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Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 141-145

Disturbed sleep and excessive daytime sleepiness in a Saudi population-based sample

1 Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
2 Department of Respiratory Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Date of Web Publication9-Dec-2019

Correspondence Address:
Dr. Mohammed D AlAhmari
Department of Respiratory Care, Prince Sultan Military College of Health Sciences, P. O. Box 33048, Dammam 31448
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjhs.sjhs_162_19

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Background: National data on the prevalence of daytime sleepiness and other sleep-related issues are limited for the general Saudi population.Objectives: The aim of this study was to screen a sample of the Saudi population for the prevalence of symptoms of disturbed sleep and excessive daytime sleepiness (EDS), in addition to the sleep duration of the sample.Patients and Methods: A cross-sectional, descriptive population-based sample of n = 1419 participants was randomly recruited from two major public places in the Eastern Province of the Kingdom of Saudi Arabia. The sociodemographic information was collected, and the Epworth Sleepiness Scale (ESS) was used to measure EDS. These and other sleep-related data were assessed after verbal agreements were received from the participants.Results: The total number of participants was n = 1419, with a mean age of 34.1 ± 9.8 years. The response rate was 76.2%, and 917 (65%) were males. The EDS based on the ESS was 53.8% for the sample, with an increasing trend in the higher age groups (11.4 ± 5.8), particularly in the 30–39 years' old age category. Snoring was highly prevalent in the males at 44% versus the females at 21%, and 55% of the participants were smokers. The mean sleep duration was 6.72 ± 1.97 h.Conclusion: EDS was prevalent in particular higher age groups in the general studied population. Snoring was among the highest prevalent sleep-related symptoms with reported shorter sleep duration in the general population. Public awareness of sleep hygiene or psychoeducation and large epidemiological studies are needed to rule out cultural factors and improve the general well-being of the population of the Kingdom of Saudi Arabia.

Keywords: Daytime sleepiness, Epworth Sleepiness Scale, prevalence, Saudi Arabia, sleep duration, sleep symptoms

How to cite this article:
AlAhmari MD, Alshehri KR. Disturbed sleep and excessive daytime sleepiness in a Saudi population-based sample. Saudi J Health Sci 2019;8:141-5

How to cite this URL:
AlAhmari MD, Alshehri KR. Disturbed sleep and excessive daytime sleepiness in a Saudi population-based sample. Saudi J Health Sci [serial online] 2019 [cited 2020 Sep 24];8:141-5. Available from: http://www.saudijhealthsci.org/text.asp?2019/8/3/141/272441

  Introduction Top

Disturbed sleep and excessive daytime sleepiness (EDS) are public health issues. They have become concerns in modern societies and are common complaints reported by patients with sleep disorders.[1] A lack of sleep, which is an essential element of good health, memory, and learning processes,[1],[2] can also be associated with psychological conditions.[3] Moreover, it can adversely affect the performances of both workers and students[2],[4] and is often the cause of increased occupational and road traffic accidents.[5],[6],[7]

Insufficient sleep at night can influence the quality of life.[8] It is recommended that 7–8 h of sleep per night is the necessary number needed for a good quality of sleep among healthy adults.[9] Disturbed sleep is often associated with a higher risk of morbidity and mortality,[9],[10],[11] as is either a shorter or longer duration of sleep.[12],[13],[14] Sleep deprivation in the general population is associated with increased obesity,[15] diabetes (particularly type II),[16] and increased risks of cardiovascular problems.[17],[18]

Previous studies have confirmed the relationship between sleep loss and its determinants, such as sociodemographic characteristics, sleep practices, as well as other sleep-related problems.[19],[20],[21] In the general Saudi population, epidemiological studies on disturbed sleep and EDS are limited. Therefore, in this study, the goal was to (1) screen a sample of the Saudi population for the prevalence of symptoms of disturbed sleep and EDS and to (2) assess the age and gender differences related to sleep duration.

  Patients and Methods Top

Study design and sample

The age, gender, and symptoms of disturbed sleep participants were determined with the use of the online Epworth Sleepiness Scale (ESS) (range 0–24 points). The results of n = 1419 working participants were recorded as part of a stratified random sampling method of the population. Two major shopping malls in the Eastern Province were selected to survey the volunteers, who verbally agreed to participate in this study. Of the n = 1863 individuals who were invited and agreed to participate in the study, n = 1419 of them completed the questionnaire. Non-Saudis were excluded from the study. This study was approved by the Institutional Review Board of the Prince Sultan Military College of Health Sciences (IRB-2018-02-14).

Sociodemographic measures

A questionnaire was constructed by the researchers, and it included questions about the sociodemographic data (age, gender, marital status, work category, salary, educational level, and smoking status) and sleep data (sleeping difficulties, snoring, and hours of sleep).

Epworth Sleepiness Scale

A validated Arabic ESS questionnaire for subjective daytime sleepiness[22] was utilized and developed on a web-based platform (www.surveymonkey.com) to improve the ease of completion and the collection of data for this study. The survey was explained to the participants who agreed to participate, and a link was then sent to each participant's mobile number. The ESS was originally validated in obstructive sleep apnea (OSA) patients, but it can be used for those suffering from other sleep-related problems.[23] An ESS score of ≥10 is considered to reflect EDS.

In order to make sure that the data were not duplicated by the same respondent for the same survey, the data underwent a uniqueness check for no two submissions with the same name and date of birth to ensure that each data set was unique.

Statistical analysis

The data were analyzed using GraphPad Prism 7 software (GraphPad Software Inc., La Jolla, CA, USA). The Kolmogorov–Smirnov test of normality was applied, and descriptive statistics, such as the mean ± standard deviation, were used to describe the quantitative variables. A description of the categorical variables was carried out by calculating the frequencies and percentages (n [%]). The Chi-squared tests were used to examine the associations between short/long sleep duration and the demographic characteristics (gender, age, and smoking). An analysis of variance test was used to test the differences in the body mass indexes (BMIs) across the 3 sleep duration categories: short sleep (<7 h), normative (7–9 h), and long (>9 h). P <0.05 was considered to be statistically significant.

  Results Top

Sample and sleep-related characteristics

The sociodemographic and sleep-related characteristics of the study participants are presented in [Table 1]. A total of n = 1419 individuals aged between 20 and 60 years old were recruited to participate in this study, with a response rate of 76.2%. The average age of the sample was 34.1 (±9.8) years old; 917 (65%) were male and 502 (35%) were female.
Table 1: Sociodemographic and sleep-related characteristics of the participants

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A high prevalence of snoring (64.8%) was reported among the participants; while 51% of them found it difficult getting to sleep and 46.3% fell asleep at unusual times.

Daytime sleepiness and sleep duration

[Table 2] shows that the gender distribution was varied among the age categories; there were more male responders than female responders in all of the age groups. There was an increasing trend toward the higher age groups being associated with greater daytime sleepiness based on the ESS scores, more specifically, in the 30–39 years' old age category.
Table 2: Age groups, gender distribution, and Epworth Sleepiness Scale scores

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[Table 3] shows the associations between the sleep durations and the sample characteristics. The short sleep duration percentage was higher in males when compared to females and in <40 years' old age group. The short sleep duration prevalence was significantly higher in smokers than in the nonsmokers and in individuals with high BMI.
Table 3: Sleep duration and its relationship to the population demographics

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  Discussion Top

Based on the results of this study, there was an increasing trend for the higher age groups to be associated with mild EDS. The study findings also showed that a higher prevalence of short sleep duration or hours was reported more often in males when compared to females. Those individuals who smoked and had a higher BMI were also associated with fewer sleeping hours. The other key findings of the study were that snoring was highly prevalent in 64.8% of the participants. The data confirmed that 51% of the individuals found it difficult getting to sleep, and 46.3% of them fell asleep at unusual hours.

It has further been determined that EDS can be caused by many sleep disorders.[24] Moreover, it is highly prevalent among young Saudis.[25] The research indicated a high prevalence of mild EDS and other sleep-related issues. Such issues included: “not getting enough sleep,” “difficulty getting to sleep,” and “snoring,” in more than 50% of the studied population. The comparison of the current study with other researches showed similar findings and an even higher prevalence (65%) of sleep disturbances and sleep-deprived individuals were found in Saudi adolescents (particularly males), along with a higher ESS score (10).[26] Thus, in Iceland, the ESS score was reported to be 83.4%,[27] but lesser percentages were reported in the US (37%) and Hong Kong (41.9%).[28],[29] Bahammam et al.[30],[31] reported an estimate of the prevalence of sleep apnea symptoms among middle-aged adults to be between 35% and 40%. However, these data were collected from primary health-care visitors. The researchers did not consider daytime sleepiness in the general population in public places, as was done in the current study.

The research also revealed that fewer hours of sleep, particularly in males when compared to females, was related to smoking. The finding of the current study of the mean sleep duration of 6.72 ± 1.97 h was similar to another local study,[31] as well as several studies found in different countries.[16],[32],[33],[34] Possible biological explanation is the link between tobacco uses and adverse respiratory symptoms such as productive cough and shortness of breath during night, which effects lung function, in particular, heavy smokers. More than 50% of studied participants in current research consisted of smokers; all were associated with shorter sleep hours (<7 h).

This study concluded that the prevalence of increased smoking not only a serious public health issue but also there is a connection between the high risk of OSA and smoking[35] and a shorter sleep duration.[36] It is known that smoking is a risk factor for OSA and associated with snoring which ultimately effects the quality of sleeping. Tobacco products with its toxic chemicals lead to oropharyngeal symptoms such as nasal irritation and subsequent inflammation in these structures and eventually lead fragmented sleep.

Snoring is a symptomatic marker that has medical significance and is also an important indicator of OSA. In this study, snoring was reported at a rate of 64.8% (males at 44% versus females at 21%). These data are similar to the findings from previous studies of the Saudi population. Many of these studies reported higher snoring rates among males when compared to females.[30],[31],[37] For instance, Bahammam et al.[30],[31] reported snoring in the Saudi population at 52.3% in males and 40.8% in females. Furthermore, Alruwaili et al.[36] reported more snoring in males compared to females at a ratio of 38.6% and 36.7%, respectively.

Obesity has become a global health issue, with a majority of the adult population being either overweight or obese.[38] Thus, current data showed that those individuals with lower sleeping durations had higher overall BMIs of ≥30 kg/m2 in most of the age groups, which is a strong predictor of OSA disorders.[39] In a study conducted in the UAE in the general population, a close correlation between higher BMI and the risk of OSA was reported.[40]

Limitations of the study

This study had several limitations that should be considered. First, the study was based on self-reporting, and it did not address subjective psychological and psychiatric factors. This is particularly true for depression, which has been shown to be associated with EDS.[41] However, other studies have reported that self-reported sleep data showed a moderate agreement.[42]

Second, this was a cross-sectional study, and it was designed to assess the prevalence of EDS and some sleep-related characteristics among the general population in Saudi Arabia. Still, this analysis was not intended to demonstrate a causal direction. In addition, the current study was limited to one region in Saudi Arabia and is, therefore, not representative of an actual general population study. To further address these limitations, investigations should be undertaken that more fully represent the general population. Despite these limitations, this research is unique in that it attempted to present the prevalence of sleeplessness in a wide-age range of the general population of Saudi Arabia located in public places.

  Conclusion Top

This study showed a high prevalence of EDS and other sleep-related issues among different age groups in the general Saudi population. The findings of this study reported that sleep duration was short, which potentially has significant implications in general public safety, productivity, and quality of life. Public awareness of sleep hygiene or psychoeducation is needed in Saudi Arabia. Further epidemiological studies and policy-makers must study and consider the Saudi cultural factors that cause short sleep durations and the long-term effects on the public well-being. Such data and other findings need to be found in the type of care addressed in the new health reformation set for Vision 2030.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3]


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