Developing Sleep Medicine Internationally.

In this month’s issue of AnnalsATS, Ozoh and colleagues (pp. 1358–1363) have an interesting article about knowledge and attitudes toward obstructive sleep apnea in medical students graduating in Lagos, Nigeria (1). The investigators used a validated instrument: the Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) (2). The response rate was very high (99%). Interestingly, more than 80% of respondents considered obstructive sleep apnea an important disorder. However, only 16.1% expressed confidence in their ability to manage the disorder. This is not surprising, as in the knowledge assessment, only 39.2% had a score higher than 50% of the total available score. Thus, there is much to be done in enhancing knowledge about obstructive sleep apnea in medical students in Nigeria. This problem is not unique to Nigeria. It has recently been described in medical schools in Saudi Arabia (3) and has also occurred in the United States, where specific programs were supported by the National Institutes of Health to address this issue. This reflects that sleep medicine is a new medical discipline (4) that is, therefore, poorly represented in the curriculum of many medical schools. Sleep medicine is probably most developed as a discipline in the United States. Kingman Strohl has provided an excellent description of the history of the development of sleep medicine in the United States (5); it has taken about 3 decades to get to the current state of sleep medicine here. The first major comprehensive textbook on sleep medicine was first published in 1989 (6). Progress has involved active collaboration among the National Center for Sleep Disorders Research at the National Institutes of Health; various professional societies, including the American Academy of Sleep Medicine, the American Thoracic Society, the Sleep Research Society, and so on; and academic medical centers. Thus, addressing sleep medicine in countries such as Nigeria will require a similar coordinated effort. They can learn from the good things we have done in the United States and also avoid some of our mistakes. A proposal about how to address the issue in Saudi Arabia has been articulated (7). Ultimately, it will require not only developing education in medical schools but also training physicians who can effectively diagnose and treat this extremely common disorder. There will, therefore, be a need for training programs for both physicians and technologists. There will also be a need for sleep centers that offer a whole range of diagnostic tests, including home sleep studies as well as provision of continuous positive airway pressure therapy. There is a need for research in countries such as Nigeria to assess the prevalence, risk factors, and consequences of obstructive sleep apnea in each specific population. Ultimately this is not specifically a Nigerian problem, it is an international one. At this time, the field of sleep medicine does not have a viable well-resourced international organization to address this issue. Merger talks are underway between the initial two small international organizations: the World Federation of Sleep Research Societies and the World Association of Sleep Medicine. Hopefully, an organization might emerge that can address this major international need. In the absence of this, efforts by institutions with large sleep medicine programs such as the University of Pennsylvania may help. Moreover, given that so much has been accomplished in the United States, a collaboration between our professional societies (the American Academy of Sleep Medicine, American Thoracic Society, and the Sleep Research Society) in the international development of sleep medicine and research is another potential strategy. It will be important to not argue about who is in charge but, rather, realize that we all have a stake in addressing the major need in countries in Africa, the Middle East, South America, India, China, and so on. Effective collaboration is essential. The need is large, and there is much to be done. Studies such as that of Ozoh and colleagues (1) should stimulate action, and we in the United States have much to contribute. n