Sleep related disorders: The case of Morocco

1. 24 April 2008 TTD Femtos Meeting Program Antalya Sleep related disorders:The case of Morocco C. NEJJARI, A.ELMEZIANE Morocco

2. Morocco • A country in epidemiological transition • Increasing of non communicable diseases • Increasing of accidents ++ • Communicable diseases are still a burden for health system

3. Estimates of disease prevalence are in the range of 3% to 7%, with certain subgroups of the population bearing higher risk. Factors that increase vulnerability for the disorder include age, male sex, obesity, family history, menopause, craniofacial abnormalities, and certain health behaviors such as cigarette smoking and alcohol use. Obstructive sleep apnea Proc Am Thorac Soc. 2008,b15;5(2):136-43.

4. SAOS in Morocco ? • Situation in Morocco • Very few data • A public health problem ? • Non sleep laboratory with high standard level • A study in preparation with SMMR

5. Prevalence of Obesity (Health Ministry survey, 2000)

6. A Study in the South of Morocco (2006) • Objectives • To rate the prevalence of the snoring. • To identify the factors associated to the ronchopathy. • To value the repercussions of the ronchopathy on the social life of the patients. • Patients and methods • Consulting general practitioners (private and public) in Agadir • The collection of the data has been based on a questionnaire referred to the patients with the participation of their spouses or husbands.

7. Prevalence of snoring • 480 patients, that 44.4% are female and 55.6% are male. • The mean age is 38.81 + 16.24

8. Prevalence of snoring according to gender and age

9. Frequency of some nocturnal symptoms

10. Diurnal symptoms

11. Ronchopathy associated factors

12. Ronchopathy associated factors

13. A panel of 132 patients with sleeping disorders followed in Casablanca (2007-2008) • Age : • Mean (± SD) : 51,76 ± 13.9 • Median : 51,50 • Range : 24-97 • Sex • Males: 75% • Females: 25% Data of AVAD SARL (Mr BOUHLAL)

14. Obesity (IMC ≥ 30) • Total sample : 45,8% • Men : 43.4% • Women : 50% • Treated by CPP : 65.2%

15. Apnea/hypopnea index (AHI) • Apnea/hypopnea index : • Total • IAH ≤ 20 : 41.38% • 20 <IAH ≤ 30 : 14.94% • IAH > 30 : 43.68% • Women • IAH ≤ 20 : 66.7 • 20 <IAH ≤ 30 16.7 • IAH ≤ 20 : 16.7% • Men • IAH ≤ 20 : 31.7 • 20 <IAH ≤ 30 14.3 • IAH > 30 : 54% P<0.05

16. Somnolence evaluation (Berlin index) • 72.6% have 2 or 3 positive categories • Men : 71.5% • Women : 77.8% • Diurnal somnolence (Epworth index > 10) • Total sample : 38.9% • Men : 23.5% • Women : 45.9% P<0.01

17. Adherence to CPP treatment • Proportion of patients treated : 64.66% • Adherence : • Poor : 28% • Moderate : 38% • Good or Very good : 34%

18. Study in Taxi drivers in Fez (Morocco centre) • At least 20% has sleeping disturb • 38% has diurnal difficulties to be concentrated • 28% has insomnia • 43% reported « agıtated sleeping» Berraho M, Nejjari C, El Rhazi K, El Fakir S, Tessier JF, Ouédraogo N, Mekouar S, Raiss N. Mesure du stress professionnel des chauffeurs de taxi à Fès – Maroc. Santé publique 2006 ;375-387.

19. Sleep Laboratory in Morocco • High standard sleep laboratory : 0 • Sleeping units : • Casablanca • Rabat • ..

20. Conclusion • SAOS : a probable Public Health problem • A very few data • Necessity to consider more this problem by Moroccan chest physicians, general practıtıoners (screenıng) and by Medical schools • A national study planıfıed