Screening for chronic mouth breathing, snoring, and obstructive sleep apnea risks among Palestinian adults in the Gaza Strip during wartime conditions: a cross-sectional study

OBJECTIVE: Obstructive sleep apnea is a sleep-related breathing disorder characterized by complete/partial upper airway obstruction. The majority of patients with OSA remain undiagnosed. A screening tool is necessary to stratify patients based on their clinical symptoms, physical examination findings, and risk factors. Therefore, this study was conducted using the modified STOP-Bang questionnaire to investigate the risk of OSA in addition to chronic mouth breathing among adults in the Gaza Strip in Palestine who are living in very difficult circumstances as a result of the war. METHODS: 1000 participants (500 males and 500 females) were selected in the Gaza Strip. The participants were asked to fill in the modified STOP-Bang questionnaire. Data were subjected to statistical analysis using tests including the Chi-Square test, Fisher's Exact test, Independent Sample t-test, and Binary Logistic Regression. RESULTS: The proportion of participants identified at intermediate risk for obstructive sleep apnea (OSA) was 20.9%, whereas the proportion at high risk was 6.1%, as determined by the modified STOP-Bang questionnaire. The prevalence of OSA was highest in the older age group ≥ 50 years, especially among males. 25.1% of the participants complained of loud snoring. The results also revealed that snorers were more likely to experience trouble breathing through their nose and breathing through their mouth during sleep and had a substantially higher risk of OSA with an increased propensity for upper airway collapse. CONCLUSION: The modified STOP-Bang screening method showed a proportion of 6.1% of high-risk OSA, especially in old age; males had a higher prevalence of OSA than females. The study also concluded that chronic mouth breathing may contribute to sleep-disordered breathing and obstructive sleep apnea (OSA).