Abstract. Elmasry A, Janson C, Lindberg E, Gislason T, Tageldin MA, Boman G (Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden; Ain Shams University, Cairo, Egypt; and Viffilsstadir Hospital, Gardabñr, Iceland). The role of habitual snoring and obesity in the development of diabetes: a 10-year follow-up study in a male population. J Intern Med 2000; 248: 13±20.Objectives. There are many similarities between diabetes (mainly type 2) and sleep breathing disturbances regarding risk factors, anthropometric criteria and consequences of morbidity and mortality. The aim of this study was to investigate whether the association between habitual snoring and diabetes is entirely dependent on obesity. Design. A population-based prospective study. Setting. The municipality of Uppsala, Sweden. Subjects and methods. In 1984 and in 1994, 2668 men aged 30±69 years at baseline answered questionnaires concerning sleep breathing disturbances and somatic diseases.Results. Of those with habitual snoring in 1984, 5.4% reported that they had developed diabetes during the 10-year period compared with 2.4% of those without habitual snoring (P , 0.001). Amongst obese snorers, 13.5% developed diabetes compared with 8.6% of obese non-snorers (P = 0.17). In a multiple logistic regression model, the odds ratio (95% confidence interval) for development of diabetes was higher in obese snorers [7.0 (2.9±16.9)] than in obese non-snorers [5.1 (2.7±9.5)] after adjustment for age, weight gain, smoking, alcohol dependence and physical inactivity. Conclusions. We conclude that, in males aged 30± 69 years, habitual snoring is associated with an increased incidence of diabetes within 10 years. Although obesity is the main risk factor for developing diabetes, coexistent habitual snoring may add to this hazard.

Abstract. Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad Tageldin M, Boman G (Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden; Ain Shams University, Cairo, Egypt; and Vi®lsstadir Hospital, Gardabaer, Iceland). Sleepdisordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med 2001; 249: 153±161.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. However, its epidemiology in many developing countries is poorly characterised. The objective of this analysis was to evaluate respiratory symptoms which could be COPD-related in a large sample of individuals aged ≥ 40 years in ten countries in the Middle East and North Africa (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan, using a standardised methodology. A random sample of 457,258 telephone numbers was contacted. A screening questionnaire was administered to each eligible participant, which included six questions relating to respiratory symptoms. Of 65,154 eligible subjects, 62,086 agreed to participate and 61,551 provided usable data. The age- and gender-adjusted prevalence of symptoms (persistent productive cough or breathlessness or both) was 14.3% [95% CI: 14.0-14.6%], ranging from 7.2% in UAE to 19.1% in Algeria. Symptoms were more frequent (p < 0.0001) in women (16.7%) than in men (12.2%). The adjusted prevalence of COPD according to the "epidemiological" definition (symptoms or diagnosis and cigarette use ≥ 10 pack · years) was 3.6% [95% CI: 3.5-3.7%] (range: 1.9% in UAE to 6.1% in Syria). COPD was more frequent (p < 0.0001) in men (5.2%) than in women (1.8%). The frequency of symptoms was significantly higher in cigarette smokers (p< 0.001), as well as in waterpipe users (p < 0.026). In conclusion, the prevalence of COPD in this region seems to be lower than that reported in industrialised countries. Under-reporting and risk factors other than smoking may contribute to this difference.