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ORIGINAL ARTICLE
Armaan Mishra, Arpita Priyadarshini

Nocturnal Gastroesophageal Reflux Disease and Microarousals in Obstructive Sleep Apnea

[Year:2018] [Month:April-June] [Volumn:13 ] [Number:2] [Pages:18] [Pages No:21-24][No of Hits : 55]


ABSTRACT

Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with a high frequency of gastroesophageal reflux and arousals. Nocturnal gastroesophageal reflux (nGER) is strongly associated with sleep disturbances and disturbed sleep results in increased nocturnal gastroesophageal reflux.

Objectives: It was aimed to study the prevalence of nocturnal gastroesophageal reflux in obstructive sleep apnea (OSA). In our study, we sought to evaluate the correlation between the frequency and type of arousals and episodes of nGER in OSA cases.

Materials and Methods: We conducted an observational study among sixty patients already diagnosed with OSA on the basis of standard sleep criteria. Demographic data, anthropometric measurements, and detailed medical history were recorded. All subjects underwent polysomnography study and filled out the validated Gastroesophagal disease-health related quality of life questionnaire (GERD-HRQL). Statistical analysis was done by the multivariate regression model.

Results: There was a strong significant correlation between apnea-hypopnea index (AHI) and GERD score. (r = 0.544, p = 0.002). Moreover, respiratory arousal index was also significantly correlated with GERD score (r = 0.370, p = 0.040). It was found that AHI was a strong predictor of GERD with a significant regression model (p < 0.002, r2 = 0.0272). Respiratory arousal index (RAI) was responsible for 13.7% (r2 = 0.137) variance which was statistically significant p = 0.040 (p < 0.05). Desaturation index (DI) also predicted significantly about the gastroesophageal reflux (p = 0.005).

Conclusion: The present results suggest that the occurrence of arousals was related to episodes of nGER in OSA.

Funding: This study was part of Short Term Research Studentship (STS) program of the Indian Council of Medical Research (ICMR).

Keywords: Microarousals, nGER, OSAS

How to cite this article: Mishra A, Priyadarshini A. Nocturnal Gastroesophageal Reflux Disease and Microarousals in Obstructive Sleep Apnea. Indian Sleep Med 2018;13(2): 21-24.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ravi Dosi, Priyanshu Jain, Arpit Jain, Satish Motiwale, Prakash Joshi

Noninvasive Ventilation Therapy: Practical issues in the Domiciliary use

[Year:2018] [Month:July-September] [Volumn:13 ] [Number:3] [Pages:17] [Pages No:39-41][No of Hits : 47]


ABSTRACT

Noninvasive ventilation (NIV) therapy has become the standard of care for home therapy of patients suffering from sleep apnea and chronic Type 2 respiratory failure. We did a retrospective study of a patient admitted with the exacerbation of these disease despite of being advised home NIV therapy. The study was performed in a tertiary care institute in the past 2 years.
A total of 186 patient of chronic respiratory failure were studied who were prescribed NIV, out of which 96 patients who adhered to NIV were followed, and reasons of readmission and practical issues were studied. All the patient admitted to respiratory and general intensive care unit (ICU) were included, who needed a stay of more than 5 days. Out of 96 patients, 30 patients are of severe sleep apnea, and 25 patients are of severe chronic obstructive pulmonary disease (COPD). The most common cause of such patients going into respiratory failure after use of NIV being recurrent infection and poor willingness to continue with NIV due to psychological and medical reasons. Commonly seen medical reasons were ulcer over the bridge of the nose; inability to sleep with a mask on and feeling of suffocation with the mask. Psychological reasons include depression symptoms and a feeling of loneliness. We recorded that patient with regular follow up; the active role played by younger family members and patient on nasal mask had better outcome results as compared to their medical counterparts.

Keywords: Compliance, Domiciliary use, NIV.

How to cite this article: Dosi R, Jain P, Jain A, Motiwale S, Joshi P. NIV Therapy: Practical issues in the Domiciliary use. Indian Sleep Med 2018;13(3):39-41.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ravi Dosi, Arpit Jain, Priyanshu Jain, Satish Motiwale, Prakash Joshi

Role of IOS in Assessing the Improvement of Obstructive Component in Moderate to Severe Obstructive Sleep Apnea Hypopnea Syndrome

[Year:2018] [Month:April-June] [Volumn:13 ] [Number:2] [Pages:18] [Pages No:25-28][No of Hits : 41]


ABSTRACT

Introduction: Impulse oscillometry (IOS), a simple, noninvasive method using the forced oscillation technique, requires minimal patient cooperation and is suitable for use in both children and adults. This method can be used to assess obstruction in the large and small peripheral airways.

Aim: To study impulse oscillometry measurements in cases of moderate to severe sleep apnea.

Materials and Methods: A study was performed in Department of Respiratory Medicine, Sri Aurobindo Institute of Medical Sciences. Thirty patients diagnosed with severe sleep apnea underwent home noninvasive ventilation therapy. Pre- and post treatment noninvasive ventilation (NIV) impulse oscillometry was given to these patients.

Results: The pre-NIV spirometry showed predominant mixed pattern of disease with Impulse oscillometry showing reduced R25 and R5 levels. Post 3 months of noninvasive ventilation therapy with > 80% compliance demonstrated improvement in R25 parameters.

Conclusion: Respiratory resistance and reactance measured by Impulse oscillometryare abnormal in preobese and obese obstructive sleep apnea hypopnea syndrome (OSAHS) patients, and these parameters are closely correlated with OSAHS severity. Impulse oscillometrymight be a useful screening tool for detecting OSAHS in clinic based populations.

Keywords: IOS, NIV, OSAHS, Spirometry.

How to cite this article: Dosi R, Jain A, Jain P, Motiwale S, Joshi P. Role of IOS in Assessing the Improvement of Obstructive Component in Moderate to Severe Obstructive Sleep Apnea Hypopnea Syndrome. Indian Sleep Med 2018;13(2):25-28.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Rohit Kumar, Jagdish C Suri, Manas K Sen

Sleep Disorders in Kidney Diseases

[Year:2018] [Month:April-June] [Volumn:13 ] [Number:2] [Pages:18] [Pages No:29-35][No of Hits : 41]


ABSTRACT

Sleep disorders are common, multi-factorial and often underrecognized in patients with renal diseases. Sleep disorders have a negative impact on the wellbeing and quality of life. Medical literature in the past few years has documented many definitive associations between kidney diseases and various sleep disorders. Prompt referral to a sleep medicine specialist for further evaluation is warranted in this group of patients at the earliest suspicion of an insidious sleep disorder. In this review, we will discuss the common sleep disorders seen in patients with kidney disorders-the restless leg syndrome/Willis-Ekbom disease (RLS/WED), sleep-disordered breathing (SDB), insomnia disorder, hypersomnolence disorder, circadian rhythm sleep-wake disorders (CRSWDs) and parasomnias.

Keywords: Kidney disease, Renal Failure, Sleep apnoea

How to cite this article: Kumar R, Suri JC, Sen MK. Sleep Disorders in Kidney Diseases. Indian Sleep Med 2018;13(2):29-35.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Kalyan Maity, SK Rajesh, V Sureshbabu Venkatasamy

Efficacy of Sleep Special Technique on Young Healthy Yoga Practitioners

[Year:2018] [Month:July-September] [Volumn:13 ] [Number:3] [Pages:17] [Pages No:42-47][No of Hits : 40]


ABSTRACT

Background: Sleep is an indicator of health. Sleep determine many aspects of our life like mood, cognitive functions such as attention and working memory, homeostasis, learning, concentration, etc. Sleep is very essential for the academic progress in college students, whereas most of the sleep-related problems are found in college students worldwide.

Aim: This study aimed to evaluate the positive effect of sleep special technique (SST) on sleep quality, stress level and quality of life in young healthy yoga practitioners.

Materials and Methods: A total of 120 healthy male yoga practitioners were screened and N = 94 were randomly allocated into two groups, experimental group N = 47, and control group N = 47. Experimental group practiced 1 month of (SST), and the control group had no exposure to SST.

Variables Measured: Pittsburgh sleep quality index (PSQI), perceived stress scale (PSS), World Health Organization quality of life-BREF (WHOQOL-BREF), and the vedic personality inventory (VPI)

Results: After one month of SST result showed the significant reduction of the global PSQI score (p < 0.001***), perceived stress scale (p < 0.001***), and considerable improvement in all domains of QOL (p < 0.001***), Sattva guna (p < 0.001***) in the experimental group compared to the control group.

Conclusion: A one-month course of SST has a significantly positive effect on overall sleep quality, quality of life and perceived stress. The transition towards sattva guna was evident during the course of SST intervention.

Keywords: College students, Sleep, Yoga, Young adults

How to cite this article: Maity K, Rajesh SK and Venkatasamy VS. Efficacy of Sleep Special Technique on Young Healthy Yoga Practitioners. Indian Sleep Med 2018;13(3):42-47.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Ketaki Utpat, Unnati Desai, Jyotsna M Joshi

Obstructive Sleep Apnea and Diabetes Mellitus: A Bitter Combo

[Year:2018] [Month:July-September] [Volumn:13 ] [Number:3] [Pages:17] [Pages No:48-52][No of Hits : 39]


ABSTRACT

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder (SRBD) hallmarked by upper airway collapsibility and obstruction leading to nocturnal hypoxia and sleep arousals. Diabetes mellitus (DM) is a chronic medical malady which stems from an aberration in the glucose metabolism leading to multisystemic complications and eventually ends organ damage. Both these disorders are independently major public health concerns by virtue of their momentous morbidity, mortality and healthcare albatross. The liaison between these two leviathans is enigmatic and multifarious. Prima facie they share a common predisposing factor of obesity. OSA is associated with impairment of glucose metabolism and predisposes the individual to the development of DM.
Moreover DM serves as a risk factor for OSA in conjunction with the other components of the metabolic syndrome. Untreated DM leads to aggravation of the severity of OSA while untreated OSA leads to suboptimal glycemic control and propagates complications of DM. This intricate relationship between DM and OSA is a fertile and deficiently fathomed terrain for contemplative research. We hereby make a humble endeavor to decipher and simplify the Daedalean association.

Keywords: DM, OSA, SRDB

How to cite this article: Utpat K, Desai U, Joshi JM. Obstructive Sleep Apnea (OSA) and Diabetes Mellitus: A Bitter Combo. Indian Sleep Med 2018;13(3):48-52.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Mahismita Patro, Dipti Gothi, Ram B Sah, Sammer Vaidya

Mirtazapine Induced Parasomnia Overlap Disorder

[Year:2018] [Month:April-June] [Volumn:13 ] [Number:2] [Pages:18] [Pages No:36-38][No of Hits : 38]


ABSTRACT

A 70-year-old non-addict man with the history of diabetes, hypertension and allergic rhinitis was referred for abnormal behavior during the night. The behaviors included shouting, punching, walking during sleep, leaving the house and dream enactment. He also had history of snoring and excessive daytime sleepiness, suspicious of obstructive sleep apnea (OSA). He was suffering from depression for which he was on antidepressants, i.e., mirtazapine, sertraline and olanzapine by a psychiatrist. The abnormal sleep behaviors developed after start of mirtazapine. After ruling out all other causes, he was finally diagnosed to be suffering from drug-induced parasomnia overlap disorder (POD) caused by mirtazapine along with OSA based on international classification of sleep disorders-3rd edition (ICSD-3). He had resolution of the parasomnia episodes after stoppage of mirtazapine.

Keywords: Nonrapid eye movement (NREM) parasomnia, POD, Rapid eye movement (REM), Sleep behaviour disorder (RBD)

How to cite this article: Patro M, Gothi D, Sah RB, Vaidya S. Mirtazapine Induced Parasomnia Overlap Disorder. Indian Sleep Med 2018;13(2):36-38.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Unnati Desai, Jyotsna M Joshi

Obstructive Sleep Apnea – Insomnia Overlap Syndrome

[Year:2018] [Month:January-March] [Volumn:13 ] [Number:1] [Pages:20] [Pages No:13-17][No of Hits : 34]


ABSTRACT

Sleep-disordered breathing and insomnia are the most common of the sleep disorders. Both these diseases are well defined, diagnosed and managed as per the current guidelines. The initial isolated reports of an overlap of these two diseases were published in the eighties. With newer studies post-2001, the existence of the comorbid obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) with insomnia has been increasingly recognized. This disease entity has been referred with diverse unstandardized terminologies. UARS is a variant nomenclature of OSA as per International Classification of Sleep Disorders- third edition (ICSD-3). We hereby address it as the OSA-insomnia overlap syndrome throughout the text and review literature. Alike the ununiform terminology, there is lack of clear textbook/guideline definitions, diagnosis, and management of the OSA-insomnia overlap syndrome. Both have an interlinked pathophysiology. The clinical features and evaluation of the OSA-insomnia overlap syndrome share similarities to the diseases in isolation with exacerbation of overlapping features. An active search for the diagnosis of the overlap syndrome in patients visiting the sleep apnea clinic and insomnia clinic is mandatory as the identification helps in optimizing the management and difficulties in poor responders/ failures. Continuous positive airway pressure (CPAP) therapy with cognitive/behavior therapy for insomnia (CBTi) is the treatment of choice. A lot is yet to surface in the research of the OSA-insomnia overlap syndrome.

Keywords: CBT, CPAP, Insomnia, OSA, Overlap, SDB

How to cite this article: Desai U, Joshi JM. Obstructive Sleep Apnea-Insomnia Overlap Syndrome. Indian Sleep Med 2018;13(1):13-17.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ankit Arora, Sahil Gagnani, Gaurav Jain, Rahul Yadav

Rapidly Developing Obstructive Sleep Apnea due to Fixation Failure of Atrophic Mandibular Bilateral Body Fractures

[Year:2018] [Month:January-March] [Volumn:13 ] [Number:1] [Pages:20] [Pages No:18-20][No of Hits : 32]


ABSTRACT

Introduction: The aim of this report was to present a case of obstructive sleep apnea (OSA) in a 74-year-old male secondary to 2 mm miniplates fixation failure.

Method: The patient had a preoperative apnea/hypopnea index of 21 and was successfully treated by 2.4 mm reconstruction plate for bifocal mandibular fracture and thus treating OSA.

Results: At two years follow-up, the patient has been doing well with no signs and symptoms of OSA.

Discussion: Treatment of atrophic mandibular fractures can certainly be challenging. Elderly, infirm patients, unopposed muscle pull, diminished blood supply, bone inadequate qualitatively and quantitatively for osteosynthesis, and inadequate ridges for stable splints or prostheses all lead to treatment that is difficult and prone to failure. Bifocal fractures that involve the anterior dentate region of the mandible may cause the lingual displacement of the central proximal fragment. Therefore, they can epitomize an important risk for the upper airways. Bilateral body fracture in an edentulous mandible as a cause of OSA has never been reported in the literature. Here, we present such a case in a 74-years-old male patient who had a preoperative apnea/hypopnea index of 21 following the failed fixation from the original operation.

Keywords: Atrophic mandible, Bilateral parasymphyseal fracture, Obstructive sleep apnea, Reconstruction.

How to cite this article: Arora A, Gagnani S, Jain G, Yadav R. Rapidly Developing Obstructive Sleep Apnea due to Fixation Failure of Atrophic Mandibular Bilateral Body Fractures. Indian Sleep Med 2018;13(1):18-20.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Viswesvaran Balasubramanian, Jagdish C Suri

Obstructive Sleep Apnea in a Patient with Pulmonary Thromboembolism

[Year:2018] [Month:July-September] [Volumn:13 ] [Number:3] [Pages:17] [Pages No:53-56][No of Hits : 32]


ABSTRACT

Pulmonary embolism (PE) is a major manifestation of venous thromboembolism (VTE). Obstructive sleep apnea (OSA) leads to hypercoagulable state and may be associated with recurrent PE in the absence of deep vein thrombosis (DVT). Early identification and treatment of OSA may be helpful in reducing the recurrence of PE. Here, we report a case of OSA presenting with isolated PE without DVT with a brief mention of therapeutic implications.

Keywords: Obstructive sleep apnoea, Pulmonary embolism, Pulmonary thromboembolism.

How to cite this article: Balasubramanian V, Suri JC. Obstructive Sleep Apnea in a Patient with Pulmonary Thromboembolism. Indian Sleep Med 2018;13(3):53-56.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Yerra Anusha, Vabitha Shetty, Amitha M. Hegde

Correlation of Nutritional Status to Sleep Problems in School going Children: A Preliminary Study

[Year:2018] [Month:January-March] [Volumn:13 ] [Number:1] [Pages:20] [Pages No:1-4][No of Hits : 27]


ABSTRACT

Introduction: Sleep disturbances in children are found to be increasing over the past few years and the knowledge about their risk factors is limited among the medical and dental practitioners. Nutritional status could be one of the contributing factors for sleep problems in children.

Methodology: 500 school going children aged 4 to 10 years were included in the study. The sleep problems were assessed using a validated sleep questionnaire which was filled by the parents of the children and simultaneously the weight of the children was recorded. The data were documented and statistically analyzed.

Results: Sleep problems were found significantly higher in obese children. Also, a significant association was observed between obesity and the following sleep problems, i.e. snoring, observable lapses in breathing sleeps with mouth open and bed wetting.

Conclusion: Obesity can be considered as one of the risk factor for sleep problems in children.

Keywords: Nutritional status, School going children, Sleep problem

How to cite this article: Anusha Y, Shetty V, Hegde AM. Correlation of Nutritional Status to Sleep Problems in School Going Children: A Preliminary Study. Indian Sleep Med 2018;13(1):1-4.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Amit Bansal, B Jayan, Prasanna Kumar MP, Mohit Sharma, Sunil Kumar

Evaluation of Therapeutic Efficacy of Adjustable Mandibular Advancement Device in the Management of Obstructive Sleep Apnea

[Year:2018] [Month:January-March] [Volumn:13 ] [Number:1] [Pages:20] [Pages No:5-12][No of Hits : 26]


ABSTRACT

Introduction: Medical dental sleep appliance (MDSA) is an adjustable mandibular advancement device (MAD) recommended for treatment of snoring and obstructive sleep apnea (OSA). There are very few studies on Indian population which evaluate the therapeutic efficacy of mandibular advancement devices in the management of OSA.

Materials and Methods: A prospective clinical study was carried out. Twenty polysomnography diagnosed OSA patients fulfilling the inclusion and exclusion criteria were treated with MDSA and changes in pre and post-treatment sleep para-meters (apneahypopnea index (AHI) and epworth sleepliness scale (ESS)) were recorded.

Results: Mean differences in pre- (T1 = 30.7 ± 5.0) and posttreatment (T2 = 17.2 ± 3.9) AHI values and ESS pre-treatment (T1 = 17.2 ± 0.6) and post-treatment (T2 = 10.9 ± 0.9) were highly statistically significant (p < 0.001). Clinically the maximum improvement was observed in mild and moderate OSA cases. Although significant clinical improvement was also observed in severe OSA cases, the post-treatment AHI and ESS were still high.

Conclusion: MDSA is a non-invasive, low risk and cost-effective treatment option for patients suffering from mild and moderate obstructive sleep apnea and also in cases of severe OSA who are not comfortable with CPAP or not willing for surgery.

Keywords : AHI, ESS, MDSA, OSA

How to cite this article: Bansal A, Jayan B, Kumar PMP, Sharma M, Kumar S. Evaluation of Therapeutic Efficacy of Adjustable Mandibular Advancement Device in the Management of Obstructive Sleep Apnea. Indian Sleep Med 2018;13(1):5-12.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Gulshan Bano, Jagdish C Suri, HP Anand, Jyotsna Suri, Tulsi Adhikari

Sleep Disordered Breathing-induced Endothelial Dysfunction and Its Association with Fetomaternal Outcomes in Preeclampsia

[Year:2017] [Month:October-December] [Volumn:12 ] [Number:4] [Pages:23] [Pages No:53-59][No of Hits : 61]


ABSTRACT

Introduction: There is a close association between sleep disordered breathing (SDB) and preeclampsia (PE). Endothelial dysfunction (ED) is the common final pathway in the development of hypertension in both the conditions.

Materials and methods: Totally, 25 women with new-onset hypertension of pregnancy and 25 age-, body mass index (BMI)-, and gestational age-matched normotensive pregnant women were subjected to polysomnography (PSG) and EndoPAT test. The maternal and fetal outcomes of all the subjects were noted.

Results: The SDB and ED occur more frequently in PE (64 vs 24%; p = 0.01 and 72 vs 28%; p = 0.002 respectively) compared with normotensive pregnant women. Mean respiratory distress index (RDI) was higher (8.28 ± 7.9 vs 4.2 ± 2.7) and mean reactive hyperemic index (RHI) lower (1.46 ± 0.33 vs 1.88 ± 7.9; 0.001) in PE. The mean blood pressure (MBP) in cases tended to correlate positively with RDI and negatively with RHI. There was a significant negative correlation between RDI and RHI (r = -0.637; p = 0.001). About 87.5% of the cases who had SDB also had ED, whereas only 12.5% of the cases who did not suffer from SDB had an ED (p = 0.02), and this trend was also observed in the controls (p = 0.001). It was seen on subgroup analysis that the women with PE, who had both SDB and ED, had poorer maternal and fetal outcomes than those who had neither of the conditions.

Conclusion: The SDB and ED are closely associated with PE. The ED occurs more frequently and with greater severity in preeclamptic women who have SDB and is associated with adverse fetomaternal outcomes.

Keywords: Adverse fetal outcomes, Adverse maternal outcomes, Endothelial dysfunction, Preeclampsia, Sleep disordered breathing.

How to cite this article: Bano G, Suri JC, Anand HP, Suri J, Adhikari T. Sleep Disordered Breathing-induced Endothelial Dysfunction and Its Association with Fetomaternal Outcomes in Preeclampsia. Indian J Sleep Med 2017;12(4):53-59.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sameer Vaidya, Ram B Sah, Anchal Teotiya, Dipti Gothi

Evaluation of Sleep Disorders in Chronic Obstructive Pulmonary Disease Patients by Subjective Questionnaire and Their Correlation with FEV1, PaO2, and PaCO2

[Year:2017] [Month:October-December] [Volumn:12 ] [Number:4] [Pages:23] [Pages No:60-63][No of Hits : 61]


ABSTRACT

Introduction/objectives: Sleep disorders are common in chronic obstructive pulmonary disease (COPD). The commonly seen sleep disorders in COPD that can worsen the quality of sleep are insomnia, restless leg syndrome (RLS), obstructive sleep apnea (OSA), and nocturnal oxygen desaturation (NOD). However, these sleep disorders have not been studied in India.

Aim: (1) To determine the prevalence of sleep disorder in COPD patients with global sleep assessment questionnaire (GSAQ). (2) To confirm the presence of insomnia, depression, and RLS. (3) To assess the sensitivity and specificity of GSAQ with respect to insomnia, depression, and RLS. (4) Correlation of GSAQ with age, body mass index (BMI), forced expiratory volume in 1 second (FEV1), and partial pressure of arterial oxygen (PaO2) and carbon dioxide (PaCO2).

Materials and methods: A prospective study of 60 clinically stable COPD patients was undertaken. Patients were screened for sleep disturbances with the help of the GSAQ. All participants were further assessed with the insomnia, Unpleasant Sensation, Rest induced, Gets relieved on movement, Evening (URGE), and patient health quality 4 (PHQ4) questionnaire. Spirometry and arterial blood gas (ABG) analysis were done in all the patients.

Results: In the enrolled 60 patients, male:female ratio was 53:7. 33 (55%) and the patients were found to have positive GSAQ. Among them, 22 (66.67.%), 17 (57.57%), and 23 (69.69%) patients were suspected to have insomnia, RLS, and depression respectively. Some of them had overlap of two disorders. The overall sensitivity and specificity of GSAQ obtained by confirmatory questionnaire were 84.61 and 95.23% respectively. The difference in the mean age, BMI, PaO2, and PaCO2 among GSAQ-positive and egative patients was nonsignificant (p > 0.05). Though low BMI was present, hypercapnea and hypoxia were more commonly present in the GSAQ-positive group. The mean FEV1 (absolute value) in GSAQ-positive group was: 1.23 ± 0.53 L/min, while in the GSAQ-negative group, it was 1.68 ± 0.62 L/min. The difference was statistically significant (p – 0.0003) for FEV1 and its low value was found correlating with high chances of sleep disorders (GSAQ positive).

Conclusion: Sleep disorders are commonly seen in COPD patients. The majority of the patients had sleep disturbance due to insomnia. Patients with lower FEV1 have higher chances of sleep disturbance.

Keywords: Forced vital capacity in 1 second, Global sleep assessment questionnaire, Partial pressure of arterial carbon dioxide, Partial pressure of arterial oxygen, Patient health quality 4.

How to cite this article: Vaidya S, Sah RB, Teotiya A, Gothi D. Evaluation of Sleep Disorders in Chronic Obstructive Pulmonary Disease Patients by Subjective Questionnaire and Their Correlation with FEV1, PaO2, and PaCO2. Indian J Sleep Med 2017;12(4):60-63.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Sonam Spalgais, Dipti Gothi

Obstructive Sleep Apnea: New Concepts, Mechanism, and Therapy

[Year:2017] [Month:October-December] [Volumn:12 ] [Number:4] [Pages:23] [Pages No:64-72][No of Hits : 53]


ABSTRACT

Continuous positive airway pressure (CPAP) is the gold standard for the management of obstructive sleep apnea (OSA). However, studies have shown that only around half use the device at the minimum recommended level of ɥ4 hours/night. The compliance further drops to 17% after 5 years. Thus, there is need to develop and apply new modalities for the OSA. Also, if the treatment of OSA is directed toward the mechanism, the results are likely to be better. This review is aimed at mechanismdirected treatment for OSA.

Keywords: Mechanism, Newer treatment, Obstructive sleep apnea.

How to cite this article: Spalgais S, Gothi D. Obstructive Sleep Apnea: New Concepts, Mechanism, and Therapy. Indian J Sleep Med 2017;12(4):64-72.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Mahavir Munot, Ketaki Utpat, Unnati Desai, Jyotsna M Joshi

Central Sleep Apnea in Motor Neuron Disease with “Two-Can” Effect

[Year:2017] [Month:October-December] [Volumn:12 ] [Number:4] [Pages:23] [Pages No:73-76][No of Hits : 45]


ABSTRACT

Motor neuron disease (MND) is an umbrella term used to signify an assorted group of progressive neurologic disorders that cripple upper and lower motor neurons with axonal loss and gliosis. The MND classically presents as progressive muscle weakness, muscle atrophy, spasticity, and bulbar symptoms like dysarthria and dysphagia. The disease has a solemn course and a poor prognosis. Respiratory jeopardy is a run-of-the-mill phenomenon in this disease. It culminates from the combination of weakness of the pharyngeal and laryngeal muscles and the major respiratory muscles like diaphragm and intercostals. The upper airway flaccidity engenders the perpetuation of sleep disordered breathing (SDB) while the respiratory muscle weakness triggers lung physio-dynamic alterations and chronic respiratory failure. Hence, spirometry and polysomnography are vital tools in the diagnostic work-up. We hereby present an intriguing case of a patient with MND manifesting both these aspects of SDB and a peculiar spirometry pattern of a “two-can” effect!

Keywords: Central sleep apnea, Flow–volume loop, Spirometry.

How to cite this article: Munot M, Utpat K, Desai U, Joshi JM. Central Sleep Apnea in Motor Neuron Disease with “Two-Can” Effect. Indian J Sleep Med 2017;12(4):73-76.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
A Ghabeli Joubari, Fariborz R Talab, M Akbari Rad, Abdollah Firoozi, Fariba Rezaeetalab

Obstructive Sleep Apnea as the Initial Manifestation of Acromegaly

[Year:2017] [Month:April-June] [Volumn:12 ] [Number:2] [Pages:31] [Pages No:21-23][No of Hits : 43]


ABSTRACT

Obstructive sleep apnea syndrome (OSAS) is the most common type of sleep disorder, a chronic condition characterized by frequent episodes of upper airway obstruction during sleep. There are serious complications associated with this condition, varying from different respiratory complications, neuropsychiatric disturbances to increased risk of hypertension and cardiovascular disorders. The OSAS frequently occurs in acromegaly patients with a high prevalence rate of 20 to 50%. The symptoms of sleep apnea, including snoring, tiredness, and excessive daytime sleepiness, are often reversible with an appropriate treatment strategy. We report here a middle-aged woman with excessive snoring and severe headaches caused by sleep apnea as a first sign, years before definite diagnosis of acromegaly.

Keywords: Acromegaly, Sleep apnea, Sleep-disordered breathing.

How to cite this article: Joubari AG, Talab FR, Rad MA, Firoozi A, Rezaeetalab F. Obstructive Sleep Apnea as the Initial Manifestation of Acromegaly. Indian Sleep Med 2017;12(2):21-23.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Rohit K Pradhan, N Sinha

Level of Alpha Amylase Activity in Human Saliva as Noninvasive Biochemical Marker of Sleep Deprivation

[Year:2017] [Month:April-June] [Volumn:12 ] [Number:2] [Pages:31] [Pages No:1-6][No of Hits : 41]


ABSTRACT

Every section of our round-the-clock society is plagued with the problem of sleep deprivation. Genetic studies conducted on lower organism have revealed that the measurement of salivary alpha amylase (sAA) levels could be a useful noninvasive diagnostic tool for the assessment of sleepiness in human beings. But the reports at population level are still lacking. The present study was conducted longitudinally over a period of 2 years and was targeted upon the adolescent school-going students whose sleep requirements and obtained sleep duration differs widely due to school timings, assignments, and social activities. Totally, 168 healthy school-going adolescents studying in ninth grade were selected randomly from morning shift (n = 84) and dayshift (n = 84) schools. The study encompassed administration of questionnaire and collection of saliva samples from the participants. Salivary alpha amylase activity was estimated spectrophotometrically and statistical analysis was performed in order to determine its association with sleep duration and sleepiness level. Findings reveal that sAA could be the most appropriate noninvasive biochemical marker for the objective assessment of sleep deprivation among individuals as well as at population level.

Keywords: Adolescents, Excessive daytime sleepiness, Salivary alpha amylase, Sleep deprivation.

How to cite this article: Pradhan RK, Sinha N. Level of Alpha Amylase Activity in Human Saliva as Noninvasive Biochemical Marker of Sleep Deprivation. Indian Sleep Med 2017;12(2):1-6.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Abhijeet Kadu, Balakrishnan Jayan, Reena R Kumar, Oommen Nainan, Probod K Chattopadhyay

Strategies for integrating Sleep Medicine in Dental Practice and Postgraduate Training

[Year:2017] [Month:July-September] [Volumn:12 ] [Number:3] [Pages:19] [Pages No:33-38][No of Hits : 38]


ABSTRACT

Dentistry’s entry into the management of upper airway sleep disorders has led to the development of a new specialty, i.e., dental sleep medicine. This specialty involves oral appliance therapy (OAT) for obstructive sleep apnea (OSA) and snoring, maxillomandibular advancement surgeries to increase upper airway volume, assessment of craniofacial risk factors, cephalometric studies for craniofacial and airway evaluation, and prevention of sleep-disordered breathing (SDB) in children. Dentists trained in dental sleep medicine, orthodontists, and maxillofacial surgeons are recognized members of interdisciplinary team to manage upper airway sleep disorders. So it is of paramount importance for dental students and orthodontists to familiarize with the basic knowledge of upper airway sleep disorders and its management in order to contribute effectively in managing those affected patients. There is need to integrate dental sleep medicine in postgraduate orthodontic curriculum. The current status of this new and challenging discipline in India, the Armed Forces Medical College and Army Dental Centre (Research and Referral) experience, and strategies to build capacity are discussed in this article.

Keywords: Dental practice, Postgraduate training, Sleep medicine.

How to cite this article: Kadu A, Jayan B, Kumar RR, Nainan O, Chattopadhyay PK. Strategies for integrating Sleep Medicine in Dental Practice and Postgraduate Training. Indian J Sleep Med 2017;12(3):33-38.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Rohit Kumar, Jagdish C Suri, Manas K Sen

Drug-induced Sleep Endoscopy

[Year:2017] [Month:April-June] [Volumn:12 ] [Number:2] [Pages:31] [Pages No:15-20][No of Hits : 37]


ABSTRACT

Obstructive sleep apnea (OSA) is a common disorder with significant associated morbidity. Though continuous positive airway pressure (CPAP) has been the treatment of choice, it has poor acceptability. Alternative therapies include surgery or oral appliances. A meticulous assessment of the airway is needed before these alternative therapies can be tailored to their specific needs. Drug-induced sleep endoscopy (DISE) provides a detailed visual description of the sites of upper airway obstruction and may conclusively lead to a better choice of therapy resulting in the wider use of this endoscopic examination in dedicated sleep centers. This review discusses the indication, procedure, and the controversies regarding DISE.

Keywords: Drug-induced sleep endoscopy, Endoscopy, Obstructive sleep apnea, Sedation.

How to cite this article: Kumar R, Suri JC, Sen MK. Druginduced Sleep Endoscopy. Indian Sleep Med 2017;12(2):15-20.

Source of support: Nil

Conflict of interest: None


 
JOURNAL SCAN

Description, Compiled by U. C. Ojha

[Year:2017] [Month:April-June] [Volumn:12 ] [Number:2] [Pages:31] [Pages No:24-31][No of Hits : 33]


ABSTRACT

The main characteristics of sleep-disordered breathing (SDB) are airflow limitation, chronic intermittent hypoxia, or apnea, which may lead to tissue hypoperfusion and recurrent arousal from sleep. These episodes of hypoxia or apnea can lead to tissue inflammation and are causal factors of disturbed sleep in both men and women. Several lines of evidence suggest that sleep patterns differ along the lifespan in both male and female subjects, and this may result from the influence of female gonadotropic hormones on sleep.


 
ORIGINAL ARTICLE
Renuka Balu, Uttumadathil G Unnikrishnan, Madhumita Kumar

Correlation of Body Habitus with Severity of Obstructive Sleep Apnea: A Prospective Study from a Single Institution

[Year:2017] [Month:April-June] [Volumn:12 ] [Number:2] [Pages:31] [Pages No:7-11][No of Hits : 28]


ABSTRACT

Objectives: To correlate body habitus with severity of obstructive sleep apnea (OSA) in Indian subjects.

Subjects: Prospective study. Consecutive patients with OSA during the period 2013 to 2016 were included.

Materials and methods: Body mass index (BMI), neck circumference (NC), and Epworth sleepiness scale (ESS) were recorded and their association with severity of OSA as graded by apnea-hypopnea index (AHI) was analyzed.

Results: Totally 100 patients were included; 91 were male. Mean age was 46.58 ± 12.92 years. Abnormal BMI, NC, and ESS were observed in 67.3, 33.6 and 52.7% respectively. Moderate and severe forms of OSA were found in 26 and 54% respectively. Severe OSA was more common in men (56 vs 33.3%; p = 0.15). There was a strong correlation of OSA with BMI (r = 0.378; p < 0.001), NC (r = 0.502; p < 0.001), and ESS (r = 0.304; p = 0.002).

Conclusions: Obstructive sleep apnea in Indian patients has strong correlation with male sex and indices of body habitus.

Keywords: Apnea-hypopnea index, Body mass index, Neck circumference, Obstructive sleep apnea.

How to cite this article: Balu R, Unnikrishnan UG, Kumar M. Correlation of Body Habitus with Severity of Obstructive Sleep Apnea: A Prospective Study from a Single Institution. Indian Sleep Med 2017;12(2):7-11.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Racheal Fernandes, Preeti Devnani

Role of Sleep in Memory

[Year:2017] [Month:April-June] [Volumn:12 ] [Number:2] [Pages:31] [Pages No:12-14][No of Hits : 25]


ABSTRACT

Sleep is essential to our survival. The various stages of sleep play a significant role in brain maturation. Memory is an important essential feature of the human brain. Memory is information that is encoded, retained, and recalled. This review summarizes various subtypes of memory and provides insight into the role of sleep in the formation of memory and the impact of sleep deprivation.

Keywords: Memory formation, Sleep deprivation and memory.

How to cite this article: Fernandes R, Devnani P. Role of Sleep in Memory. Indian Sleep Med 2017;12(2):12-14.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sapna E Sreedharan, Pragati Agrawal, Chembakode A Anees, MJ Pradeep, P Sankara Sharma, Ashalatha Radhakrishnan

Diabetics with Obstructive Sleep Apnea need Higher Positive Airway Pressures

[Year:2017] [Month:July-September] [Volumn:12 ] [Number:3] [Pages:19] [Pages No:39-43][No of Hits : 25]


ABSTRACT

Introduction: Continuous positive airway pressure (CPAP) is the only proven therapy for moderate to severe obstructive sleep apnea syndrome (OSAS). The CPAP requirements can widely vary among individuals. We studied the demographic, clinical, and polysomnographic (PSG) predictors of high CPAP requirement (pressures >10 cm H2O) in a cohort of patients with OSAS.

Materials and methods: Consecutive patients with PSG-proven moderate to severe OSAS attending the Sleep Clinic, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, were prospectively recruited for the study from November 2014 till October 2015. After informed consent, demographic data, risk factor profile, and PSG data were extracted using a structured pro forma. All the patients underwent overnight CPAP titration in the sleep laboratory as per guidelines. The patients were grouped into two, those requiring CPAP ≤ 10 and >10 cm H2O. Pearson correlation and chi square tests were used to study the association between variables.

Results: A total of 64 patients (55 male, 9 female) with OSAS underwent CPAP titration during the study period. Mean age of the study group was 53.81 ± 12.01 (26.85 years) and majority were overweight by Asian standards [mean body mass index (BMI) 29.31 ± 5.01]. Mean apnea-hypopnea index (AHI) of the cohort was 62.28. Average CPAP requirement was 11.82 cm H2O. We found that neck circumference, presence of diabetes mellitus (DM), and AHI severity were independent predictors for higher PAP requirements, while gender, BMI, and other vascular risk factors were not predictive of high PAP requirements.

Conclusion: Diabetes mellitus and neck circumference are better predictors of higher CPAP requirements in Indian population than BMI. Those with higher AHI required more pressures while apnea duration failed to show an association with higher PAP.

Keywords: Diabetes mellitus, Neck circumference, Obstructive sleep apnea, Positive airway pressure therapy.

How to cite this article: Sreedharan SE, Agrawal P, Anees CA, Pradeep MJ, Sharma PS, Radhakrishnan A. Diabetics with Obstructive Sleep Apnea need Higher Positive Airway Pressures. Indian J Sleep Med 2017;12(3):39-43.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
A Elavarsi, Garima Shukla

Sleep Disorders in Parkinson’s Disease

[Year:2017] [Month:July-September] [Volumn:12 ] [Number:3] [Pages:19] [Pages No:44-48][No of Hits : 23]


ABSTRACT

Sleep disorders in Parkinson’s disease (PD) have been recognized as one of the nonmotor symptoms of PD and is the common cause of poor quality of life in these patients, as motor symptoms are very well controlled by drugs as well as deep brain stimulation. Assessment and treatment of these disorders are essential for optimal management of the disease. This article presents a brief overview of various disorders and how to approach them.

Keywords: Excessive daytime sleepiness, Insomnia, Parkinson disease, Rapid eye movement sleep behavior disorder, Sleep.

How to cite this article: Elavarasi A, Shukla G. Sleep Disorders in Parkinson’s Disease. Indian J Sleep Med 2017;12(3):44-48.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Zia Hashim, Loveleen Mangla, Garima Shukla, Anupama Gupta, Alok Nath, Ravi Mishra

Hypersomnolence among Adolescents: Narcolepsy an Often Misdiagnosed Condition

[Year:2017] [Month:July-September] [Volumn:12 ] [Number:3] [Pages:19] [Pages No:49-52][No of Hits : 22]


ABSTRACT

Hypersomnolence is becoming an important problem in adolescents because of the change of lifestyle. Narcolepsy is a chronic and incurable sleep disorder, classically presenting with excessive daytime sleepiness associated with cataplexy, hypnagogic hallucinations, sleep paralysis and nocturnal sleep fragmentation. It’s most common presenting symptom and essential feature is excessive daytime sleepiness. Diagnosis is often missed in India because of lack of proper sleep labs and training to diagnose this disorder
This case highlights the need to keep Narcolepsy among the common differentials for adolescents presenting with excessive daytime sleepiness, while also looking for other common causes of the same. A detailed approach to the same is also discussed.

Keywords: Adolescent, Hypersomnolence, Multiple sleep latency test, Sleep, Type II narcolepsy.

How to cite this article: Hashim Z, Mangla L, Shukla G, Gupta A, Nath A, Mishra R. Hypersomnolence among Adolescents: Narcolepsy an Often Misdiagnosed Condition. Indian J Sleep Med 2017;12(3):49-52.

Source of support: Nil

Conflict of interest: None


 
Case Report
SS Agarwal, B Jayan, NK Sahoo, ID Roy, K Nehra and Mohit Sharma

Mandibular Corpus Distraction Osteogenesis for the Management of Severe Obstructive Sleep Apnea Secondary to Bilateral Temporomandibular Joint Ankylosis: A Case Report

[Year:2017] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:39] [Pages No:12-18][No of Hits : 12]


ABSTRACT

Dentistry is witnessing the entry of a relatively new field - management of simple snoring and Obstructive Sleep Apnea (OSA). OSA comprises of repetitive episodes of cessation of breathing during sleep due to upper airway collapse. It leads to symptoms like excessive daytime sleepiness and is often associated with various cardiovascular, neurological and other health problems1. The mortality rate for untreated severe OSA cases is about 30% at 15 years2.


 
Review Article
Dipti Gothi and Sonam Spalgais

COPD with hypoxemia- CPAP, LTOT, NIVWhen How What: Review

[Year:2017] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:39] [Pages No:5-11][No of Hits : 9]


ABSTRACT

Daytime hypoxemia in chronic obstructive pulmonary disease (COPD) patients is common. The causes of daytime hypoxemia are varied and are linked to nocturnal breathing disorders.These nocturnal breathing disorders of COPD are: 1) obstructive sleep apnoea (OSA), 2) nocturnal oxygen desaturation (NOD) without CO2 retention and 3) nocturnal hypoventilation. OSA with COPD i.e. overlap syndrome is seen in overweight rather than obese patients. They do not have excessive daytime sleepiness unlike OSA alone hence it is easily missed. Continuous positive airway pressure (CPAP) is the treatment of choice in these patients. Nocturnal oxygen desaturation without CO2 retention is due to V/Q mismatch and is seen in those with respiratory COPD phenotype. Long-term oxygen therapy (LTOT) alone is adequate for patients who develop consequent daytime hypoxemia. Contrarily, daytime hypoxemia due to nocturnal hypoventilation is seen in systemic COPD phenotype and it responds to non-invasive ventilator (NIV) with LTOT. This review is aimed at deciding if CPAP, LTOT or NIV with LTOT is required in COPD patients with daytime hypoxemia.


 
Journal Scan
U. C. Ojha

Journal Scan

[Year:2017] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:39] [Pages No:35-39][No of Hits : 6]


ABSTRACT

OBJECTIVE: To develop and validate a Seven Emotions Impairment questionnaire (SEIQ), to define an optimum cut-off point for the SEIQ, and to examine whether SEI was predictive of Phlegm and Blood Stasis (BS).


 
Original Article
Swapnil Manaji Thorve, Vishwas Gupta and Pralhad Prabhudesai

Cardiovascular Effects of Obstructive Sleep Apnoea Syndrome

[Year:2017] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:39] [Pages No:19-28][No of Hits : 6]


ABSTRACT

Introduction: Obstructive sleep apnoea syndrome affects 4% men and 2% women. It is the most common sleep disordered breathing and is associated with recurrent episodes of upper airway collapse during sleep. Arousal from sleep is required to re-establish the airway patency. This distortion of sleep pattern, repetitive awakening and nocturnal hypoxia lead to pulmonary and systemic hypertension as well as other cardiac and metabolic complications. Cardiovascular disturbances like systemic hypertension, acute myocardial infarction, nocturnal arrhythmias, corpulmonale and sudden nocturnal death are serious complications of obstructive sleep apnoea syndrome.

Aim: To study the association between cardiovascular abnormalities/ cardiovascular risk factors and apnoea hypopnoea index (AHI) in patients diagnosed with obstructive sleep apnoea syndrome.

Methods and Material: 50 patients diagnosed with obstructive sleep apnoea syndrome were divided in to 3 grades-mild, moderate and severe OSAS as per American Academy of Sleep Medicine. Patients were interviewed in detail, clinically examined and investigated (random blood sugar, lipid profile, thyroid function tests chest roentgenogram, ECG and 2D echocardiogram). On basis of history, examination and investigations patients were diagnosed of having hypertension, diabetes mellitus, hypothyroidism, hyperlipidemia and ischaemic heart disease. The prevalence of these associated disease with OSAS and its statistical association with grades of severity of OSAS was calculated.

Statistical Analysis: Frequency and Percentage table, association among study group: Chi-Square test and Fisher Exact test.

Results: In our study the prevalence of hypertension was 48%, diabetes mellitus was 38%, hypothyroidism was 18%, hyperlipidaemia was 30% and ischaemic heart disease was 34%. 24% patients of OSAS in our study had history of smoking. 24% patients has ST-T changes on electrocardiogram, 18% had left ventricular hypertrophy and 18% had left ventricular ejection fraction less than 45% on 2D echocardiography. The prevalence of Pulmonary hypertension was 30%. Statistically significant co-relation was observed between hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart disease with grades of severity of OSAS.

Conclusions: Cardiovascular abnormalities and risk factors are more common in obstructive sleep apnoea patients and hence patients should undergo periodic evaluation.

Keywords: Hypertension, diabetes mellitus, hypothyroidism, cardiovascular abnormalities, hyperlipidaemia


 
Review Article
Deepak Shrivastava

Health Effects of Acute and Chronic Sleep Deprivation in Different Age Groups

[Year:2017] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:39] [Pages No:1-4][No of Hits : 6]


ABSTRACT

Sleep deprivation is becoming more common in our society today. Nearly 50 to 70 million Americans experience a deficiency in sleep1. This is a substantial increase compared to several decades ago and may be partly attributed to modern work, education, and lifestyle demands. While some people have environmental factors to blame for their poor sleep, others suffer from a variety of medical conditions that inhibit their ability to achieve a full night of restful sleep, including sleep apnea, restless leg syndrome, and insomnia2. No matter what the reason may be for getting less sleep, recent studies have shown that sleep deprivation has a number of health manifestations.


 
Original Article
Fariborz Rezaeitalab, Amir Rezaei Ardani, Yalda Ravanshad, Fariba Rezaeetalab, Mohammad Reza Sobhani and Saeidehanvari

A Comparison of Sleep Apnea Syndrome in Military Veterans with Control Group

[Year:2017] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:39] [Pages No:29-34][No of Hits : 5]


ABSTRACT

Introduction: Sleep is frequently complicated in military veterans with post-traumatic stress disorder (PTSD). Obstructive sleep apnea (OSA), a common sleep disordered breathing which affects mostly middle aged men, may be an important reason for sleep disturbances symptoms in military veterans. This study was conducted to compare the clinical features and polysomnographic parameters of OSA in PTSD veterans and control group.

Materials: 26 PTSD veterans diagnosed with OSA by standard polysomnography were studied. Body mass index (BMI) was recorded and Epworth Sleepiness Scale, a questionnaire for evaluation of daytime sleepiness was applied. The control group was consisting of men matched for age who diagnosed also with OSA.

Results: The mean age of veterans was 53.73 ± 8.7, and of the control group was 52.11 ± 6.2 years. The most common initial complaint in veterans was insomnia (57.5%) following by aggressiveness (14.5%), while non-veterans mostly complained from snoring (53.8%) and sleepiness (23%). Apnea-hypopnea index (AHI) was on average 38.8 ± 27.2. Mean BMI of veterans was 28.5 ± 5.7 and it was not related with AHI.

Conclusions: Unlike most of patients with sleep apnea, veterans mainly complain of insomnia and aggression. Moreover, BMI cannot predict the severity of sleep apnea in such patients. Therefore, it is recommended that veterans should be carefully investigated for OSA, even in the absence of typical presentation of OSA.


 
Case Report
Samhita Panda

Pediatric Narcolepsy Masquerading as Acute Insomnia

[Year:2016] [Month:July-September] [Volumn:11 ] [Number:3] [Pages:33] [Pages No:114-117][No of Hits : 11]


ABSTRACT

Narcolepsy, a disorder of the borderline between wakefulness and sleep is rarely diagnosed in the pediatric population. This is despite the fact that majority of narcoleptic signs and symptoms begin in the second decade. Misdiagnosis and delayed diagnosis inadvertently leads to increased social and economic burden on the children and their families with interference in normal mental and physical well being and academic performance. The commonest cardinal symptom of narcolepsy is excessive daytime sleepiness. However, patients with narcolepsy have significantly disturbed sleep patterns and may have associated mood disorders. This report describes a child presenting with acute insomnia who was found to have narcolepsy.

Keywords: Narcolepsy, insomnia, paradoxical insomnia, early morning awakening, sleep perception


 
Review Article
B Jayan, Abhijeet Kadu and Reena Ranjith Kumar

Airway Centric Orthodontics : A View Point

[Year:2016] [Month:July-September] [Volumn:11 ] [Number:3] [Pages:33] [Pages No:89-94][No of Hits : 10]


ABSTRACT

Airway Centric Orthodontics is a philosophy which trumps everything else in contemporary Orthodontics. The philosophy focuses on practice of clinical orthodontics aimed at achieving ideal jaw relationship, establish normal oral function and performance, optimal proximal and occlusal contact of teeth. The central aspect of function and performance is airway and breathing which in fact is hierarchically the most important function for humans. Ideal health and ideal facial development is dependent on correct tongue posture and nasal breathing. Therefore contemporary protocols be it Preventive, interceptive or corrective orthodontics should factor upper airway improvement in addition to improving smile and facial appearance. Today Orthodontic profession is crucial and integral part of the interdisciplinary team in the management of upper airway sleep disorders, thus well poised to become a part of mainstream health profession. The paper would revisit the decision making process in orthodontics and discuss orthodontic strategies to improve the vital human airway which is essential for good health, longevity, and well-being.

Keywords: Airway, malocclusion, orthodontics


 
Review Article
Deepak Shrivastava

Childhood Adenoidectomy and Tonsillectomy (CHAT) Randomized Controlled Trial: Impact on the Management of Obstructive Sleep Apnea in Children

[Year:2016] [Month:April-June] [Volumn:11 ] [Number:2] [Pages:40] [Pages No:47-50][No of Hits : 10]


ABSTRACT

The results of the first randomized controlled trial popularly known as Childhood adenoidectomy and tonsillectomy (CHAT) in otherwise healthy children of older age (five to nine years) are at best intriguing. These subjects diagnosed with mild to moderate Obstructive sleep apnea (OSA) by polysomnography (PSG) underwent the recommended first line treatment adenotonsillectomy (AT) or watchful waiting. AT provided benefit in terms of quality of life, improvement in symptoms and behavior. There is high quality evidence that AT is beneficial in terms of improvement in PSG parameters. On the contrary, high quality evidence indicates lack of benefit in objective measures of attention and neurocognitive performance compared with watchful waiting. Since its publication, CHAT database has been used for many follow up randomized trials with assessment of cardio-metabolic and demographic variables, respiratory parameters, complication rates, and weight gain.


 
Review Article
Sachit Anand Arora, Shivjot Chhina, Anjali Goel, Shivesh Mishra and John Kazimm

Interconnect Between Periodontal Disease & Daytime Somnolence: A Cross-Sectional Study

[Year:2016] [Month:April-June] [Volumn:11 ] [Number:2] [Pages:40] [Pages No:59-65][No of Hits : 10]


ABSTRACT

Background: Periodontal Diseases encompass diseases of the gingiva & supporting structures such as bone and cementum. Periodontal diseases are known to have an interconnect with cardiovascular diseases, metabolic disorders, and atherosclerosis. Recent evidence suggests a relationship between periodontal diseases and Obstructive sleep apneas (OSA).

Aim: The present study was conducted to assess the relationship between periodontal diseases and Daytime Somnolence using the Epworth Sleepiness Scale (ESS).

Results: The results of this study revealed a strong relationship between severity of periodontal diseases and Daytime somnolence, although not statistically significant.

Keywords: Obstructive sleep apnea (OSA), Daytime somnolence, Periodontitis, Gingivitis, Epworth Sleepiness Scale (ESS).


 
Review Article
Dipti Gothi and Sonam Spalgais

Manual Versus Automated Sleep Scoring for Diagnosis of Obstructive Sleep Apnoea

[Year:2016] [Month:January-March] [Volumn:11 ] [Number:1] [Pages:45] [Pages No:5-7][No of Hits : 10]


ABSTRACT

There are two types of sleep scoring techniques for evaluation of obstructive sleep apnea (OSA) on polysomnography, they are manual and automated scoring. Manual scoring with expert technician is considered as a gold standard scoring technique. It evaluates total sleep time, stage of sleep, and apnoea or hypopnea index (AHI) better than automated scoring. However, this technique needs more manpower, money, and infrastructure. Automated scoring technique is simple, cost effective, and less time consuming. Both techniques can be performed with home sleep testing or in laboratory polysomnography. Though, automated scoring technique is less accurate in diagnosis of mild form of OSA, it is a viable option for moderate and severe OSA especially where the patient load is high and facilities are limited.


 
Review Article
Chinmaye Sapre, Devangi Desai and Soaham Desai

Hypersomnia as a Result of Neurologic Disorders: A Case-based Review

[Year:2016] [Month:April-June] [Volumn:11 ] [Number:2] [Pages:40] [Pages No:51-58][No of Hits : 8]


ABSTRACT

Hypersomnia is defined as the inability to consistently attain and sustain, wakefulness and alertness required to meet demands to accomplish daily living tasks. Hypersomnia can be due to the following mechanisms: (a) failed alertness mechanism leading to sleep attacks, (b) weak alerting systems leading to the requirement of excessive efforts to stay awake or (c) hyperactive sleep-promoting processes leading to excess daytime sleepiness [EDS].


 
Review Article
Debajyoti Bhattacharyya, Yadvir Garg, Manu Chopra, Indramani Pandey and BNBM Prasad

Drug Therapy for Obstructive Sleep Apnoea

[Year:2016] [Month:July-September] [Volumn:11 ] [Number:3] [Pages:33] [Pages No:95-98][No of Hits : 8]


ABSTRACT

Obstructive sleep apnea (OSA) is a common disorder that is characterized by obstructive apnoeas and hypopneas due to the repetitive collapse of the upper airway during sleep. A variety of effective behavioral and airway-specific therapies are available for the treatment of OSA, including weight loss, positive airway pressure therapy, oral appliances, and surgical procedures. Behavior modification is indicated for most patients who have OSA. This includes losing weight, exercising, abstaining from alcohol, and avoiding certain medications. For patients with severe OSA, positive airway pressure is recommended as initial therapy. Oral appliance may be tried for patients with mild to moderate OSA. Surgical therapy is usually for the surgically correctable obstructing lesion. Hypoglossal nerve stimulation via an implantable neurostimulator device is a novel treatment strategy. Patients who continue to have excessive daytime sleepiness despite adequate OSA-specific therapy that is severe enough to warrant treatment may benefit from adjunctive pharmacologic therapy like modafinil and armodafinil. Other drugs have been tried in the management of OSA. In small trials, benefits have been found sporadically with remifentanil, zolpidem, triazolam, eszopiclone, and sodium oxybate. Further large multicentric trials are required to prove their efficacy. There is also a scope for research for thedevelopment of some novel group of drugs for the primary treatment for OSA.

Keywords: Obstructive sleep apnoea (OSA), Drug therapy, Modafinil, Armodafinil, Positive airway pressure therapy (PAP).


 
Original Article
Rohit Kumar, J C Suri, R Manocha, and M K Sen

Study of Sleep Disordered (SDB) and Sleep Architecture in Stroke Patients in India

[Year:2016] [Month:July-September] [Volumn:11 ] [Number:3] [Pages:33] [Pages No:99-108][No of Hits : 7]


ABSTRACT

Introduction: Sleep disordered breathing (SDB) is being recognized as a risk factor for stroke. OSA is easily modifiable; the diagnosis is simple, and the treatment straight-forward. These characteristics make OSA an ideal target for interventions aimed to reduce cerebrovascular disease burden. However, data from India is lacking.

Methodology: Fifty subjects with a history of recent onset stroke, and hundred matched controls were recruited. A comprehensive history and other relevant features were recorded. After the acute phase of the stroke was over, the patients underwent an overnight polysomnography (PSG). The sleep architecture was also analyzed.

Results and Conclusions: SDB was seen in 78% stroke patients but in only 28% of controls (OR 9.1169 (95 % CI 4.1009 to 20.2684) P < 0.0001). Mixed apnea was seen in 53.85% of the cases and was the predominant type of sleep apnea observed. The prevalence of SDB was high in stroke patients with obesity and congestive cardiac failure. We found a reduction in total sleep time, sleep efficiency and REM sleep in stroke patients and an increased stage 2 sleep. Also, stroke topography affected sleep architecture with patients with multiple sites involved having decreased REM sleep.

Keywords: Stroke, Cerebro-vascular accident (CVA), Sleep disordered breathing (SDB), polysomnography (PSG), sleep architecture.


 
Original Article
Dipti Gothi and Sonam Spalgais

Restless Leg Syndrome in Patients Referred for Obstructive Sleep Apnea

[Year:2016] [Month:July-September] [Volumn:11 ] [Number:3] [Pages:33] [Pages No:109-113][No of Hits : 7]


ABSTRACT

Background: Restless leg syndrome (RLS) or Willis-Ekbom disease is a common disorder. It may present with excessive daytime sleepiness (EDS). EDS is seen often in obstructive sleep apnea (OSA) as well. Obesity and diabetes mellitus (DM) can be associated with both RLS and OSA.

Aim: To study the prevalence of RLS among patients with suspected OSA.

Material and Method: A retrospective evaluation of data was performed from proforma of patients referred for polysomnographic evaluation of OSA from January 2015 to December 2015 at a tertiary care post-graduate teaching institute. The sleep proforma through which the datawas collected also had RLS diagnostic criteria.

Result: Out of 69 patients who underwent the sleep study for suspected OSA, 9 (13%) patients fulfilled the diagnostic criteria of RLS. The majority of the patients i.e. 7/9 (78%) were women while 2/9 (22%) were men. The mean age was 50 ±3.5 years. History of excessive daytime sleepiness (EDS) was positive in 8 cases with the Epworth sleepiness score (ESS) of > 8. History of snoring was present in all 9 cases. Six out of 9 cases had a history of insomnia. The mean body mass index (BMI) was 34.5± 4.2 kg/m2. On polysomnography, three patients were diagnosed to have OSA with anapnea-hypopnea index of 5.2, 15 and 42 per hour. Periodic limb movement in sleep (PLMS) was documented in 7/9 (78%) patients. Eight out of 9 cases had secondary RLS, 4 due to diabetes, 2 had iron deficiency and the remaining 2 patients had RLS because of chronic obstructive pulmonary disease.

Conclusion: RLS is common among patients suspected with OSA. Screening of RLS should be done in all OSA suspect cases to prevent misdiagnosis and mismanagement of RLS in patients.

Keywords: Restless leg syndrome (RLS), Periodic limb movement in sleep (PLMS), Obstructive sleep apnea (OSA).


 
Original Article
Deepthi Laldayal, Unnati Desai and Jyotsna M. Joshi

Role of Adjusted Neck Circumference Score for Screening of Obstructive Sleep Apnea

[Year:2016] [Month:January-March] [Volumn:11 ] [Number:1] [Pages:45] [Pages No:30-35][No of Hits : 7]


ABSTRACT

Background: Obstructive sleep apnoea (OSA) is a common medical condition diagnosed by polysomnography (PSG). The long waiting timefor PSG prompted researchers to make various pre-test probability scores for triaging the need for PSG. While most scores were formulated and evaluated in preoperative cases, modified sleep apnoea clinical score (SACS), the adjusted neck circumference score (ANCS), was also assessed for pre-test probability testing in OSA. This study was undertaken to explore the role of ANCS in our clinical setting.

Methods: Retrospective analysis of 113 patients with an apnoea hypopnoea index (AHI) of more than 5/hour on PSG was performed. The age and sex distribution was studied. ANCS, SACS and ESS were reviewed and correlated with AHI.Descriptive and analytical statistical analysis was applied.

Results: Hundred and thirteen cases of OSA consisted of 82 men and 31 women were taken. Average AHI of the study group was found to be 34.6 (22.7) per hour. Twenty-six, 34, 53 patients had mild, moderate, severe OSA, respectively.The mean AHI in the mild, moderate, and severe OSA groups were 10.87, 21.19, and 54.21 per hour, respectively. Mean ANCS and SACS were found to be 47.8 (4.7) and 17.8 (12.9), respectively. ANCS of 43 or more could identify 89.3% of cases while SACS was positive (>8) in only 76%. ANCS severity did not correlate with the severity of OSA. Screening patients with ANCS and ESS (>10) could identify all cases of moderate to severe OSA.

Conclusion: It is proposedthat ANCS in adjunct with ESS has the potential to be a simple screening tool for OSA.

Keywords: Polysomnography, Pre-test probability scores, Apnoea hypopnoea index (AHI), Adjusted neck circumference score


 
Original Article
Shailesh Kalamkar, Unnati D. Desai and Jyotsna M. Joshi

Association of Hypothyroidism in Obstructive Sleep Apnea Syndrome

[Year:2016] [Month:October-December] [Volumn:11 ] [Number:4] [Pages:40] [Pages No:145-150][No of Hits : 7]


ABSTRACT

Background: Hypothyroidism and obstructive sleep apnea syndrome (OSAS) are common comorbid conditions with overlapping clinical presentation. We decided to study the association of hypothyroidism in our OSAS patients.

Methodology: This observational study included 108 patients with clinical features suggesting OSAS. The clinical details were noted; Polysomnography (PSG) and thyroid function tests (TFT) were done. Qualitative and quantitative data was analyzed with appropriate tests.

Results: Seventy-two (66.7%) men and 36 (33.3%) women were included. PSG confirmed OSAS in 78 (72.2%). The severity of OSAS was mild, moderate, severe in 30 (38%), 28 (36%), 20 (26%) respectively. Thirteen (12%) had hypothyroidism; subclinical in 2 (15%) and clinical in 11 (85%). Only 2 (15%) were on optimal medical treatment. Hypothyroidism was seen in 11(14%) of OSAS, against in 2(7%) of the non-OSAS group. OSAS was found in 11(85%) of hypothyroid, against in 67 (71%) of the Euthyroid group. A statistically significant association between OSAS and hypothyroidism treatment was observed.

Conclusion: The prevalence of hypothyroidism was higher in OSAS; though statistically insignificant. Association between OSAS and hypothyroidism treatment was statistically significant.

Keywords: Apnea-hypopnea index (AHI), Polysomnography, Thyroid function tests (TFT), OSAS, Hypothyroid treatment.


 
Original Article
Amit Kumar Bansal, B Jayan, Prasanna Kumar MP, Mohit Sharma, Sunil Kumar