Clinical Association Between Obstructive Sleep Apnea (OSA) and Facial Pigmentation, and the Relation Between OSA and Vasovagal Symptoms With Resulting Smoking Tendency and the Effect of Treatment in Patients Referred for Sleep Study.
Conditions: Obstructive Sleep Apnea, Vasovagal Syncope, Smoking, Acanthosis Nigricans
Sponsor: Jordan Collaborating Cardiology Group

Clinical association between obstructive sleep apnea and facial
pigmentation, and the relation between obstructive sleep apnea
and vasovagal symptoms with resulting smoking tendency and the
effect of treatment on the disorders in patients referred for sleep
study.
September 2024

Research Design and Methodology
In this prospective cohort study, participants referred for a sleep study by in-lab polysomnography at
the Jordan University Hospital and those who preferred their study conducted at a private clinic or by
at-home sleep study will be screened and physically examined for any facial discoloration which will
be accordingly graded as low, moderate, or high based on severity of difference from normal skin
color and texture and pictured with patients’ consent and privacy maintained. In addition to a general
history, participants will be asked in detail about their smoking habits, vasovagal symptoms, sleeping
habits, and any specific obstructive sleep apnea symptoms. After the sleep study is performed,
positive and negative results will be collected and correlated with presence of facial discolouration.
Severity of OSA will be graded by apnea-hypopnea index (AHI) and recorded as mild (5 - 15
events/hour), moderate (15 - 30 events/hour), or severe (> 30 events/hour). Participants with positive
results will then be followed up with at 3 weeks and 6 months to determine what treatment they were
given, assessed for improvement on treatment, and be questioned regarding smoking and vasovagal
symptoms again. Improvement is defined as better sleep quality and reduction of initial symptoms.
Participants with negative results will also be followed up with and asked about their smoking habits
and vasovagal symptoms. Correlation will then be made between the group that improved on
treatment and the group that did not (whether due to ineffective treatment or not receiving treatment at
all) to see if improvement reduces smoking tendency with alleviated vasovagal symptoms, and
compared with participants with negative sleep study results for any change in smoking habits as well.
Population and Sample
A purposive sampling technique will be utilized to determine the study population. The target
population is patients above the age of 18 referred for sleep study at the Jordan University Hospital
and Jordan Hospital. Patients who agree to participate in this study and sign the consent form.
Data Collection
Researchers will interview patients in person at their initial sleep study visit to physically examine and
observe participants’ faces for discoloration and take pictures for future reference with consent.
Follow up at 3 weeks and 6 months will be done either in the clinic or over the phone and Email.
Ethical Considerations
Informed consent will be obtained from participants with anonymity confidentiality assured. The
study will be explained to patients, after which they must sign a consent form. Each will be assigned a
number and the collected data will be used for analysis without reference to patients’ identities.
Participation does not add risk to the patients since their treatment plan will not be altered, only
followed up with.