Outline• History of SDSM• Sleep Medicine in Malaysia• Training in Sleep Medicine• Challenges• Research Collaboration• Future Direction• Multidisciplinary Approach

History of SDSM

• Inaugurated following first AGM Jan 2001• 1st President – Dato’ Dr. Haji Abdul Aziz

Abdullah, HOD Psychiatric Dept. HKL• Immediate past president, Prof. Dr. Syed

Hassan Almashoor• Among the first sleep lab in Malaysia – in

UNIMAS since 1996 using PSG machine from Nightingale

Council MembersAdvisor: Prof Dr Syed Hassan Almashoor Dato’ Dr Zainuddin Mohd ZainPresident: Dr Muhd Muhsin, PPUMV. President: Dr Ashari Yunus, IPRSecretary: Dr Rusdi Abdul Rashid, PPUMA. Secretary: Prof Dr Mohd Fadzillah, UnimasTreasurer: Dr Raymond Tan, Pantai HospCommittee member: Dr Ahmad Izuanuddin Ismail Dr Norzila Mohd Zainudin Dr Siti Nor Aizah Ahmad Dr Salina Mohamed

Objectives• To foster exchange of information relating to

sleep research at both national, regional and international levels

• To encourage development and involvement of various disciplines in sleep research

• To develop and ensure adherence to code of ethics in field of sleep medicine

• To provide Continuing Medical Education to the General Practitioners and Medical colleagues

• To disseminate information to the general public on sleep disorders

Activities• Involved in workshop and symposium on sleep

medicine in the country since 2002• CME talks on training general practitioners in

sleep medicine• CME talk on management of sleep disorders

at RIPAS Hospital, Brunei September 2002• Round table meeting on sleep apnoea with

industrial supplier and sleep researchers• Attendance at international meeting including

World Federation Sleep Research meeting and Asian Sleep Research Society meeting

Membership• Three types of membership

– Ordinary member– Associate member– Honorary member

• Who currently in the society– Respiratory Physicians (Adult & Paediatrics)– Psychiatrists– ENT Surgeon– Neurologist– Sleep Technicians

Sleep Medicine in Malaysia

• Started since early 1990’s• First 3 sleep lab in Klang Valley – PPUKM, IPR,

PPUM• Now increasing in numbers, including in

private hospitals• Usually runs by Resp Physicians, Neurologists,

ENT and Psychiatrists• MA&SN, as well as Sleep Tech

Klang ValleyPPUKMIPRPPUMHosp SerdangCTC UiTM Sg Buloh

HRPZII, KBHUSM Hosp QE2, KK

Unimas

HTAA, Kuantan

HSB, Alor Setar

Sleep Lab in Malaysia

Hosp P.Pinang

HSA, JB

Training in Sleep Medicine

• Clinical attachment– Prof Collin Sullivan & Prof Roy Gruenstein, Royal

Prince Alfred Hospital, Sydney– Dr Jeremy Goldin & Prof Lou Irving, Royal

Melbourne Hospital

• Hands-on session on Sleep Reporting at Meeting and Conferences

Challenges

• Sleep technician– MA & SN

• Transfer & retired• Training• No incentive• Not interested & just do the job

• Doctors – lack of knowledge about sleep• Policy & guideline – not clear

Sleep Program started in 2001

Sleep Lab in IPR

• Ward – lab• 1 bed – Diagnostic and CPAP initiation• PSG – Partial – Ward based - Clinically OSA - Full PSG – in sleep lab• Waiting time – up to 3 months (but FREE!!)• Sleep report once a week

Sleep Clinic

• Once a week on Tuesday morning• 30-35 patients with 5-10 new cases per

session

Who Referred Cases to Sleep Clinic

• Government, private hospital & IJN• GP’s, OPD, ENT, Anaesthetist, Psychiatrist etc• Cases

– 70% OSA– 20% OHS– 5% imsomnia– 5% misc

Challenges• Sleep technician

– MA&SN– Transfer & retired– Training– No incentive– Not interested & just do the job as told

• Doctors – lack of knowledge and exposure on sleep medicine

• Policy & guidelines – not clear

2003 – 2004 – closed sleep lab - specialist – further study - transferred - resigned from MOH

2004 – many patients - ↑ bed in sleep lab – 2 – diagnostic & CPAP - 2 cases/night except public holiday - waiting for sleep study – 2- 3 months

2008 - ↑↑ cases - waiting time for sleep study – 3/12 to 1/12 → sleep study in sleep lab → CPAP PD in ward

Research in Sleep Medicine• Multiple case reports in early 1990’s

– Liam CK et al, Singapore Med J 1994– Reported patient who had history of chronic heavy

snoring and diagnosis of obstructive sleep apnoea (OSA) supported by an overnight sleep study presented with recurrent acute pulmonary oedema

– Abdullah BJ et al, Br J Radiol 1997– Reported a 60-year-old man who presented at the

ENT clinic with a history of loud snoring associated with sleep apnoea secondary to a right parapharyngeal space lipoma

Epidemiological Studies• Noradina AT et al, Singapore Med J 2006

– Looking at prevalence of sleep disordered breathing in patients admitted with acute ischaemic stroke

– More than one third (37%) had AHI ≥ 20

• Kamil MA et al, Respirology 2007– Large study involving 1600 subjects– Prevalence of habitual snoring, breathing pauses and

excessive daytime sleepiness were 47.3%, 15.2% and 14.8%, respectively

– Sleep-related breathing disorders in Malaysian adults are associated with significant morbidity

Warning on Challenges Ahead??

• Yusoff MF, et al, Traffic Inj Prev 2010– Prevalence of OSA among express bus driver in

Malaysia– 289 drivers from 5 different companies– 128 (44%) diagnosed with OSA, 26 (6%) were

severe– ?Time for pre-employment screening

Future Research

• Development of Malay version of ESS/Berlin questionnaire

• Large scale epidemiological studies looking at risk factors associated with OSA in Malaysian populations

• Screening of OSA in post RTA subjects

Future Direction

• Clear policy from MOH & Sleep Society• We need trained technician to conduct sleep

study• Yearly Sleep Conference• Multi-discipline approach• Research – multi disciplinary involvement• Day time sleep study – lack of MSLT/MWT• CPG – need for sleep CPG

Multidisciplinary Approach

• Single sleep lab in one centre

• Multidisciplinary clinic comprising of Respiratory Physicians, ENT surgeons, Psychiatrists & Sleep Psychologist, Neurologists

• Research collaboration and epidemiological studies

Training in PSG

• Institutional driven, supported by supplier• Lecture-based and hands-on training• Scoring sleep stage and interpretating PSG

• Introduction to Sleep Medicine post basics• Accreditated training• Helps from RPSGT

First Announcement

1st Annual Sleep Conference10th – 11th December 2011

Thank you