Obstructive sleep apnea among Hajj pilgrims: Prevalence and outcomes

Background: Hajj is an annual Islamic pilgrimage where millions gather in confined spaces under physically demanding conditions. Pilgrims with untreated obstructive sleep apnea (OSA), characterized by breathing disruptions during sleep, may be at higher risk of acute medical incidents and communicable diseases. Objectives: This study aimed to estimate the prevalence of pilgrims at high risk of developing OSA and compare health incident rates between those at high and low risk. Methodology: A cross-sectional study was conducted in Mina during the Hajj season of 1444 Hijri. Data were collected from 228 adult pilgrims using validated instruments: the STOP-Bang Questionnaire (SBQ) for OSA risk, the Epworth Sleepiness Scale (ESS) for daytime sleepiness, and the insomnia severity index (ISI) for sleep disturbances. Participants’ demographic and health information, including acute health incidents, were also recorded. Results: High OSA risk (SBQ score>3) was identified in 21% of participants and was more prevalent among older, obese males with comorbidities. Participants at high OSA risk showed significantly higher ESS and ISI scores and experienced more frequent exacerbations of comorbidities during Hajj (26% vs. 3%, P < 0.001) than those at low risk. However, rates of flu-like illnesses and gastrointestinal infections were similar across groups. Conclusion: One in five pilgrims is at high risk of OSA development, with exacerbated health challenges in those with comorbid conditions. These findings underscore the need for targeted OSA screening and management, including raising awareness of healthcare providers, to enhance health outcomes during Hajj.