Indian Journal of Sleep Medicine

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2006 | April-June | Volume 1 | Issue 2

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EDITORIAL

J. C. Suri

Portable Sleep Studies for Diagnosis of Sleep Apnea – Where We are Today?

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:7] [Pages No:65 - 71]

   DOI: 10.5005/ijsm-1-2-65  |  Open Access |  How to cite  | 

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REVIEW ARTICLE

Sunil Sharma, Rose Franco

Sleep and its Disorders in Pregnancy

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:6] [Pages No:72 - 77]

   DOI: 10.5005/ijsm-1-2-72  |  Open Access |  How to cite  | 

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REVIEW ARTICLE

T. Mohan Kumar

Some Points to Ponder through Some New and Old Concepts in Sleep Medicine

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:3] [Pages No:78 - 80]

   DOI: 10.5005/ijsm-1-2-78  |  Open Access |  How to cite  | 

1,352

REVIEW ARTICLE

A. G. Ghoshal, Indranil Halder

Perioperative Issues in Sleep Disordered Breathing

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:6] [Pages No:81 - 86]

Keywords: obstructive sleep apnoea, perioperative issues,airway management

   DOI: 10.5005/ijsm-1-2-81  |  Open Access |  How to cite  | 

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ORIGINAL ARTICLE

Sunil Sharma, Mary E Klink, Thom Feroah

Comparison of CPAP Titration Pressures as Obtained by Split Night Study versus Auto-CPAP Titration at Home for 2 Weeks

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:6] [Pages No:87 - 92]

Keywords: Auto –CPAP, Split- night polysomnography, Position dependent Sleep apnea, Sleep stage Dependent sleep apnea

   DOI: 10.5005/ijsm-1-2-87  |  Open Access |  How to cite  | 

Abstract

PURPOSE: The growing epidemic of sleep-related breathing disorders plus the high cost of polysomnography has led most labs across the country to switch to split-night studies (SNS). This has resulted in significant reduction in time allowed for titration. Hence the final effective pressure (Peff) as obtained by SNS may not reflect the ideal pressure needed to consistently overcome the sleep airflow limitation. This may potentially lead to therapeutic failure and poor compliance. Auto-CPAP has emerged as potential alternative which may provide a more physiological background to identify the optimal pressure for CPAP therapy. METHODS: 33 consecutive patients diagnosed with Obstructive apnea hypopnea syndrome (AHI >15/hr) after undergoing split-night study in sleep laboratory were prescribed a 2-week Auto CPAP trial (Resmed Auto Set T). The pressures obtained by SNS (Peff) were compared to optimal pressures (95th percentile) and Maximum pressures (100th percentile) as obtained by Auto-CPAP trial at home for two weeks. We also looked at pressure differences after segregating patients into positional / nonpositional sleep apnea and patients requiring pressures below or above 10 cm H2O. Demographics and patient preferences were also recorded. RESULTS: Out of 32 patients (one patient was excluded due to noncompliance with Auto-CPAP) 72% were males. Mean BMI was 36.5 and Mean time spent on CPAP titration was during SNS was 159.8 min. Mean AHI (Apnea hypopnea Index) at final CPAP pressure (Peff) was 1.5 versus 6.1 with Auto-CPAP (P<0.001). Mean pressure on (Peff) on SNS titration was 8.8 (1.7) cm of H2O versus mean 95th percentile pressure on Auto-CPAP of 11.3(1.4) cm of H2O (P<0.001) and mean maximum pressure on Auto-CPAP of 12.5(1.6) cm of H2O (P<0.001). We also found the pressure differences were more profound in the patient group with initial pressure requirements of 10 cm H2O or less. We also found no significant difference between positional and non-positional groups. CONCLUSION: There is a significant difference in therapeutic pressures noted between CPAP titration by SNS and subsequentAuto-CPAP trial for 2 weeks. CLINICAL IMPLICATIONS: By allowing greater sleep sampling timeand a physiological background, use of Auto-CPAP device to derivemaximum optimal pressures may provide an appropriate alternative to SNS.

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ORIGINAL ARTICLE

D. J. Roy, A. Bhattacharya, A. G. Ghosal, R. K. Das

Relation between Epworth Sleepiness Scale and Obstructive Sleep Apnea - A study conducted in PULSAR, KOLKATA

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:4] [Pages No:93 - 96]

Keywords: Obstructive sleep apnea, Excessive daytime sleepiness, Epworth sleepiness scale, Apnea – hypopnea index.

   DOI: 10.5005/ijsm-1-2-93  |  Open Access |  How to cite  | 

Abstract

737 adult persons more than 18 years of age of both gender, randomly selected from Kolkata, were put to Epworth Sleepiness Scale (ESS) questionnaire. 11.3% showed excessive daytime sleepiness (EDS) by ESS score. 74 polysomnographically diagnosed cases of obstructive sleep apnea (OSA), more than 18 years of age, showed presence of EDS in 81.1% of cases. EDS, as calculated from ESS score, has good predictive value in assessing OSA and may be used as a screening tool in diagnosis of OSA. The ESS score of the diagnosed cases showed positive association with moderate and severe OSA cases.

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ORIGINAL ARTICLE

Neelima Gupta, V. P. Venkatachalam

Evaluation of Polysomnographic Patterns with Reference to Various Treatment Modalities in the Management of Patients with Upper Airway Obstruction

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:4] [Pages No:97 - 100]

   DOI: 10.5005/ijsm-1-2-97  |  Open Access |  How to cite  | 

Abstract

Seventy five patients with symptoms and signs of upper airway obstruction and OSAS were studied. Clinical, endoscopic, radiological and polysomnographic examination were performed. An approriate surgical procedure to correct the upper airway obstruction was performed. All patients were followed up for a period of 12 weeks, at the end of which a polysomnographic examination was repeated. The results of the study are discussed.

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ORIGINAL ARTICLE

Manvir Bhatia, V. Aggarwal, R.M. Pandey

Snoring and its Risk Factors in Obese Indian Population

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:5] [Pages No:101 - 105]

Keywords: Obesity, BMI, Snoring

   DOI: 10.5005/ijsm-1-2-101  |  Open Access |  How to cite  | 

Abstract

Objective: To investigate the prevalence of snoring and its risk factors in obese Indian Population. Method: Cross – sectional study. 300 subjects, with BMI> 25 kg /m2 were evaluated with a questionnaire for symptoms of sleep disorders, details of significant medical history, family history, anthropometric measurements, and Epworth Sleepiness Scale (ESS) were noted. A univariate and logistic regression analysis was done a ROC curve generated. The sensitivity, specificity was calculated and formula devised for calculating the snoring score. Results: The mean age was 34.59 (sd 10.83), M: F = 1:1, 49 (16%) had history of habitual snoring. Univariate and multivariate logistic regression analysis revealed age, gender, nocturia, and presence of arthritis, family history of snoring, smoking and higher ESS score as significant risk factors of snoring. Conclusion: Snoring is more common in males, the modifiable risk factor being smoking.

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CASE REPORT

Dipti Gothi, J. M. Joshi

Obstructive Sleep Apnoea (OSA) in a Case of Oculo-Auriculo-Vertebral Spectrum (OAVS)

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:3] [Pages No:106 - 108]

Keywords: Oculo-auriculo-vertebral spectrum (OAVS), Goldenhar's syndrome, Obstructive sleep apnoea (OSA)

   DOI: 10.5005/ijsm-1-2-106  |  Open Access |  How to cite  | 

Abstract

We report a 3 year old girl with Oculo-auriculo-vertebral spectrum also called the Goldenhar's syndrome presenting with microtia, hemifacial microsomia, cardiac anomaly and obstructive sleep apnoea. Sleep related breathing disorders in children have received considerable attention in recent times. Obstructive sleep apnoea in OAVS has been has been reported rarely and is due to aplastic mandible or micrognathia. Polysomnography confirmed obstructive sleep apnoea enabling an appropriate surgical therapy.

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CASE REPORT

D. Bhattacharya, S. Chakrabarti, N. K. Gupta

An Interesting Case of Central and Obstructive Sleep Apnea in A Patient of Congestive Heart Failure with Unmasking of CSA's Following CPAP Use

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:9] [Pages No:109 - 117]

Keywords: OSA: Obstructive sleep apnea, CSA: Central Sleep apnea, CPAP: continuous positive airway pressure, BiPAP: bilevel positive airway pressure, PSG: polysomnography.

   DOI: 10.5005/ijsm-1-2-109  |  Open Access |  How to cite  | 

Abstract

An elderly man with acute anterior wall myocardial infarction who underwent medical therapy followed by angioplasty and stenting was referred to our centre for evaluation of sleep-disordered breathing. The gentleman had moderate hypothyroidism for which he was on replacement therapy. At our centre PSG showed OSA for which a trial of CPAP was given. On correction of OSA by CPAP, presence of underlying CSA was unmasked. The patient improved over time on intensified medical therapy, continuous use of CPAP and regulated thyroid replacement therapy.

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JOURNAL REVIEW

Clinical Research Update Corner

[Year:2006] [Month:April-June] [Volume:1] [Number:2] [Pages:2] [Pages No:118 - 119]

   DOI: 10.5005/ijsm-1-2-118  |  Open Access |  How to cite  | 

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