Pediatric sleep-disordered breathing in children is a spectrum of primary snoring, upper airway resistance syndrome, obstructive hypoventilation, and obstructive sleep apnea syndrome (OSAS). The prevalence of pediatric OSAS is 1%-3%. Pediatric OSAS is most commonly caused by adenoid and tonsillar hypertrophy, which is correctable by surgery. The gold standard test for diagnosis is polysomnography (PSG). OSA in children is a distinct disorder form that occurs in adults with respect to clinical manifestations, PSG diagnostic criteria, and treatment approaches. In addition, PSG has its own challenges in children. Hence, simplification of approach by appropriate use of alternative diagnostic tests including oximetry scoring systems, questionnaires, and home respiratory polygraphy is highlighted. This will ensure early diagnosis, referral for corrective surgical management versus medical therapy on basis of severity, and performance of PSG in only selective cases.
Sleep disorders in chronic obstructive pulmonary disease (COPD) can occur in 60-70% of patients. They have adverse outcome in terms of both morbidity and mortality of COPD. The various sleep disorders seen in COPD are insomnia, restless leg syndrome (RLS), obstructive sleep apnea (OSA), nocturnal hypoventilation, and nocturnal oxygen desaturation (NOD). Of these disorders,insomnia and RLS can be diagnosed on history. OSA, sleep hypoventilation, and NODmay require type I polysomnography with/without transcutaneous or exhaled CO2 monitoring. Management consists of either conservative management or drug therapy for insomnia and RLS. If pharmacotherapy is required, ramelteon for insomnia and dopaminergic drug for RLS may be given. Treatment of OSA is continuous positive airway pressure, which relieves both OSA and COPD. Nocturnal hypoventilation usually requires oxygen along with noninvasive ventilator. Treatment of only NOD is controversial, but nocturnal oxygen may be given after ruling out nocturnal hypoventilation. This review emphasises the need of sleep disorders evaluation for comprehensive management of COPD.
A series of images, ideas, emotions, and sensations that happen involuntarily in the mind at the time of sleep are known as dreams. A definite understanding of the content and purpose of dreams is not yet established. They have frequently been a subject of scientific assumption and a focus of philosophical and religious interest. Although there are several studies on dreams, there is no concrete evidence or explanation on purpose, occurrence, or consistency. The objective of this article is to review available literature on dreams with a specific focus on the character, content, and types of dreams.
Uma Maheswari Krishnaswamy,
Background: This hospital-based study was undertaken to determine the prevalence of obstructive sleep apnea (OSA) in patients with metabolic syndrome. Methods: Consecutive patients with metabolic syndrome were included. After relevant clinical and laboratory work-up, subjects were screened for symptoms of OSA and administered Epworth Sleepiness Scale (ESS). Patients with suggestive symptoms and ESS score of e ”10 underwent polysomnography. Results: Ninety-four patients with metabolic syndrome (53 males, 41 females) were included. Thirty-five (37.2%) patients with high clinical probability of OSA underwent sleep study; of these, 32 had OSA. Thus, the prevalence of OSA was 34% in patients with metabolic syndrome. The values of body mass index and neck circumference were significantly higher in patients with OSA compared to those who had metabolic syndrome alone. Conclusion: Early detection and treatment of OSA in metabolic syndrome can prevent development of systemic consequences due to the combined effect of both diseases.
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Biswas RS, Bhattacharjee B. Patient profile and sleep abnormalities among the patients visiting a general physician in an urban slum area, Chittagong, Bangladesh. Indian Sleep Med 2015; 10 (1):37-41.
Background: In general practice, a variety of patients visit general physicians (GPs) for different clinical conditions. There is an influence of seasonal patterns on patient output. Among those, sleep disturbances is a common presenting complaint. Thus, the objective of this study was to find a pattern of GP visits for patients throughout a year with a special emphasis on frequency of insomnia and its characters. Methods: A total of 977 patients visiting the researcher, who is also a GP in an urban slum area of Chittagong town, Bangladesh, in 2013 participated in the study. Information regarding sleep pattern and comorbidity in the form of acute and chronic disease was collected using a questionnaire. Necessary data was retrieved from those documents and analyzed using Microsoft Excel 2007. Results: Of the 977 patients seen in the year 2013, there was a huge rush of patients from April to July. More female patients (59.7%) visited GPs than the male (40.3%) patients in which patients at both extremes of age (<12 years, 35.31%; >60 years, 21.3%) were the sufferers. Of all patients in whom most had short duration of sleep (53.8%) and others had delayed onset of sleep (24.8%) and early awakening (21.4%), insomnia was found to be present in 17.7% (173 of 977 patients). Among 173 patients with insomnia, 67 (39%) presented primarily with insomnia and other primary presenting medical problems, and 103 (61%) had insomnia that was extracted on further query. Among all, 95 (54.91%) had acute disease, 45 (26.01%) had chronic disease, and 33 (19.07%) had undetermined disease during the initial evaluation.
Central hypoventilation syndrome has been reported in children as a rare congenital disorder with associated Hirschsprung disease and several neural crest tumors. In adults, hypoventilation syndromes are usually associated with obesity, chest wall and neuromuscular disorders, and lower airways obstruction. We report a rare case of idiopathic central hypoventilation syndrome in an adult, nonobese man without any comorbidity who presented to us with chronic type 2 respiratory failure.