Clinical Factors Associated with Very Severe Obstructive Sleep Apnea in Mongolian Patients: A Case-Control Study

Objectives: To determine risk factors and clinical characteristics of obstructive sleep apnea patients (OSA) according to the severity of the value of AHI ≥ 60 (Apnea-Hypopnea Index). Methods: A hospital-based, case-control study, December 2018 - 2020. Patients were grouped by severity of AHI as moderate, severe, and very severe. Results: Of 103 male cases, 52 were very severe obstructive sleep apnea (vsOSA). The control group consisted of 16 moderate OSA (mOSA) and 35 severe OSA (sOSA) patients. The case group consisted of 52 vsOSA patients. The average age was 48.7 ± 12.6. There was statistically significant increased body mass index (p < 0.003), systolic blood pressure, and abdominal circumference (p < 0.006) in the vsOSA group. Moreover, on polysomnography there was less deep sleep (p < 0.004), a greater arousal index (p < 0.000), higher apnea-hypopnea index (p < 0.000), and higher night systole pressure (p < 0.010). According to a bivariate analysis, abdominal circumferences were the variable with the closest association to the vsOSA group (crude OR: 9.14, p > 0.004), followed by decreased maximum saturation of O2 (crude OR: 6.6, p > 0.451). Conclusion: Of male OSA patients, 50.1% have vsOSA (AHI > 60) and most of them were obese and suffered from high blood pressure. Lower levels of O2 saturation and increased abdominal and neck circumferences were significant risk factors for the very severe obstructive sleep apnea group

Obstructive Sleep Apnea in a Clinical Population: Prevalence, Predictive Factors, and Clinical Characteristics of Patients Referred to a Sleep Center in Mongolia

Obstructive sleep apnea (OSA) disrupts sleep. This study examined factors related to OSA severity. A cross-sectional, prospective, hospital-based study was conducted with 205 patients who underwent polysomnography (PSG). Demographic, anthropometric, clinical, PSG, and sleep quality assessment data were analyzed. Participants (N = 205) were classified into four groups based on apnea–hypopnea index (AHI); no OSA (AHI < 5/h; N = 14), mild (mOSA, 5 < AHI < 15/h; N = 50), moderate (modOSA, 15 < AHI < 30/h; N = 41), severe (sOSA, 30 < AHI < 60/h; N = 50), and very severe (vsOSA, AHI ≥ 60; N = 50). Men had more severe OSA than women (p < 0.001). Anthropometric characteristics differed with OSA severity (p < 0.001). OSA patients had decreased sleep quality and increased excessive daytime sleepiness (EDS). Body mass index (BMI), neck/waist circumference, and blood pressure (BP) differed between groups (p < 0.001). Patients with vsOSA had the highest Mallampati grades (p < 0.001). Multiple linear regression indicated that OSA severity was related to gender and sleep quality. PSG parameters (oxygen saturation, systolic BP, and arousal/respiratory arousal) were strongly related to OSA severity. In conclusion, about half of study-referred patients had severe/very severe OSA; these groups were predominantly obese men with high BP. OSA severity associated with high BP, BMI, waist circumference, and neck circumference

The professional practice and training of neurology in the Asian and Oceanian Region: A cross-sectional survey by the Asian and Oceanian Association of Neurology (AOAN)

Objective: To survey AOAN member countries regarding their organizational structure, postgraduate neurology training program, and resources for neurological care provision. Methodology: A cross-sectional survey using a 36-item questionnaire was conducted among country representatives to AOAN from August 2015 to August 2016. Results: A total of 18/20 AOAN member countries participated in the survey. All the countries have organized association with regular meetings, election of officers and neurology training program. In 9/18 countries, professionals other than neurologists were eligible for affiliation. In 11/18 countries, prior Internal medicine training (or equivalent postgraduate housemanship) is prerequisite to neurology program. Recertification examination is not a practice, but submission of CME is required in 7/18 countries to maintain membership. 12/18 countries publish peer-reviewed journals with at least 1 issue per year. Subspecialty training is offered in 14/18 countries. The ratio of neurologist to population ranges from 1:14,000 to as low as 1:32 million with 9/18 having \u3c1 neurologist per 100,000 population. 6/18 countries have at least 1 specialized center solely for neurological diseases. In government-funded hospitals, the lag time to be seen by a neurologist and/or obtain neuroimaging scan ranges from 1day to 3months. All except one country have several medical- and lay- advocacy or support groups for different neurological conditions. Implications: The data generated can be used for benchmarking to improve neurological care, training, collaborative work and research in the field of neurosciences among the AOAN member countries. The paper presented several strategies used by the different organizations to increase their number of neurologists and improve the quality of training. Sharing of best practices, academic networking, exchange programs and use of telemedicine have been suggested