Workforce and Employment Status of Sleep Medicine Graduates in Iran

Background and Objective: Sleep medicine is a multidisciplinary specialty that focuses on diagnosing and treating sleep disorders. Sleep medicine fellowship programs in Iran commenced in 2012 at Tehran University of Medical Sciences, Tehran, Iran. This study aimed to investigate the human resources and employment status of sleep medicine fellowship graduates in Iran. Materials and Methods: This study was a descriptive cross-sectional study conducted in Iran in 2022 using conven-ience sampling and included 41 sleep medicine fellows in Iran. Data collection tools included a demographic question-naire and a researcher-made survey. Data were analyzed using the SPSS software. Results: Out of 57 sleep medicine fellows, 41 individuals with an average age of 44.95 ± 7.57 years participated in the study. Only 12% of the fellows were satisfied with their income, and all participants expressed dissatisfaction with their insurance coverage. 92% considered the existence of a national guideline for sleep medicine to be crucial, while 66.7% felt the curriculum of medical sleep medicine had some deficiencies. Conclusion: Lack of a suitable national guideline for treating and preventing sleep disorders, lack of insurance coverage for tests and respiratory assist devices, and high costs of establishing and equipping specialized sleep clinics are major challenges recognized by sleep medicine fellows. Additionally, due to the low priority given to these diseases by authorities and the inappropriate distribution of sleep medicine specialists in the country, access to appropriate treatment for sleep disorders is only feasible in giant cities

Methanolic Extract of Ficus carica

The antiangiogenesis effect of Ficus carica leaves extract in an air pouch model of inflammation was investigated in rat. Inflammation was induced by injection of carrageenan into pouches. After antioxidant capacity and total phenolic content (TPC) investigations, the extract was administered at 5, 25, and 50 mg/pouch, and then the volume of exudates, the cell number, TNFα, PGE2, and VEGF levels were measured. Angiogenesis of granulation tissues was determined by measuring hemoglobin content. Based on the DPPH assay, the extract had significant antioxidant activity with TPC of 11.70 mg GAE/100 g dry sample. In addition, leukocyte accumulation and volume of exudate were significantly inhibited by the extract. Moreover, it significantly decreased the production of TNFα, PGE2, and VEGF, while angiogenesis was significantly inhibited by all administered doses. Interestingly, attenuation of angiogenesis and inflammatory parameters (except leukocyte accumulation) by the extract was similar to that shown by diclofenac. The extract has anti-inflammatory effects and ameliorated cell influx and exudation to the site of the inflammatory response which may be related to the local inhibition of TNFα, PGE2, and VEGF levels as similarly shown by diclofenac. The antiangiogenesis and anti-VEGF effects of Ficus carica may be correlated with its significant antioxidant potentials

The need to promote sleep health in public health agendas across the globe.

Healthy sleep is essential for physical and mental health, and social wellbeing; however, across the globe, and particularly in developing countries, national public health agendas rarely consider sleep health. Sleep should be promoted as an essential pillar of health, equivalent to nutrition and physical activity. To improve sleep health across the globe, a focus on education and awareness, research, and targeted public health policies are needed. We recommend developing sleep health educational programmes and awareness campaigns; increasing, standardising, and centralising data on sleep quantity and quality in every country across the globe; and developing and implementing sleep health policies across sectors of society. Efforts are needed to ensure equity and inclusivity for all people, particularly those who are most socially and economically vulnerable, and historically excluded

To study the relationship between occupational injury and AHI adjusted for age, sex, and BMI in patients referring to the sleep clinic at Baharloo Hospital, Tehran

The aim of this study was to examine the relationship between occupational injury and AHI adjusted for age, sex and BMI in patients referring to the sleep clinic at Baharloo Hospital, Tehran. The study is practical in purpose and descriptive in experimental methods. Patients with obstructive sleep apnea were divided into her three groups based on the apnea hypopnea index (AHI):  mild: AHI = 14-5, moderate: AHI = 15-29, and severe: AHI ≥ 30. The sample size was set to 259 individuals. Data analysis was performed using SPSS software. The mean body mass index for the sample population is 29.79 with a standard deviation of 5.4. The mean and standard deviation of the ages of the study population are 41.5 and 9.7 years, respectively. Results showed that hypopnea-apnea index and lack of treatment in patients with obstructive sleep apnea were associated with occupational injuries, even after adjusting for the effects of age, gender, and BMI variables

The importance of medicine and sleep health in the field of community health

Sleep medicine is one of the new and leading branches of medical knowledge. During the past two decades, it has got a special position in the countries' health programs due to the development and identification of more effective diagnostic and management methods, and the identification of the adverse consequences of overlooked sleep disorders on the community's health. It is included in many countries' health programs in industrialized and developed countries such as the United States, South American countries, Australia, Europe, and China. Sleep disorders with a variety of more than 80 types of diseases constitute complicated, high-risk, and costly diseases that affect the public health system. The prevalence and adverse consequences of these disorders could be reduced by implementing sleep health and appropriate preventive measures. Furthermore, it should be noted that if patients with these disorders are diagnosed correctly and on time, there would be effective management modalities in the world and the country (1). This letter had explained the importance of sleep health and its association with non-communicable diseases, associated consequences, and the urgent need to pay attention to sleep health and sleep disorders in the public health system

An Evaluation of Obstructive Sleep Apnea Patient’s Quality of life Following Continuous Positive Airway Pressure and Uvulopalatopharyngoplasty

Aims: Obstructive sleep apnea (OSA) is characterized by episodic sleep state–dependent upper airway collapse. OSA can markedly decrease quality of life (QoL) and productivity. Continuous Positive Airway Pressure (CPAP) has been used as an effective treatment for OSA. Recently, uvulopalatopharyngoplasty (UPPP) treatment has emerged as effective management among patients with OSA, especially non-adherent ones to conventional therapies such as CPAP. Our aim was to determine whether CPAP and UPPP treatment could improve the quality of life in patients with moderate OSA. Design: Prospective. Setting: Patients with moderate OSA, confirmed by polysomnography from March 2019 to March 2020, participated. CPAP and UPPP treatments were considered for patients according to their preferences. The Sleep Apnea Quality of Life Index (SAQLI) questionnaire before and after treatment was completed. Methods: Change in their QoL was compared between the CPAP group and UPPP treatment. In addition, QoL was compared between these groups and patients who did not receive any of these treatment methods. Results: Seventy-eight patients were included in treatment groups, 40 using CPAP and 38 undergoing UPPP treatment. Furthermore, 10 patients who did not receive treatment were considered the control. Both methods of treatment significantly (p < 0.001) improved QoL, but UPPP treatment was superior (p = 0.042) to CPAP. There was a poor correlation between post-treatment BMI (0.037), Respiratory Disturbance Index (RDI) (0.096), age (0.022), and post-treatment SAQLI score. Conclusion: Based on these results, CPAP and UPPP treatment can improve QoL. UPPP treatment could be considered an effective arm of OSA management among the study population

Sleep traits and associated factors among people living with HIV/AIDS in Iran: a two-step clustering analysis

Abstract Sleep plays an essential role in improving the quality of life of people living with HIV (PLWH); however, sleep traits in this population are not well studied. This study aims to evaluate the sleep traits and related associated factors among PLWH in Iran. A nationwide cross-sectional study was conducted with 1185 PLWH who attended Voluntary Counseling and Testing centers in 15 provinces in Iran between April 2021 and March 2022. The Berlin Obstructive Sleep Apnea questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Insomnia Severity Index were used. A two-step clustering method was employed to identify the number of sleep clusters in PLWH. Prevalence of poor sleep quality, sleepiness and insomnia were 49.6%, 21.15% and 42.7% respectively. Three sleep trait clusters were identified: I. minor sleep problems (45.6%); II. Snoring & sleep apnea (27.8%), and III. poor sleep quality and insomnia (26.7%). Age (Odds Ratio (OR) 1.033, 95% Confidence Interval (CI) 1.017–1.050), academic education (OR 0.542, 95% CI 0.294–0.998) and HIV duration were associated with being in Snoring & sleep apnea cluster, while age (OR = 1.027, 95% CI 1.009–1.040) was associated with being in Poor sleep quality and insomnia cluster. PLWH with depression had higher odds of being in Poor sleep quality and insomnia cluster, and those with anxiety had higher odds of being in Snoring & sleep apnea cluster and Poor sleep quality and insomnia cluster. A significant proportion of PLWH have poor sleep quality, sleepiness, and insomnia. The identification of three distinct sleep trait clusters underscores the need for increased attention and tailored interventions to address the specific sleep issues experienced by PLWH

Non-communicable disease comorbidities in HIV patients: diabetes, hypertension, heart disease, and obstructive sleep apnea as a neglected issue

Abstract The present study evaluates the non-communicable disease (NCD) patterns and related risk factors among people living with HIV (PLWH) in Iran. This national cross-sectional survey study was conducted on 1173 confirmed PLWHs with a mean age of 35.35 (56.82 Over 50 years old, 33.90 Under 50 years old) admitted from 15 different provinces in the country. Logistic regression was used to analyze the association of factors with having at least one NCD comorbidity. From 1173 PLWH, 225(19.18%) participants experienced at least one NCD (15.20% and 38.69% among under- and over-50-year-old patients, respectively). The prevalence of heart disease, hypertension, diabetes, and sleep apnea among all patients was 1.59%, 2.05%, 1.55%, and 10.26%, respectively. The similar prevalence for each NCD among those over 50 years was 10.11%, 15.71%, 9.01%, 25.44%, and 1.01%, 1.12%, 1.04%, and 9.23% among those under 50 years, respectively. The odds of being at risk of at least one NCD stood higher in patients over 50 years (ORadj = 2.93, 95% CI 1.96–4.37), married (ORadj = 2.48, 95% CI 1.41–4.35), divorced or widowed (ORadj = 2.78, 95% CI 1.48–5.20), and obese (ORadj = 3.82, 95% CI 2.46–5.91). According to our findings regarding the prevalence of NCDs among patients under 50 years of age, we recommend that policymakers give greater consideration to this group in the screening and care programs for NCDs since adults and the elderly are both vulnerable to the risk factors for developing NCDs

Methanolic Extract of Ficus carica Linn. Leaves Exerts Antiangiogenesis Effects Based on the Rat Air Pouch Model of Inflammation

The antiangiogenesis effect of Ficus carica leaves extract in an air pouch model of inflammation was investigated in rat. Inflammation was induced by injection of carrageenan into pouches. After antioxidant capacity and total phenolic content (TPC) investigations, the extract was administered at 5, 25, and 50 mg/pouch, and then the volume of exudates, the cell number, TNF , PGE 2 , and VEGF levels were measured. Angiogenesis of granulation tissues was determined by measuring hemoglobin content. Based on the DPPH assay, the extract had significant antioxidant activity with TPC of 11.70 mg GAE/100 g dry sample. In addition, leukocyte accumulation and volume of exudate were significantly inhibited by the extract. Moreover, it significantly decreased the production of TNF , PGE 2 , and VEGF, while angiogenesis was significantly inhibited by all administered doses. Interestingly, attenuation of angiogenesis and inflammatory parameters (except leukocyte accumulation) by the extract was similar to that shown by diclofenac. The extract has anti-inflammatory effects and ameliorated cell influx and exudation to the site of the inflammatory response which may be related to the local inhibition of TNF , PGE 2 , and VEGF levels as similarly shown by diclofenac. The antiangiogenesis and anti-VEGF effects of Ficus carica may be correlated with its significant antioxidant potentials