Indian Journal of Sleep Medicine

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2006 | January-March | Volume 1 | Issue 1

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EDITORIAL

From the Desk of The Editor-in-Chief

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijsm-1-1-i  |  Open Access |  How to cite  | 

876

EDITORIAL

From the Editor's Desk

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijsm-1-1-ii  |  Open Access |  How to cite  | 

781

From the Desk of The Editor in Chief

From the Desk of The Editor-in-Chief

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijsm-1-1-iv  |  Open Access |  How to cite  | 

860

From the Editors Desk

From the Editor's Desk

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijsm-1-1-v  |  Open Access |  How to cite  | 

790

EDITORIAL

J. C. Suri

Leptin, obesity and sleep disordered breathing

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:5] [Pages No:1 - 5]

   DOI: 10.5005/ijsm-1-1-1  |  Open Access |  How to cite  | 

1,107

REVIEW ARTICLE

Sunil Sharma, Rose Franco

Positive airway pressure therapy in sleep related breathing disorders

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:6] [Pages No:6 - 11]

   DOI: 10.5005/ijsm-1-1-6  |  Open Access |  How to cite  | 

1,135

REVIEW ARTICLE

Samavedam A. Krishna

Sleep-Related Leg Movement Disorders

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:7] [Pages No:12 - 18]

   DOI: 10.5005/ijsm-1-1-12  |  Open Access |  How to cite  | 

Abstract

Restless-legs syndrome and periodic leg movements in sleep are sleep-related limb movement disorders that often disrupt nocturnal sleep and cause excessive daytime sleepiness. This article reviews the recent literature regarding epidemiology, etiology, pathogenesis, clinical features, differential diagnosis and management.

1,168

REVIEW ARTICLE

Manvir Bhatia

Stroke and Sleep Apnoea: Cause or Consequence?

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:3] [Pages No:19 - 21]

Keywords: OSA, STROKE, CPAP

   DOI: 10.5005/ijsm-1-1-19  |  Open Access |  How to cite  | 

1,031

REVIEW ARTICLE

RK Mani

Noninvasive ventilation and sleep

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:5] [Pages No:22 - 26]

   DOI: 10.5005/ijsm-1-1-22  |  Open Access |  How to cite  | 

913

ORIGINAL ARTICLE

D Gothi, Shailly Saxena, J M Joshi

Prevalence of symptoms and risk of sleep disordered breathing in Mumbai (India)

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:5] [Pages No:27 - 31]

Keywords: Obstructive sleep apnoea, Sleep disordered breathing, Prevalence

   DOI: 10.5005/ijsm-1-1-27  |  Open Access |  How to cite  | 

Abstract

Study Objective: To estimate prevalence of sleep disordered breathing (SDB) in a questionnaire based survey in Mumbai (India). Methods: The observational design of the study was on a cross-sectional basis conducted at various locations in the city of Mumbai, India. 20 patients of obstructive sleep apnoea (OSA) were selected randomly as index cases and their residential addresses were noted. From the neighborhood of each of the 20 index cases, a random sample of 20 households was selected providing a sample of 20 x 20 = 400 households. In each the selected households a well-structured questionnaire was canvassed. The information thus collected from the 400 sample households formed the basis of the present study. A total of 1188 sleep questionnaires were administered by a paramedical worker to individuals above 18 years of age and the responses regarding the occurrence of snoring, habitual during or non habitual, cessation of breathing during sleep (witnessed apneas), and daytime sleepiness as per the Epworth sleepiness scale were noted. Results: The information obtained from 1188 subjects – 667 males and 521 females, was tabulated and statistical analysis was carried out using SPSS software. Habitual snoring was observed in 6.4% of population. Out of these habitual snorers, two cases had excessive daytime sleepiness and witnessed apneas. The prevalence SDB, after considering its risk factors i.e. habitual snoring, excessive daytime sleepiness and witnessed apneas was found to be 3.42% on the maximum side in the study population. Conclusion: 6.4% of adult Indian population suffers from snoring and prevalence of OSA on the maximum side in the study population is 3.42%.

1,369

ORIGINAL ARTICLE

J. C. Suri, Pinak Shrikhande, M.K. Sen

Fexofenadine: Assessment of sleepiness potential using objective criteria

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:5] [Pages No:32 - 36]

Keywords: fexofenadine, sleepiness scale, multiple sleep latency test

   DOI: 10.5005/ijsm-1-1-32  |  Open Access |  How to cite  | 

Abstract

Abstract : To evaluate the sedating effect of fexofenadine by subjective and objective assessment, 28 healthy male subjects were randomized to receive either placebo or fexofenadine 120 mg orally on day 1 or 2. Subjects were subjectively assessed for drowsiness on the basis of Stanford sleepiness scale (SSS) and visual analog scale (VAS). On day 2, multiple sleep latency tests were done at 0930, 1030, 1130, 1230, 1330, 1430, 1530 and 1700 hours. The procedure was repeated on day 3 and 4. Multiple sleep latency test (MSLT) (range) seen with placebo and fexofenadine is 14.36(± 2.83) and 13.5(± 3.66) minutes respectively. There was also no significant difference after fexofenadine and placebo between subjective sleepiness assessed by (VAS) (p=0.05) and (SSS) (p=0.412) respectively.

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ORIGINAL ARTICLE

SP Agarwal, Rajendra Prasad, Ram K Verma, RC Ahuja

A study on snoring habits in healthy population of Lucknow

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:4] [Pages No:37 - 40]

Keywords: Snoring, Prevalence, Sleep disturbed breathing

   DOI: 10.5005/ijsm-1-1-37  |  Open Access |  How to cite  | 

Abstract

Introduction: Snoring is a common complaint, the prevalence of which has been documented from 16-89% in general population. Objective: Paucity of data from our country on this important but neglected topic prompted us to conduct this study. Methodology: It was single centre cross sectional study done at Dept. of Pulmonary Medicine, King George's Medical University, Lucknow(India) in apparently healthy adults, using ‘Snore Survey’ questionnaire adopted from category 1 symptom details of Berlin Questionnaire. Results: Out of 702 men and women 31.1% snored, 11.1% did not know whether they snore. The ratio of male to female snorers was 2.35:1 and 33.8% of men and 26 % of women were snorers.17.4 % of the snorer were loud snorer and 21.5% were having snoring frequency e” 3-4 times/wk. Conclusion: This is probably the first such big study from our country to our best of knowledge and literature survey, which fulfils the objective of obtaining the numbers of snorers in wide ranging population from India. The present study reveals that 1/3rd of the population over the age of 35 years snores. Clinical Implication: Considering the large population of our country these data are substantial and triggers the need of increasing the awareness among the patients as well as health professionals about this neglected but very significant medical health problem which leads to development of several other medical diseases.

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ORIGINAL ARTICLE

D. V. Shah, J. M. Joshi

Role of nocturnal oxygen therapy in interstitial lung disease with obstructive sleep apnoea syndrome

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:4] [Pages No:41 - 44]

Keywords: nocturnal hypoxemia, oxygen therapy, apnoea- hypopnea index (AHI), nighttime recording of respiratory variables (NTRRV)

   DOI: 10.5005/ijsm-1-1-41  |  Open Access |  How to cite  | 

Abstract

Background: This study was conducted to demonstrate the effects of nocturnal oxygen therapy on patients of interstitial lung disease (ILD) with associated obstructive sleep apnoea syndrome (OSAS). Methods: 12 patients (5 males, 7 females) of ILD with OSAS were included in the study. All patients had a restrictive abnormality on spirometry with a mean forced vital capacity (FVC) of 40 (+/- 14.22). The mean daytime pressures of oxygen in arterial blood (Pao2) were 71.88 (+/- 12.44) and that of carbon dioxide was 36.39 (+/- 8.27). 10 out of the 12 patients had a BMI of less then 25, while 2 patients had a BMI of 27 each. None of the patients had complaints of snoring or excessive daytime sleepiness. All patients were subjected to nighttime recording of respiratory variables (NTRRV). The first night study was done while breathing room air followed by a second night study supplemented with 2 litres of nasally administered oxygen. The effect of nasally administered oxygen on the apnoea- hypopnea index (AHI) was studied. Results: The mean AHI while breathing room air was 23.33 (+/- 6.27). On breathing oxygen at 2 litres per minute AHI dropped to 8 (+/- 8.03). In 11 out of 12 patients, the AHI decreased from a mean of 23.09 to 6.36, while the AHI in 1 patient remained unchanged. Thus overall there was a significant improvement (p<0.001) in AHI from 23.33 (+/- 6.27) to 8 (+/- 8.03) on breathing 2 litres per minute of nasally administered oxygen. Baseline oxyhaemoglobin saturation improved in all patients. Conclusion: Nocturnal oxygen therapy has a beneficial effect on the obstructive sleep apnea syndrome in selected patients of ILD and OSAS.

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ORIGINAL ARTICLE

Kiran Agarwal, J. C. Suri

Evaulation & workup to detect regions of disproportionate anatomy and its subsequent management in patients of snoring and OSA

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:5] [Pages No:45 - 49]

   DOI: 10.5005/ijsm-1-1-45  |  Open Access |  How to cite  | 

Abstract

50 patients with complaints of snoring with or without symptomatology OSA were selected. The distribution of symptoms was bimodal either in the paediatric age group (mean age 6.4) or in middleaged & elderly (mean age 43.94). In children adenoid and/or tonsillar enlargement (72%) was the commonest cause followed by facial dysmorphism (20%). In adults, disproportionate upper airway anatomy at multiple levels with or without skeletal malformation was the most important cause e.g. long thick soft palate (62.8%), long & oedematous uvula (42.9%), webbing of pillars with reduced interpillar distance (40%). All patients underwent clinical and radiological examination in addition to polysomnographic analysis. Children were generally managed surgically and adults received NCPAP mainly. Surgical treatment was less favored in adults due to involvement of multiple sites.

1,254

ORIGINAL ARTICLE

Mittal A, Vijayan VK, Patial K

Questionnaire for diagnosing Obstructive Sleep Apnoea in Indians

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:8] [Pages No:50 - 57]

Keywords: sleep related breathing disorders, reliability, validity, polysomnography.

   DOI: 10.5005/ijsm-1-1-50  |  Open Access |  How to cite  | 

Abstract

Objective To construct a questionnaire for estimation of sleep related breathing disorders in Indians. Methodology To assess the inter-observer reliability, a specialist and a trained health worker administered the questionnaire to 135 adult individuals, who presented in the outpatient department of V.P. Chest Institute. Taking the specialist's opinion as the reference, various parameters of reliability were calculated. The test-retest reliability was calculated by questioning 50 individuals twice after an interval of one week by the same observer. The questionnaire was validated by performing polysomnography on 11 normal and 11 individuals with sleep related symptoms suggestive of obstructive sleep apnoea (based on the questionnaire). Results The sensitivity, specificity and predictive values were calculated for each question. While sensitivity ranged from 42 - 55% (questions on snoring and daytime sleepiness with a sensitivity of 87% and 93% respectively), specificity was found to be 94 – 96% with an efficiency of 0.899. The kappa value for intra-observer reliability was found to be 0.815. With polysomnography as the gold standard for diagnosing sleeprelated breathing disorders, the questionnaire had a sensitivity of and specificity of 82%. Discussion Our questionnaire compares favourably with other standard questionnaires like the Berlin Questionnaire. Conclusion This short questionnaire with good reliability is suitable for Indian population studies.

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CASE REPORT

D. Bhattacharya, S. Chakrabarti

A difficult case of obstructive sleep apnea with obesity hypoventilation syndrome

[Year:2006] [Month:January-March] [Volume:1] [Number:1] [Pages:7] [Pages No:58 - 64]

   DOI: 10.5005/ijsm-1-1-58  |  Open Access |  How to cite  | 

Abstract

A middle aged morbidly obese lady with symptoms of obstructive sleep apnea and obesity hypoventilation syndrome was admitted to our hospital emergency in circulatory and Type II respiratory failure. She was resuscitated and put on invasive mechanical ventilation. After extubation she was put on non invasive bilevel positive airway pressure ventilation. Despite two weeks on ventilatory support the patients blood gas did not show significant improvement. The patient was given a trial of oral medroxyprogesterone and aectazolomide with continuation of BiPAP support. By two weeks the patient could be discharged on nocturnal non invasive BiPAP ventilation

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