<0.0001); three patients had mild, 12 had moderate, and eleven showed severe OSAHS. There was no significant statistical difference among patients having OSAHS in relation to age, sex, or family history of NE. The frequency of bedwetting was statistically significantly higher in patients with severe OSAHS (P=0.003).
Patients with refractory NE had a significantly higher prevalence of OSAHS with no sex difference. The frequency of bedwetting was higher in patients with severe OSAHS.
PMCID: PMC3958496  PMID: 24648781
nocturnal enuresis; refractory; OSA

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