1. OBSTRUCTIVE SLEEP APNEA IN ETHIOPIAN PATIENTS Sleep apnea is a cessation of breathing due to obstruction of the respiratory air passages during sleep. It is a worldwide phenomenon but it is not fully recognized by both the medical community and the public in general. It leads to a reduction in body oxygen level and considerable rises in stress hormones and carbon dioxide during sleep. The beginning of studying sleep apnea to launch an intervention service in this country is just in the making.

2. It is now fully understood that the changes secondary to sleep apnea have very considerable health impact on the human body. The impact can involve any part of the body, but the brain, the cardiovascular system and the metabolism of the body in general tend to be the most affected. Signs of obstructive sleep apnea (OSA) are often observed by family members of patients. These might include snoring, restless sleep, gasping and deep breathing at night.

3. The patients with obstructive sleep apnea (OSA ) may be experiencing shortness of breath at night, morning headache, day time sleepiness, lack of memory and concentration, and a decline in sexual drive. Sleep apnea may lead to day time accidents on the road because of generalized fatigue, lack of attention and day time sleepiness. If these conditions are not treated, the anomalies including hypertension, stroke, irregularity of heartbeat, heart failure, and even death can occur during sleep.

4. The prevalence rate of obstructive sleep apnea (OSA) in Ethiopia is apparently understood to be similar to the prevalence rate of obstructive sleep apnea elsewhere in the world. The pulmonologist and I believe that the prevalence of obstructive sleep apnea in this country is rising with the change in life style and other associated factors. Many thousands of Ethiopian obstructive sleep apnea patients are, at present, in desperate need for intervention. It is, therefore, high time that an effort must be made to raise awareness among the public and the medical community, and to fetch funds (global and local) so that a sleep medicine service is established in Ethiopia without further delay.

5. To meet the challenges obstructive sleep apnea (OSA) is posing in this country, a collaborative new venture on introducing health service and research is underway between Dr. Asefa Jejaw Mekonnen (one of the leading experts in the field at Premier Sleep Center, in Maryland, USA), and some staff members of the School of Medicine, here in AAU, spearheaded by myself, Prof. Yoseph A. Mengesha (Medical Physiologist and Expert General Medical Practitioner). The venture is intended to be established both in the public and private sectors with the goal of creating awareness, providing service and implementing innovative research on sleep apnea on a nationwide basis.

6. Just to kick off the sleep medicine service for the first time in this country, diagnostic tests are done on two Ethiopian patients with severe obstructive sleep apnea (OSA). Both of these patients are suffering from episodes of night time breathlessness. They are very much discomforted by breathlessness every night and look very desperate for any medical assistance that can open up their airways during sleep time. Using the language of medicine, which may be vaguely understood by the general public, the conditions of these two test patients are explained as follows:

7. The first patient is Feye Mulat, a 58-year old man. He has a BMI of 32.2 that reflects marked obesity as shown in the photo and video below:

8. ….

9. Video I of first patient

10. Video II of first patient

11. In the present trial study, this patient was attached to an Itamar home study device as shown below. Video III of first patient

12. He was studied overnight in the supine position in a first class ward room. He claimed that he was being awakened by shortness of breath every now and then at night and was hardly able to sleep due to the supine position and the new bed room environment. However, following attachment of the Itamar home study device to this patient, there was no sign of device error and the “good night sign” was observed on the watch- PAT200. Therefore, sleep disorder pattern (polysomnogram) might probably be recorded during the flickers of REM sleep that the patient had during the night. Anyway, this is going to be seen on analysis of the records.

13. This patient has been diabetic, polycythemic with a Hct value of up to 63%, hypertensive and asthmatic for many years. He has been visiting the chest clinic for about 16 years as a severe case of asthma and was occasionally depending on the use of salbutamol inhaler and the removal of one unit of blood. The aforementioned conditions and his lung function test results recently suggested that he is a classical case of COPD.

14. The second patient, Senayit Moges, is a 50-year old woman. She was attached to an Itamar home study device as shown in the photo below at her home

15. Photo of second patient

16. Her sleep disorder pattern (polysomnogram) could not be recorded because of error apparently relating to failure of initial patient file loading. She is very obese and has a BMI of 42.22. She looks incapacitated by her obesity as shown in the video below.

17. Video of second patient

18. Her Hct value rises to up to 63%. She is hypertensive and her O2 saturation sometimes falls below 60%. She has had stage II COPD for the last nine years now. This has made her periodically dependent on pure O2 from a stand-by O2 cylinder in her bed room and a removal of one unit of blood.

19. The data from the two patients will be sent to USA for analysis. Any deficiency in sleep disorder recording (polysomnography) should not rule out the need for immediate intervention in these two patients. Their physical conditions and the diagnostic results that the pulmonologist and I have observed confirm that they are obstructive sleep apnea (OSA ) patients beyond any shadow of doubt.

20. Therefore, providing them with some means (e.g. CPAP, jaw supporter, etc) to relieve their frequent choking episodes at night will be most helpful to them. If a positive gesture is made to help them and this ends up with good patient response, many thousands of obstructive sleep apnea patients here in Ethiopia will be incited and attracted to get the sleep apnea medicine service.