Towards healthier sleep for all malaysian


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  • Interview our past immediate president, Prof Syed Hassan Almashoor The initial ideal came during Malaysian Psychiatrist Meeting in 2000 when some of the psychiatrist with interest in sleep disorders start this group to promote multidisciplinary approach to sleep medicine 2 nd President – Prof Syed Hassan Almashoor – Head of Medical Science Cluster, UiTM; previous Foundation Dean, Faculty of Medicine, UNIMAS Current president – Dr Muhsin, Consultant Psychiatrist in PPUM Original members – mainly psychiatrists, respiratory physicians, neurologist – Dato’ Dr. Rani – Ampang Putri Specialist Prof Syed reported initial experience with sleep medicine in the country in Sleep and Hypnosis in 1999 Current committe members include resp physician, paeds resp physician, psychiatrist, n ENT surgeon
  • Prof Syed and Dato Dr Zainuddin were the two person who developed the first sleep labs in Malaysia in UNIMAS and UKM in early 1990’s Dr Norzila, Paeds Respirologist involved with the development of first sleep lab for paeds population in Hospital Serdang
  • RIPAS – Raja Isteri Pengiran Anak Saleha hospital, main tertiary hospital in Brunei
  • Sleep medicine has been in Malaysia for more than 20 years now. Patients usually either presented with excessive daytime sleepiness to the Respi physicians, or symptoms of upper airway obstruction with excessive snoring to ENT surgeon. Our psychiatrist usually see those with sleep disorders including insomnias, and sleep walking. With obesity pandemics, the demand for sleep medicine is increasing, and we are currently experiencing the same scenarios. One of the challenges in Malaysia at present is diagnosing sleep disordered breathing in less obese patient and determining the factors involved. The other challenges would be maintaining the standard of care and continuous training for the doctors and sleep technicians. We need to affiliate ourselves with the bodies such as NAPST and Board of registered polysomnographic technologist in maintaining the standard of training in sleep medicine. Certainly, the demand for trained sleep tech is very high, and we, especially in the government hospital relying heavily on the medical assistants and staff nurse which pose their own problem. At present, we are working on introducing a certificate qualification for training in sleep medicine post basic qualification to ensure the standard of training for the future sleep tech.
  • HSB – Sultanah Bahiyah HRPZ – Raja Perempuan Zainab II HSA – Sultanah Aminah Serving 27 million populations
  • MSLT – multiple sleep latency test MWT – maintenance of wakefulness test
  • Towards healthier sleep for all malaysian

    1. 2. Outline <ul><li>History of SDSM </li></ul><ul><li>Sleep Medicine in Malaysia </li></ul><ul><li>Training in Sleep Medicine </li></ul><ul><li>Challenges </li></ul><ul><li>Research Collaboration </li></ul><ul><li>Future Direction </li></ul><ul><li>Multidisciplinary Approach </li></ul>
    2. 4. History of SDSM <ul><li>Inaugurated following first AGM Jan 2001 </li></ul><ul><li>1 st President – Dato’ Dr. Haji Abdul Aziz Abdullah, HOD Psychiatric Dept. HKL </li></ul><ul><li>Immediate past president, Prof. Dr. Syed Hassan Almashoor </li></ul><ul><li>Among the first sleep lab in Malaysia – in UNIMAS since 1996 using PSG machine from Nightingale </li></ul>
    3. 5. Council Members <ul><li>Advisor: Prof Dr Syed Hassan Almashoor </li></ul><ul><li>Dato’ Dr Zainuddin Mohd Zain </li></ul><ul><li>President: Dr Muhd Muhsin, PPUM </li></ul><ul><li>V. President: Dr Ashari Yunus, IPR </li></ul><ul><li>Secretary: Dr Rusdi Abdul Rashid, PPUM </li></ul><ul><li>A. Secretary: Prof Dr Mohd Fadzillah, Unimas </li></ul><ul><li>Treasurer: Dr Raymond Tan, Pantai Hosp </li></ul><ul><li>Committee member: Dr Ahmad Izuanuddin Ismail </li></ul><ul><li>Dr Norzila Mohd Zainudin </li></ul><ul><li>Dr Siti Nor Aizah Ahmad </li></ul><ul><li>Dr Salina Mohamed </li></ul>
    4. 6. Objectives <ul><li>To foster exchange of information relating to sleep research at both national, regional and international levels </li></ul><ul><li>To encourage development and involvement of various disciplines in sleep research </li></ul><ul><li>To develop and ensure adherence to code of ethics in field of sleep medicine </li></ul><ul><li>To provide Continuing Medical Education to the General Practitioners and Medical colleagues </li></ul><ul><li>To disseminate information to the general public on sleep disorders </li></ul>
    5. 7. Activities <ul><li>Involved in workshop and symposium on sleep medicine in the country since 2002 </li></ul><ul><li>CME talks on training general practitioners in sleep medicine </li></ul><ul><li>CME talk on management of sleep disorders at RIPAS Hospital, Brunei September 2002 </li></ul><ul><li>Round table meeting on sleep apnoea with industrial supplier and sleep researchers </li></ul><ul><li>Attendance at international meeting including World Federation Sleep Research meeting and Asian Sleep Research Society meeting </li></ul>
    6. 8. Membership <ul><li>Three types of membership </li></ul><ul><ul><li>Ordinary member </li></ul></ul><ul><ul><li>Associate member </li></ul></ul><ul><ul><li>Honorary member </li></ul></ul><ul><li>Who currently in the society </li></ul><ul><ul><li>Respiratory Physicians (Adult & Paediatrics) </li></ul></ul><ul><ul><li>Psychiatrists </li></ul></ul><ul><ul><li>ENT Surgeon </li></ul></ul><ul><ul><li>Neurologist </li></ul></ul><ul><ul><li>Sleep Technicians </li></ul></ul>
    7. 9. Sleep Medicine in Malaysia <ul><li>Started since early 1990’s </li></ul><ul><li>First 3 sleep lab in Klang Valley – PPUKM, IPR, PPUM </li></ul><ul><li>Now increasing in numbers, including in private hospitals </li></ul><ul><li>Usually runs by Resp Physicians, Neurologists, ENT and Psychiatrists </li></ul><ul><li>MA&SN, as well as Sleep Tech </li></ul>
    8. 10. Klang Valley PPUKM IPR PPUM Hosp Serdang CTC UiTM Sg Buloh HRPZII, KB HUSM Hosp QE2, KK Unimas HTAA, Kuantan HSB, Alor Setar Sleep Lab in Malaysia Hosp P.Pinang HSA, JB
    9. 12. Training in Sleep Medicine <ul><li>Clinical attachment </li></ul><ul><ul><li>Prof Collin Sullivan & Prof Roy Gruenstein, Royal Prince Alfred Hospital, Sydney </li></ul></ul><ul><ul><li>Dr Jeremy Goldin & Prof Lou Irving, Royal Melbourne Hospital </li></ul></ul><ul><li>Hands-on session on </li></ul><ul><li>Sleep Reporting at </li></ul><ul><li>Meeting and </li></ul><ul><li>Conferences </li></ul>
    10. 13. Challenges <ul><li>Sleep technician </li></ul><ul><ul><li>MA & SN </li></ul></ul><ul><ul><ul><li>Transfer & retired </li></ul></ul></ul><ul><ul><ul><li>Training </li></ul></ul></ul><ul><ul><ul><li>No incentive </li></ul></ul></ul><ul><ul><ul><li>Not interested & just do the job </li></ul></ul></ul><ul><li>Doctors – lack of knowledge about sleep </li></ul><ul><li>Policy & guideline – not clear </li></ul>Sleep Program started in 2001
    11. 14. Sleep Lab in IPR <ul><li>Ward – lab </li></ul><ul><li>1 bed – Diagnostic and CPAP initiation </li></ul><ul><li>PSG – Partial – Ward based </li></ul><ul><li>- Clinically OSA </li></ul><ul><li>- Full PSG – in sleep lab </li></ul><ul><li>Waiting time – up to 3 months (but FREE!!) </li></ul><ul><li>Sleep report once a week </li></ul>
    12. 15. Sleep Clinic <ul><li>Once a week on Tuesday morning </li></ul><ul><li>30-35 patients with 5-10 new cases per session </li></ul>
    13. 17. Who Referred Cases to Sleep Clinic <ul><li>Government, private hospital & IJN </li></ul><ul><li>GP’s, OPD, ENT, Anaesthetist, Psychiatrist etc </li></ul><ul><li>Cases </li></ul><ul><ul><li>70% OSA </li></ul></ul><ul><ul><li>20% OHS </li></ul></ul><ul><ul><li>5% imsomnia </li></ul></ul><ul><ul><li>5% misc </li></ul></ul>
    14. 18. Challenges <ul><li>Sleep technician </li></ul><ul><ul><li>MA&SN </li></ul></ul><ul><ul><li>Transfer & retired </li></ul></ul><ul><ul><li>Training </li></ul></ul><ul><ul><li>No incentive </li></ul></ul><ul><ul><li>Not interested & just do the job as told </li></ul></ul><ul><li>Doctors – lack of knowledge and exposure on sleep medicine </li></ul><ul><li>Policy & guidelines – not clear </li></ul>
    15. 19. <ul><li>2003 – 2004 – closed sleep lab </li></ul><ul><li>- specialist – further study </li></ul><ul><li>- transferred </li></ul><ul><li>- resigned from MOH </li></ul><ul><li>2004 – many patients </li></ul><ul><li>- ↑ bed in sleep lab – 2 – diagnostic & CPAP </li></ul><ul><li>- 2 cases/night except public holiday </li></ul><ul><li>- waiting for sleep study – 2- 3 months </li></ul><ul><li>2008 - ↑↑ cases </li></ul><ul><li>- waiting time for sleep study – 3/12 to 1/12 </li></ul><ul><li>-> sleep study in sleep lab </li></ul><ul><li>-> CPAP PD in ward </li></ul>
    16. 20. Research in Sleep Medicine <ul><li>Multiple case reports in early 1990’s </li></ul><ul><ul><li>Liam CK et al, Singapore Med J 1994 </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Abdullah BJ et al, Br J Radiol 1997 </li></ul></ul><ul><ul><li>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 </li></ul></ul>
    17. 21. Epidemiological Studies <ul><li>Noradina AT et al, Singapore Med J 2006 </li></ul><ul><ul><li>Looking at prevalence of sleep disordered breathing in patients admitted with acute ischaemic stroke </li></ul></ul><ul><ul><li>More than one third (37%) had AHI ≥ 20 </li></ul></ul><ul><li>Kamil MA et al, Respirology 2007 </li></ul><ul><ul><li>Large study involving 1600 subjects </li></ul></ul><ul><ul><li>Prevalence of habitual snoring, breathing pauses and excessive daytime sleepiness were 47.3%, 15.2% and 14.8%, respectively </li></ul></ul><ul><ul><li>Sleep-related breathing disorders in Malaysian adults are associated with significant morbidity </li></ul></ul>
    18. 22. Warning on Challenges Ahead?? <ul><li>Yusoff MF, et al, Traffic Inj Prev 2010 </li></ul><ul><ul><li>Prevalence of OSA among express bus driver in Malaysia </li></ul></ul><ul><ul><li>289 drivers from 5 different companies </li></ul></ul><ul><ul><li>128 (44%) diagnosed with OSA, 26 (6%) were severe </li></ul></ul><ul><ul><li>?Time for pre- </li></ul></ul><ul><ul><li>employment screening </li></ul></ul>
    19. 23. Future Research <ul><li>Development of Malay version of ESS/Berlin questionnaire </li></ul><ul><li>Large scale epidemiological studies looking at risk factors associated with OSA in Malaysian populations </li></ul><ul><li>Screening of OSA in post RTA subjects </li></ul>
    20. 24. Future Direction <ul><li>Clear policy from MOH & Sleep Society </li></ul><ul><li>We need trained technician to conduct sleep study </li></ul><ul><li>Yearly Sleep Conference </li></ul><ul><li>Multi-discipline approach </li></ul><ul><li>Research – multi disciplinary involvement </li></ul><ul><li>Day time sleep study – lack of MSLT/MWT </li></ul><ul><li>CPG – need for sleep CPG </li></ul>
    21. 25. Multidisciplinary Approach <ul><li>Single sleep lab in one centre </li></ul><ul><li>Multidisciplinary clinic comprising of Respiratory Physicians, ENT surgeons, Psychiatrists & Sleep Psychologist, Neurologists </li></ul><ul><li>Research collaboration and epidemiological studies </li></ul>
    22. 26. Training in PSG <ul><li>Institutional driven, supported by supplier </li></ul><ul><li>Lecture-based and hands-on training </li></ul><ul><li>Scoring sleep stage and interpretating PSG </li></ul><ul><li>Introduction to Sleep Medicine post basics </li></ul><ul><li>Accreditated training </li></ul><ul><li>Helps from RPSGT </li></ul>
    23. 28. First Announcement 1 st Annual Sleep Conference 10 th – 11 th December 2011
    24. 31. Thank you