Purpose:
Intermittent hypoxia and transient arousals in obstructive sleep apnea (OSA) can lead to poor sleep quality and acute stress. Rising levels of obesity and increased incidence of OSA in young adults predisposes them to acute stress. We propose a mediation model to assess if risk of OSA is associated with acute stress and if the relationship between risk for OSA and acute stress is mediated by sleep quality.
Methods:
493 healthy individuals (F=237, M=256) from 18-25 years of age (mean age=20.3+/-1.53 years) were screened for OSA, sleep quality and acute stress using STOP-BANG questionnaire, Pittsburg Sleep Quality Index and American Psychiatry Associations National Stressful Events Survey Acute Stress Disorder Short Scale (NSESS-S) respectively. Binary and logistic regression were used establish the relationships between the variables. Sobel test for mediation analysis was conducted.
Results:
73 participants (17.3%) were found at an intermediate and high risk of OSA by STOP BANG questionnaire. 79 (16%) participants reported level of stress as None. Mild, moderate and severe stress was present in 248 (50.3%), 109 (22.1%), 51 (10.3%) and 16 (3.2%) participants respectively. The odds of having severe and extreme stress among those at risk of sleep apnea is 2.18 times higher than that among those not at risk of sleep apnea (OR: 2.18, 95% Confidence Interval: 1.37-3.51). Sobel test established that the relationship between OSA and acute stress is mediated by sleep quality.
Conclusion
Sleep quality mediates the relationship between risk for sleep apnea and acute stress. This highlights the importance of screening for OSA in young adults, particularly young men with high BMI, presenting with high stress levels.
Pakistan is one of the most complex multi-ethnic societies in the developing Islamic world. Each of the ethnic groups that now comprise Pakistan has very distinctive identity, folklore, history and political interests. However, Pakistan's nation builders were not alive to the ethnic question and failed to integrate ethnic groups into a Pakistani nationhood through recognised principles of autonomy, representation and empowerment. Instead, a non-representative, military-led authoritarian system suppressed legitimate regional and ethnic aspirations, relying too heavily on Islam and Pakistan ideology (two nation theory) to forge a sense of common nationhood. It didn't work: since the 1950s there have been four major insurrections against the central government by Baluch nationalists. Although the Baluch national question has its roots in the colonial era, it emerged as a significant political and security issue because an over-centralised and non-representative power system couldn't address the issue of ethnic diversity. Baluchistan is now a hub of interests for regional and major powers.
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