The prevalence of symptoms and risk factors associated with obstructive sleep apnea among patients attending primary health centers in Erbil, Iraq

  • Hana Hoshmand Abdul-Majeed Brayati Family Center, Erbil, Iraq.
  • Ali Shakir Dauod Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
Keywords: Sleep apnea, Snoring, Day time sleepiness, Primary care, Erbil


Background and objective: Although snoring and day time tiredness and are a common finding in persons with obstructed sleep apnea; however, most of them are unaware of their diseases. This study aimed to find the prevalence of sleep apnea and symptoms at the primary care level.

Methods: A cross-sectional study was conducted among randomly selected 500 patients aged ≥ 18 years attending two primary care centers in Erbil city, from the 1st of April 2018 to the end of February 2019. A Berlin modified questionnaire was used to address an individual's characteristics, risk factors, and clinical symptoms.

Results: The mean age + SD of 500 individuals was 41.06 + 14.79 years. Nearly all (97.2%) of the participants were living in urban areas. Around three quarters (72.2%) of the sample were married, 27.8% were smokers, 45.8% were overweight, and 18.6% were obese. The overall prevalence of obstructed sleep apnea was 23.2%, the prevalence of low-risk OSA was 22.4%, and the prevalence increased with age. Obstructed sleep apnea was more among females (26%) than males (20.8%), although the difference was not significant. A high percentage was observed among those with raised blood pressure and obese persons (87.9% and 86%, respectively). No significant association was detected between obstructed sleep apnea and smoking.

Conclusion: High risk of obstructive sleep apnea was common among patients attending primary care. Awareness and education of physicians and patients about the disease is essential. Those at high risk should be referred to sleep centers for further evaluation.


Khassawneh B, Ghazzawi M, Khader Y, Alomari M, Amarin Z, Shahrour B, et al. Symptoms and risk of obstructive sleep apnea in primary care patients in Jordan. Sleep Breathing 2009; 13(3):227–32.

Mahboub B, Afzal S, Alhariri H, Alzaabi A, Vats M, Soans A. Prevalence of symptoms and risk of sleep apnea in Dubai, UAE. Int J Gen Med 2013; 6:109.

Singh A, Prasad R, Garg R, Kant S, Hosmane GB, Dubey A, et al. A study to estimate prevalence and risk factors of obstructive sleep apnoea syndrome in a semi-urban Indian population. Monaldi Arch Chest Dis 2017; 87(1):773.

Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thoracic Soc 2008; 5(2):136–43.

Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea. J Thorac Dis 2015; 7(8):1311.

Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165(9):1217–39.

Garvey JF, Pengo MF, Drakatos P, Kent BD. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis 2015; 7(5):920.

Nakano H, Furukawa T, Nishima S. Relationship between snoring sound intensity and sleepiness in patients with obstructive sleep apnea. J Clin Sleep Med 2008; 4(06):551–6.

Bouscoulet LT, Vá JC, Muiñ A, Má M, Ló MV, de Oca MM, et al. Prevalence of sleep-related symptoms in four Latin American cities. J Clin Sleep Med 2008; 4(06):579–85.

Koehler U, Apelt S, Augsten M, Dette F, Jerrentrup L, Langanke J, et al. Daytime sleepiness in patients with Obstructive Sleep Apnoea (OSA)-pathogenetic factors. Pneumologie (Stuttgart, Germany) 2011; 65(3): 137–42.

Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Eng J Med 2000; 342(19):1378–84.

Johansson K, Hemmingsson E, Harlid R, Lagerros YT, Granath F, Rössner S, et al. Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from the randomized controlled trial: a prospective observational follow-up study. BMJ 2011; 342:d3017.

Chirinos JA, Gurubhagavatula I, Teff K, Rader DJ, Wadden TA, Townsend R, et al. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med 2014; 370(24):2265–75.

BaHammam AS, Alrajeh MS, Al-Jahdali HH, Bin Saeed AA. Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi males in primary care. Saudi Med J 2008; 29(3):423–6.

Thunström E, Manhem K, Rosengren A, Peker Y. Blood pressure response to losartan and continuous positive airway pressure in hypertension and obstructive sleep apnea. Am J Respir Crit Care Med 2016; 193(3):310–20.

Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med 2007; 167(8):757–64.

Guo J, Sun Y, Xue LJ, Huang ZY, Wang YS, Zhang L, et al. Effect of CPAP therapy on cardiovascular events and mortality in patients with obstructive sleep apnea: a meta-analysis. Sleep Breathing 2016; 20(3):965–74.

Bertsias G, Mammas I, Linardakis M, Kafatos A. Overweight and obesity in relation to cardiovascular disease risk factors among medical students in Crete, Greece. BMC Public Health 2003; 3(1):3.

Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB, et al. Obesity in Saudi Arabia. Saudi Med J 2005; 26(5):824–9.

Alkhalil M, Schulman E, Getsy J. Obstructive sleep apnea syndrome and asthma: what are the links? J Clin Sleep M 2009; 5(01):71–8.

Netzer NC, Hoegel JJ, Loube D, Netzer CM, Hay B, Alvarez-Sala R, et al. Prevalence of symptoms and risk of sleep apnea in primary care. Chest 2003; 124(4):1406–14.

How to Cite
Abdul-Majeed, H., & Dauod, A. (2020). The prevalence of symptoms and risk factors associated with obstructive sleep apnea among patients attending primary health centers in Erbil, Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 24(2), 298-306.
Original Articles