Optimal positive airway pressure requirement and polysomnography indices of obstructive sleep apnea severity in the Saudi population.

CONTEXT: Positive airway pressure (PAP) is the first-line therapy for obstructive sleep apnea (OSA). Overnight PAP titration for determining optimal PAP requirements is expensive and often inconvenient. Prediction of optimal PAP requirements from diagnostic polysomnography via mathematical equations is possible but variable across populations. AIMS: We aimed to (1) determine the optimal PAP requirement, (2) determine differences in optimal PAP requirements across OSA severity groups, (3) determine the relationship between optimal PAP requirement and diagnostic polysomnography measurements of OSA severity, and (4) develop a pilot equation to predict the optimal PAP requirement from diagnostic polysomnography in a sample from the Saudi population. METHODS: We analyzed records pertaining to adult OSA patients (n = 215; 63% of males) who underwent standardized diagnostic and titration polysomnography in our sleep laboratory between 2015 and 2019. Demographic, anthropometric, and clinical information were also collected for the analysis. Inferential statistics were performed for comparisons between diagnostic and titration studies and between OSA severity groups. Regression analyses were also performed to determine the potential predictors of optimal PAP requirements. Data were presented as the mean (± standard deviation) or median (25th-75th quartiles) according to normality. RESULTS: The median optimal PAP requirement was 13 (9-17) cmH2O. The optimal PAP requirement was significantly greater for male versus female participants (14 [10-17] vs. 12 [8-16] cmH2O) and for participants with severe OSA (16 [12-20] cmH2O, n = 119) versus those with moderate (11 [8-14] cmH2O, n = 63) or mild (9 [7-12] cmH2O, n = 33) OSA. When combined, nadir oxygen saturation, oxygen desaturation index, and arousal index could be used to predict the optimal PAP requirement (R 2= 0.39, F = 34.0, P < 0.001). CONCLUSIONS: The optimal PAP requirement in the Saudi population is relatively high and directly correlated with OSA severity. Diagnostic polysomnography measurements of OSA severity predicted the optimal PAP requirement in this sample. Prospective validation is warranted.

Impact of COVID-19 Pandemic Lockdown on the Prognosis, Morbidity, and Mortality of Patients Undergoing Elective and Emergency Abdominal Surgery: A Retrospective Cohort Study in a Tertiary Center, Saudi Arabia.

The SARS-CoV-2 pandemic's main concerns are limiting the spread of infectious diseases and upgrading the delivery of health services, infrastructure, and therapeutic provision. The goal of this retrospective cohort study was to evaluate the emergency experience and delay of elective abdominal surgical intervention at King Abdul-Aziz University Hospital from October 2019 to October 2020, with a focus on post-operative morbidity and mortality before and during the COVID-19 pandemic. This study compares two groups of patients with emergent and elective abdominal surgical procedures between two different periods; the population was divided into two groups: the control group, which included 403 surgical patients, and the lockdown group, which included 253 surgical patients. During the lockdown, surgical activity was reduced by 37.2% (p = 0.014), and patients were more likely to require reoperations and blood transfusions during or after surgery (p= 0.002, 0.021, and 0.018, respectively). During the lockdown period, the average length of stay increased from 3.43 to 5.83 days (p = 0.002), and the patients who developed complications (53.9%) were more than those in the control period (46.1%) (p = 0.001). Our tertiary teaching hospital observed a significant decline in the overall number of surgeries performed during the COVID-19 pandemic and lockdown period. During the lockdown, abdominal surgery was performed only on four patients; they were positive for COVID-19. Three of them underwent exploratory laparotomy; two of the three developed shock post-operative; one patient had colon cancer (ASA score 3), one had colon disease (ASA score 2), and two had perforated bowels (ASA scores 2 and 4, respectively). Two out of four deaths occurred after surgery. Our results showed the impact of the COVID-19 lockdown on surgical care as both 30-day mortality and total morbidity have risen considerably.

Acceptance of COVID-19 Vaccine and Associated Factors Among Pregnant Women in Saudi Arabia.

Background: Coronavirus disease 19 (COVID-19) vaccination has been established as preventing severe and mortal COVID-19. Vaccination is critical strategy in controlling the COVID-19 pandemic, to restrict infections and reduce disease severity. Vaccination coverage will be more extensive if we can better identify vaccination barriers in the population, especially among vulnerable groups, of which one is pregnant women. The aim of this study was to determine the level of acceptance of COVID-19 vaccination and detect the factors that influence vaccine acceptance among pregnant women in Saudi Arabia. Methods: This was a cross-sectional, web-based study conducted in Western, Eastern, North, South, and Central Regions in Saudi Arabia between July and September 2021 among pregnant women, using multi-stage sampling. All pregnant women above 18 years were invited to participate in the study. Pregnant under 18 years of age and those with a contraindication to receiving COVID-19 vaccination were excluded. Binomial logistic regression (univariate and multivariate) was used to identify the influencing factors on vaccination acceptance. Results: Among the 5307 pregnant women, the acceptance level of COVID-19 vaccine was 68%. In the multivariate regression model analysis, the most common predictors of acceptance were living in North Region (P = 0.001, OR = 1.9), living in South Region (P = 0.000, OR = 3.06), and living in Central Region (P = 0.035, OR = 1.42) in comparison to living in Western Region. Gestational week (P = 0.018, OR=0.98), income more than 8000 SR (P = 0.000, OR = 0.51), education level (primary, secondary, and university; P = 0.002, 0.008, and 0.010, respectively), having had gestational diabetes mellitus (P = 0.013, OR = 1.86), being vaccinated with influenza vaccine during present pregnancy (P = 0.000, OR = 4.55, OR = 1.81), being vaccinated with tetanus vaccine during present pregnancy (P = 0.039), and believing that the COVID-19 vaccine could harm their baby (P = 0.000, OR = 0.12). Conclusion: Our study reported high acceptance of COVID-19 vaccination. The major two reasons for refusal were concerns about a lack of data on COVID-19 vaccination safety and the possibility of harming the fetus. Continued public health efforts, such as educational television programs and awareness campaigns about the safety of the COVID-19 vaccine for pregnant women, are required to raise awareness. More studies of COVID-19 vaccine safety in pregnant women would assist in overcoming these obstacles and encourage pregnant women to be vaccinated.