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Aim: To determine the subjective quality of sleep among temporarily employed individuals at high altitude and analyze the factors associated with poor sleep quality. Study design: Descriptive cross sectional study Subjects and Methods: The sample population comprised of men living at a height of 4500 meter or more above sea level at Karakorum ranges in periphery of district Skardu for more than one month and less than three months and having normal BMI and good sleep quality at sea level. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). Relationship of Age, altitude, smoking, use of naswar, Frequent awakenings during the night, temperature-related discomfort, multiple calls for toilet, environment related issues (too many people in one room, snoring of companion, untidy room), uncontrollable worry, and breathing difficulties was assessed with the sleep disturbances. Results: A total of 103 men with good sleep quality at sea level when screened through the PSQI were included in the final analysis. Out of them, 39.8% persisted with good sleep quality, while 60.2% had poor sleep quality at HA. After applying the logistic regression we found that smoking, frequent awakenings, uncontrollable worry and breathing difficulties had significant association with poor sleep quality at HA. Conclusion: This study showed a high prevalence of poor sleep quality among individuals at high altitude. Special attention should be paid to smokers and those who suffer from breathing difficulties or remain worried or anxious most of the times.

Tobacco is being used in various forms including cigarette, shisha, cigar and bidi smoking and smokeless tobacco. Smokeless tobacco constitutes various forms of tobacco i-e paan/ betel quid, tobacco with lime, naswar, gutka, qiwam, tobacco tooth powder, minpuri, areca nut (supari) [1,2]. Qiwam consists of thick paste of boiled tobacco mixed with powdered spices such as saffron, cardamom, aniseed and aroma, while paan/ betel quid is a mixture of the leaf of the Piper betle vine, aqueous calcium hydroxide paste [slaked lime] [1,2]. Smokeless tobacco is commonly used in South Asia, where it has become part of South Asian culture. Furthermore, South Asia is a major producer and exporter of tobacco and over one-third of tobacco consumed in South Asia is smokeless [2]. Traditional forms like, tobacco with lime; betel quid and tobacco tooth powder are commonly used among South Asian population [2]. With the passage of time, tobacco usage is increasing not only among men but also among women of reproductive age, children, teenagers, medical and dental students [2].

Objective: To estimate the pattern of tobacco use among outdoor, depressed patients reported for private psychiatric consultation at Karachi. Method: This observational study is based on cases reported at a private psychiatric clinic in Karachi from 1stJanuary, 2012 to 31st December 2012. A total of 178 patients, consecutively diagnosed as Depressive disorder according to ICD-10 were selected. All patients were male and their age range was from 18 years to 70 years. Their mean age with standard deviation was 36.16 ± 12.01 years. Informed consent, in all the patients, was taken. Approval from IRB (Institutional Review Board) Jinnah Postgraduate Medical Centre, Karachi was obtained. The approved protocol was used in the study overseeing the ethical and legal aspects of the clinical investigations. Data was tabulated and analysed using SPSS version 20. Descriptive statistics were used to describe the data. Results: Total number of depressed patients screened was1445. Out of these 178 patients was using tobacco. Their average age ± SD were 36.16 ± 12.01 years .The age range was from 18 to 70 years. Out of 178 cases, 139(78.1%) cases were married, 28(15.7%) were unmarried, and 6(3.4%) had second marriages, and the rest were engaged, divorced or separated. Their ethnic languages were Pushto (65.7%); Urdu (12.4%), Punjabi (5.1%), Sindhi (7.3%), Balochi (3.4%), and the rest were from other ethnic languages. The pattern of tobacco use was, smoking only (32.58%), chewing Paan (37.07%), using Naswar (14.60%), while the rest (15.73%) chewed and smoked in combination. Conclusion: This study revealed that depressive disorder has co-morbidity of tobacco use invariably among younger married males. Contrary to the western pattern, majority of the cases were using tobacco in forms other than smoking only.