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 with an at-home sleep study kit 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 colour 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.
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.
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.
The data will be analysed using frequencies, means, standard deviations, and chi-square
tests using SPSS for windows. The chi-square test will be used to assess the significance
of the correlation between obstructive sleep apnea and facial discolouration, which will
be considered significant at below p<0.05. Prevalence of vasovagal symptoms as well as
smoking habits in patients referred for polysomnography will be recorded and evaluated
for significance, and then compared with patients' follow up at 3 weeks and 6 months to
assess changes on improvement using the chi-square test as well.
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.