OSA Knowledge and Attitudes

This study was approved by the institutional review board (IRB) of King Fahad Military Medical Complex – Dhahran, Saudi Arabia (IRB number AFHER-IRB-2020-014). The participants’ consents were obtained by electronic consent methods. This survey-based cross-sectional study utilized a previously validated questionnaire called the “OSAKA questionnaire.” The OSAKA questionnaire is composed of 18 items that are used to assess one’s knowledge and 5 items to assess one’s attitudes concerning dealing with OSA. An online questionnaire was sent between July and August 2020 via email and WhatsApp instant messaging to the Saudi board’s ORL trainee residents, including those in their second year of residency (R2) to their final year of residency (R5) (n = 185). First- year residency trainees were not included, as they were rotating in preparatory rotations and had no previous exposure to ORL clinical training. The survey was conducted anonymously. Along with the OSAKA questionnaire, sociodemographic data and data about previous exposure to sleep practices were also collected. The sociodemographic data included age, gender, level of training, years of ORL practice including residency, year of graduation from medical college, and residency program region (by province). Data reflecting previous exposure to sleep practices were also collected, such as the frequency of exposure to diagnosed OSA patients, patients susceptible to OSA, polysomnography data, obese patients, and surgery directed to treat OSA. We also collected data on trainees’ self-reported awareness and previous consideration of other sleep disorders during their clinical training (such as inadequate sleep hygiene, insomnia, narcolepsy, and periodic limb movement disorder) as well as awareness of other related disorders (such as overlap syndrome and obesity hypoventilation syndrome). We considered those who answered that they were “aware of other sleep disorders” and who gave examples of other sleep disorders as the aware group. The knowledge section of the OSAKA questionnaire was assessed by calculating the total true responses for the knowledge section. The total knowledge score was calculated out of 18. The attitude section of the OSAKA questionnaire consisted of five questions (two for importance and three for confidence). It was calculated out of 5 for each question (the responses “extremely important” and “strongly agree” were scored as scores of 5). The total attitude score was calculated using a maximum score of 25, reflecting the sum score of the five attitude elements. For the confidence questions, we considered those who answered “agree” and “strongly agree” as the confident group in identifying OSA-susceptible patients and managing OSA patients. Exposure to each of the aforementioned clinical exposure items was divided and classified as either no exposure or any number of exposure incidences.

本研究已获得沙特阿拉伯达兰法赫德国王军事医疗综合机构伦理审查委员会（Institutional Review Board，IRB）批准，伦理审查编号为AFHER-IRB-2020-014。研究对象的知情同意通过电子知情方式获取。
本项基于问卷调查的横断面研究采用了此前经过验证的“OSAKA问卷”。该问卷包含18个条目，用于评估受试者对阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea，OSA）的相关知识，另有5个条目用于评估其针对OSA的处理态度。
2020年7月至8月期间，研究团队通过电子邮件与WhatsApp即时通讯工具，向沙特耳鼻咽喉科（Otorhinolaryngology，ORL）住院医师培训项目的受训医师发放了线上问卷，涵盖住院医师第二年（R2）至第五年（R5）的参训人员，共计185人。住院医师第一年受训者未纳入本研究，因其处于预备轮转阶段，未接受过耳鼻咽喉科临床培训。
本次调查以匿名方式开展。除OSAKA问卷外，研究团队同时收集了受试者的社会人口学数据，以及既往睡眠医学相关临床暴露经历的数据。其中，社会人口学信息包括年龄、性别、培训阶段、含住院医师培训在内的耳鼻咽喉科从业年限、医学院毕业年份，以及住院医师培训项目所在省份。既往睡眠医学相关临床暴露经历数据包括：确诊OSA患者接触频次、OSA高危患者接触频次、多导睡眠监测（Polysomnography，PSG）相关数据、肥胖患者接触情况，以及针对OSA的外科治疗相关经历。
研究团队同时收集了受训医师自我报告的临床培训期间对其他睡眠障碍的认知情况与既往关注情况，涵盖睡眠卫生不良、失眠、发作性睡病、周期性肢体运动障碍等，以及重叠综合征、肥胖低通气综合征等相关疾病的认知水平。将自我报告“知晓其他睡眠障碍”且能列举具体睡眠障碍类型的受试者归为认知组。
OSAKA问卷的知识维度得分通过统计知识条目总答对数计算得出，满分为18分。问卷的态度维度包含5个问题（2个关于重要性认知，3个关于自信心评估），每个问题采用5级计分（其中“极其重要”与“完全同意”计为5分）。总态度得分满分为25分，为5个态度条目得分之和。针对自信心相关问题，将回答“同意”与“完全同意”的受试者归为OSA高危患者识别与OSA患者管理的自信组。前述各项临床暴露经历均被划分为“无暴露”与“有暴露”两类（无论暴露次数多少）。