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Obstructive sleep apnoea (OSA) is associated with repetitive breathing obstructions during sleep. These episodes of hypoxia and associated arousals from sleep induce physiological stress and nocturnal over-activation of the sympathetic nervous system (SNS). One consequence of OSA is impairment in a range of cognitive domains. Previous research into cognitive impairment in OSA have focussed on intermittent hypoxia and disrupted sleep, but not nocturnal over-activation of the SNS. Therefore, we investigated whether nocturnal over-activity of the SNS was associated with cognitive impairments in OSA. The extent of nocturnal SNS activation was estimated from heart rate variability (HRV), pulse wave amplitude (PWA) and stress response biomarkers (cortisol and glucose levels). OSA severity was significantly associated with PWA indices and the HRV low frequency/ high frequency ratio ( p  < 0.05). Morning blood glucose levels were significantly associated with the duration of a blood oxygen saturation (SaO 2 ) < 90% (p < 0.01). PWA and HRV were significantly associated with the time taken to perform a task involving visuospatial functioning (p < 0.05), but not with impairments in sustained attention, reaction time or autobiographical memory. These results suggest that the visuospatial dysfunction observed in people with OSA is associated with increased nocturnal activity of the SNS.

PurposeTo evaluate the association of recently diagnosed obstructive sleep apnea (OSA) with TNF-α and IL-6 and to measure the effect of short-term continuous positive airway pressure (CPAP) therapy on these markers.MethodsA prospective, open-label, controlled trial was conducted among patients referred for diagnostic polysomnography (PSG). After PSG, patients were divided into 3 groups: OSA intervention group (N = 21), OSA control untreated group (N = 19), and non-OSA control group (N = 24). IL-6 and TNF-α levels were measured at baseline and 1 month after intervention. Repeated measures (RM) ANOVA and ANCOVA were used to compare the three groups regarding changes in TNF-α and IL-6 levels by analyzing between-subject and within-subject effects as a function of time and adjusting for significant covariates.ResultsAt baseline, IL-6 (p = 0.05) and TNF-α (p = 0.04) were significantly higher in the OSA patients than in the non-OSA controls. There was no effect of time either on the TNF-α (p = 0.069) or IL-6 (p = 0.717) after 1 month of CPAP. No interaction effect between group and time was found for either TNF-α (p = 0.240) or IL-6 (p = 0.552) after 1 month of CPAP. There was neither a group effect nor an interaction effect between group and time for either IL-6 or TNF α after adjusting for age, BMI, neck circumference, and AHI.ConclusionThis study showed increases in proinflammatory state as illustrated by plasma TNF-α and IL-6 levels among recently diagnosed OSA patients, but there were no changes in these inflammatory markers following 1-month CPAP therapy.

PurposeRestless legs syndrome is a movement sleep disorder that may be linked to dopaminergic dysfunction and in which vitamin D may play a role. This 12-week randomized, placebo-controlled trial elucidated the efficacy of vitamin D supplements in decreasing restless legs syndrome symptom severity.MethodsThirty-five subjects with restless legs syndrome, diagnosed using the International Restless Legs Syndrome Study Group criteria, were enrolled. The subjects were randomized to orally receive either vitamin D (50,000 IU caplets) or a placebo. All medications were administered weekly using a direct observation technique. Clinical assessments, including those for restless legs syndrome severity, were conducted at baseline and the end of the study using the International Restless Legs Syndrome Study Group rating scale. The serum vitamin D levels and bone profiles were measured at baseline and every 4 weeks. The primary endpoint was the change in the restless legs syndrome severity score from baseline to week 12. There were 17 and 18 patients in the vitamin D and placebo groups, respectively.ResultsThe groups did not differ with respect to age, sex, restless legs syndrome severity, or vitamin D levels. Participants in the vitamin D group showed no significant change in the mean restless legs syndrome severity score compared with the placebo group.ConclusionsThe results suggest that vitamin D supplementation does not improve restless legs syndrome symptoms.Clinical trial registration numberClinicalTrials.gov: NCT02256215 (available from: https://clinicaltrials.gov/ct2/show/NCT02256215).

OBJECTIVE: Currently accepted guidelines categorize obstructive sleep apnea (OSA) severity according to the Apnea-Hypopnea Index (AHI). However, it is unclear how to best define OSA severity. The present study sought to evaluate the concurrent validity of the widely accepted AHI by correlating it with various oxygen saturation (SpO2) and polysomnographic parameters. METHODS: The study utilized the data of a previous survey concerning the prevalence of OSA among a middle-aged Saudi population (n = 2682). Among the 346 individuals who underwent polysomnography, 178 had total sleep times of at least 240 min with rapid eye movement (REM) sleep and were included in the study. The standard classification of OSA severity was compared with different SpO2and polysomnographic parameters. RESULTS: The study found that there were correlations between the standard OSA severity based on AHI severity classification and different SpO2and polysomnographic parameters, including the desaturation index (DI), the sum of all desaturations, desaturation below 90%, the average duration of respiratory events, and indices of total arousals and respiratory arousals. All of these parameters correlated directly with OSA severity classification (P < 0.001 for each). However, REM sleep duration and SpO2nadir were inversely correlated with OSA severity (P < 0.003 and < 0.001, respectively). In addition, only the DI, SpO2nadir, and respiratory arousal index were predictors of OSA severity, as determined through a multiple logistic regression analysis. CONCLUSION: Our findings support the clinical reliability of the currently used standard classification of OSA severity based on the AHI.

To evaluate the presence of obstructive sleep apnea (OSA), using home sleep testing in pilots and first officers in Saudi-based airlines. This will allow for proper diagnosis and management of OSA in that group which can help in minimizing any possible aviation accidents related to sleep disturbances secondary to OSA. This is a cross-sectional study conducted through Saudi-based aviation among pilots and first officers who were in service, active, and flying short- to medium-haul flights. Forty-one participants met the inclusion criteria. However, 39 out of 41 completed the study questionnaires (Berlin questionnaire, Epworth sleepiness scale, Pittsburgh sleep quality index (PSQI), Fatigue severity scale (FSS), Visual analog fatigue scale (VAFS), and Patient health questionnaire (PHQ9), along with home sleep testing. Sixty-nine percent of the study population had OSA by home sleep testing. Majority of which had mild OSA (64%) and 5% had moderate and severe OSA (2.5% each). Results of different questionnaires showed one-third of the participants had insomnia, 33.3% of the participants had severe fatigue, excessive daytime sleepiness was found in 23.1% of the participants, and 10.3% had moderate depression, while 25.6% were classified as having mild depression symptoms. Sleep apnea is prevalent among the studied Saudi-based airline pilots and first officers. Screening for workers of this high-risk occupation needs to be considered. Fatigue, depression, and insomnia can be secondary consequences of sleep apnea and should be assessed and treated early.

To determine the prevalence of common sleep problems among patients with rheumatoid arthritis (RA) and their relationship with the disease activity and quality of life. The study sample consisted of 101 patients who attended a rheumatology clinic at a university hospital between October 2015 and May 2016. All subjects were clinically examined and interviewed by physicians using a questionnaire. The collected information included sociodemographic characteristics, the patients' medical histories, the Disease Activity Score (DAS28), the Berlin questionnaire to assess the risk of obstructive sleep apnea (OSA), the Epworth Sleepiness Scale to assess excessive daytime sleepiness (EDS), the Athens Insomnia Scale to assess insomnia, the International RLS Study Group score to diagnose restless legs syndrome (RLS), and the Health Assessment Questionnaire (HAQ) to assess the quality of life. The mean age of the participants was 48.7±14.6 years, and 95% of the participants were females. Approximately 60% of the participants were in the remission/low category of disease activity, and the average DAS28 score was 3.3±0.8 years. The prevalence rates of insomnia, EDS, sleep disturbance, risk of OSA, and RLS were 63%, 20%, 20%, 37%, and 63%, respectively. Furthermore, the distribution of sleep disorders was not affected by the disease activity. The association between the HAQ and sleep disorders among the RA patients was not significant. Sleep disorders are common among RA patients and may require further attention by treating clinicians; nevertheless, these disorders are not associated with disease activity and do not affect the quality of life.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition with significant economic burden, morbidity, and mortality rates worldwide. In the Kingdom of Saudi Arabia (KSA), 4.2% of adults 40 years and older have COPD, with a higher prevalence in men and older populations. Key risk factors include smoking, air pollution, occupational exposures, and genetics. COPD coexists with cardiovascular disease (CVD) often, making diagnosis and management more difficult. This study proposes two referral algorithms to optimize care for COPD patients with coexisting CVD in the KSA. Methods: A nine-member cardiopulmonary task force reviewed pertinent literature, guidelines, and held virtual meetings from April to August 2025. Every algorithmic component was iteratively refined; consensus was reached when at least 80% of participants agreed, and items not reaching this threshold were revised until full agreement was reached. Results: According to the cardiology-to-pulmonology algorithm, patients who have unidentified respiratory symptoms or COPD risk factors undergo spirometry assessment and, if confirmed, are referred to pulmonology for diagnostic confirmation, phenotyping, and treatment, including triple fixed-dose combination therapy (TFDC) when necessary. On the other hand, the pulmonology-to-cardiology algorithm directs the evaluation of CVD risk factors and comorbidities using clinical evaluation, electrocardiogram, echocardiography, and biomarker testing, for cardiology referral. Conclusions: By establishing bidirectional referral pathways, morbidity and healthcare burden can be decreased, early detection can be improved, and multidisciplinary management can be strengthened. Future research should assess the feasibility, cost-effectiveness, and real-world impact within KSA’s healthcare system.

BACKGROUND: Previous studies have reported increased levels of inflammatory mediators in patients with obstructive sleep apnea (OSA), but their relation with the severity of OSA is controversial. OBJECTIVE: To address potential relationships between OSA-related inflammatory markers, namely, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and fibrinogen, with different oxygenation parameters and with BMI. METHODS: All eligible patients with suspected OSA newly referred to the Sleep Medicine Research Center at King Abdulaziz University Hospital, Jeddah, were evaluated demographically and anthropometrically, and underwent overnight polysomnography. Fasting morning blood samples were collected to measure serum levels of CRP, fibrinogen, TNF-α, and IL-6. Potential correlations between these inflammatory mediators and severity measures of OSA and body mass index (BMI) were explored. RESULTS: Sixty-four patients completed the study (40 with OSA and 24 without OSA). Significantly increased levels of CRP, fibrinogen, IL-6, and TNF-α emerged in patients with OSA compared to non-OSA. Significant associations between log CRP and log fibrinogen levels emerged with increasing BMI. However, there was no significant association between any of the inflammatory markers and the severity of OSA based on the apnea/hypopnea index or oxyhemoglobin saturation-derived parameters. CONCLUSIONS: OSA patients exhibit increased levels of inflammatory mediators that do not appear to be associated with polysomnographic measures, but exhibit positive correlation with the degree of adiposity.

Introduction Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse resulting in episodes of apnea and hypopnea. Studies have shown worsened coronavirus disease 2019 (COVID-19) severity due to coexisting respiratory conditions and suggest increased severity of COVID-19 in patients with or at high risk of OSA. However, the extent of this correlation is unclear. This retrospective study aimed to evaluate the association between OSA severity and COVID-19 severity and assess the impact of continuous positive airway pressure (CPAP) compliance. Methods This single-center retrospective study was conducted at King Abdulaziz University Hospital (KAUH), a tertiary care center in Jeddah, Saudi Arabia. Data were collected from 62 adult patients with OSA who were diagnosed via polysomnography (PSG) and had a positive documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test result. COVID-19 severity was categorized into mild, moderate, and severe. Results There was no significant correlation between OSA severity as measured by the apnea-hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), arousal index (AI), respiratory disturbance index (RDI), or the type of treatment used, including adherence to CPAP, and the outcomes of COVID-19. However, higher arousal with respiratory index (ARI) and a lower percentage of time with SpO2 < 90% (T90) values were linked to moderate COVID-19 severity with significant p-values of 0.046 and 0.007, respectively. Conclusion There was no significant correlation between the severity or types of OSA treatment and the severity of COVID-19. Further research including multicenter studies with bigger populations and extensive sleep study data is warranted. Understanding the OSA-COVID-19 link may improve risk stratification and patient management.

Background: Sleep quality ensures better physical and psychological well-being. It is regulated through endogenous hemostatic, neurogenic, and circadian processes. Nonetheless, environmental and behavioral factors also play a role in sleep hygiene. Electronic device use is increasing rapidly and has been linked to many adverse effects, raising public health concerns. Objective: This study aimed to investigate the impact of electronic device addiction on sleep quality and academic performance among health care students in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted from June to December 2019 at 3 universities in Jeddah. Of the 1000 students contacted, 608 students from 5 health sciences disciplines completed the questionnaires. The following outcome measures were used: Smartphone Addiction Scale for Adolescents–short version (SAS-SV), Pittsburgh Sleep Quality Index (PSQI), and grade point average (GPA). Results: The median age of participants was 21 years, with 71.9% (437/608) being female. Almost all of the cohort used smartphones, and 75.0% (456/608) of them always use them at bedtime. Half of the students (53%) have poor sleep quality, while 32% are addicted to smartphone use. Using multivariable logistic regression, addiction to smartphones (SAS-SV score >31 males and >33 females) was significantly associated with poor sleep quality (PSQI >5) with an odds ratio of 1.8 (1.2-2.7). In addition, male gender and older students (age ≥21 years) were significantly associated with lower GPA (<4.5), with an odds ratio of 1.6 (1.1-2.3) and 2.3 (1.5-3.6), respectively; however, addiction to smartphones and poor sleep quality were not significantly associated with a lower GPA. Conclusions: Electronic device addiction is associated with increased risk for poor sleep quality; however, electronic device addiction and poor sleep quality are not associated with increased risk for a lower GPA.