Indian Journal of Sleep Medicine

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2015 | April-June | Volume 10 | Issue 2

REVIEW ARTICLE

Deepak Shrivastava

Current status of autotitrating continuous positive airway pressure: a review

[Year:2015] [Month:April-June] [Volume:10] [Number:2] [Pages:6] [Pages No:53 - 58]

PDF  |  DOI: 10.5005/IJSM-10-2-53  |  Open Access |  How to cite  | 

Abstract

The prevalence of obstructive sleep apnea (OSA) is increasing requiring easier access to largescale screening and treatment of general population. Autotitrating Positive Airway Pressure (APAP) devices change effective pressure in a feedback circuit based on airflow, pressure changes, or airway resistance changes. This aids in pressure titration process throughout the sleep period. In patients with moderate to severe OSA without co-morbid conditions APAP and Continuous Airway Pressure (CPAP) are similar in affecting change in Apnea hypopnea index, Arousal index, and Sleep efficiency, Time in REM sleep, Quality of life, and adverse events. According to some studies, there has not been a significant difference in blood pressure changes between the APAP and CPAP groups. Current recommendations are to avoid APAP in patients with clinically significant co-morbid conditions including congestive heart failure, severe COPD, central sleep apnea, asthma and other obstructive pulmonary disorders or obesity hypoventilation syndrome and neuromuscular disorders. Further recommendation is to avoid using APAP for the diagnosis of OSA. Careful patient selection, monitoring of APAP data and proper mask fitting and leak control are essential to the success of APAP therapy. This article reviews the current scientific literature and emphasizes the need for more research before APAP can become the most efficacious mode of OSA treatment. Obstructive sleep apnea (OSA) prevalence is rising owing to many factors. Among these, obesity epidemic is considered a major confounder. Parallel with this increase in OSA, rapidly building public health and public safety burden drives the need for more widespread screening of the at-risk populations. Over the years, a gradual shift favoring “out of center testing” (OCST), popularly known as home sleep test (HST), portable monitoring (PM), and other names, has occurred. Autotitrating continuous positive airway pressure (APAP) was introduced in 1990, mainly for screening patients for nasal continuous positive airway pressure (CPAP) and for those patients whose health prevented visit to sleep laboratory for testing and CPAP titration. The combination of OCST and APAP use has literally eliminated the need for sleep laboratory from the management of OSA in many patients. The versatile technological design of APAP machine offers a wide range of pressures that responds to patient\'s variable breathing patterns and behaviors. The ability to track and monitor the results from these machines makes APAP a reasonable choice in properly selected patients.

REVIEW ARTICLE

Kumar Budur

Portable Monitoring and the Diagnosis of Obstructive Sleep Apnea

[Year:2015] [Month:April-June] [Volume:10] [Number:2] [Pages:5] [Pages No:59 - 63]

Keywords: Pediatric sleep apnea, adenotonsillectomy, polysomnography, Rapid maxillary expansion

PDF  |  DOI: 10.5958/0974-0155.2015.00008.X  |  Open Access |  How to cite  | 

Abstract

Sleep disordered breathing (SDB) in children is a frequent disease with a prevalence varying from 1–5%. It is distinct from adults with respect to ideology, gender distribution, clinical manifestation, and treatment. Adenotonsillar enlargement is the most common cause of SDB in children. The diagnosis of SDB requires the use of special sensors such as nasal pressure transducer and esophageal pressure monitoring. The treatment of SDB in children includes amelioration of symptoms, normal cranio-facial growth and prevention of adult SDB. Adenotonsillectomy (AT) is the first line treatment of otherwise healthy children and also the initial treatment for children with multifactorial SDB. The success of AT as defined by reduction of AHI below 1 varies between 30 and 50% in various studies. A number of clinical factors such as nasal allergy, narrow and high hard palate, retro-position of mandible, enlargement of nasal inferior turbinates, high Mallampatti scale score, long face syndrome, age more than 8 years at the time of AT, and pretreatment apnea- hypopnea index (AHI) were associated with poor outcome. An impairment of nasal breathing due to adenotonsillar enlargement results in abnormal development of maxilla-mandibular skeleton resulting in narrowed upper airway. Surgery should be performed in young children as early as possible. Majority of patients have residual disease which requires additional treatment with orthodontic procedures such as rapid maxillary expansion (RME) and nasal CPAP. A multidisciplinary approach to evaluation and management of these children may lead to better treatment outcome.

REVIEW ARTICLE

Pediatric sleep apnea-need for multidisciplinary approach

[Year:2015] [Month:April-June] [Volume:10] [Number:2] [Pages:6] [Pages No:64 - 69]

Keywords: Pediatric sleep apnea, adenotonsillectomy, polysomnography, Rapid maxillary expansion

PDF  |  DOI: 10.5958/0974-0155.2015.00009.1  |  Open Access |  How to cite  | 

Abstract

Sleep disordered breathing (SDB) in children is a frequent disease with a prevalence varying from 1–5%. It is distinct from adults with respect to ideology, gender distribution, clinical manifestation, and treatment. Adenotonsillar enlargement is the most common cause of SDB in children. The diagnosis of SDB requires the use of special sensors such as nasal pressure transducer and esophageal pressure monitoring. The treatment of SDB in children includes amelioration of symptoms, normal cranio-facial growth and prevention of adult SDB. Adenotonsillectomy (AT) is the first line treatment of otherwise healthy children and also the initial treatment for children with multifactorial SDB. The success of AT as defined by reduction of AHI below 1 varies between 30 and 50% in various studies. A number of clinical factors such as nasal allergy, narrow and high hard palate, retro-position of mandible, enlargement of nasal inferior turbinates, high Mallampatti scale score, long face syndrome, age more than 8 years at the time of AT, and pretreatment apnea- hypopnea index (AHI) were associated with poor outcome. An impairment of nasal breathing due to adenotonsillar enlargement results in abnormal development of maxilla-mandibular skeleton resulting in narrowed upper airway. Surgery should be performed in young children as early as possible. Majority of patients have residual disease which requires additional treatment with orthodontic procedures such as rapid maxillary expansion (RME) and nasal CPAP. A multidisciplinary approach to evaluation and management of these children may lead to better treatment outcome.

ORIGINAL ARTICLE

Umesh Kumar Vyas

Effects of quetiapine on sleep

[Year:2015] [Month:April-June] [Volume:10] [Number:2] [Pages:4] [Pages No:70 - 73]

Keywords: quetiapine, polysomnography, sleep architecture and parameters.

PDF  |  DOI: 10.5005/ijsm-10-2-70  |  Open Access |  How to cite  | 

Abstract

Objectives: To determine effects of quetiapine on polysomnographicrecorded sleep architecture and parameters. Introduction and Hypothesis: Quetiapine receptor profile suggests that sleep-inducing and sleep-modifying properties may be causing changes in sleep architecture and parameter, which may have therapeutic value. Methods: A cross-sectional retrospective study conducted at the sleep center. Polysomnographic sleep records were selected and reviewed from among patients who presented over 24-months for evaluation. Twenty-one patients were selected and matched based on age, sex, body-mass index (BMI), and the presence/absence of obstructive sleep apnea (OSA) to control subjects without quetiapine. Correlation analysis was performed to assess the association of quetiapine with sleep architecture and parameters. Results: Quetiapine was not significantly associated with altered sleep efficiency, sleep latency, wake time after sleep onset, or the relative percentage of sleep stages. A notablebut not significant (p = 0.08), increase in the rapid eye movement latency was observed. Conclusions: Among the study population quetiapine was not found associated with changes in sleep architecture and parameters. Hypothesis : Use of quetiapine will be associated with shortened sleep latency (SL), increased total sleep time (TST), and increased non-rapid eye movement (NREM) stage III (most restorative sleep).

ORIGINAL ARTICLE

Umesh Kumar Vyas

Effects of quetiapine on sleep

[Year:2015] [Month:April-June] [Volume:10] [Number:2] [Pages:4] [Pages No:70 - 73]

Keywords: quetiapine, polysomnography, sleep architecture and parameters

PDF  |  DOI: 10.5958/0974-0155.2015.00010.8  |  Open Access |  How to cite  | 

Abstract

Objectives: To determine effects of quetiapine on polysomnographicrecorded sleep architecture and parameters. Introduction and Hypothesis: Quetiapine receptor profile suggests that sleep-inducing and sleep-modifying properties may be causing changes in sleep architecture and parameter, which may have therapeutic value. Methods: A cross-sectional retrospective study conducted at the sleep center. Polysomnographic sleep records were selected and reviewed from among patients who presented over 24-months for evaluation. Twenty-one patients were selected and matched based on age, sex, body-mass index (BMI), and the presence/absence of obstructive sleep apnea (OSA) to control subjects without quetiapine. Correlation analysis was performed to assess the association of quetiapine with sleep architecture and parameters. Results: Quetiapine was not significantly associated with altered sleep efficiency, sleep latency, wake time after sleep onset, or the relative percentage of sleep stages. A notablebut not significant (p = 0.08), increase in the rapid eye movement latency was observed. Conclusions: Among the study population quetiapine was not found associated with changes in sleep architecture and parameters. Hypothesis: Use of quetiapine will be associated with shortened sleep latency (SL), increased total sleep time (TST), and increased non-rapid eye movement (NREM) stage III (most restorative sleep).

ORIGINAL ARTICLE

Anand Kumar, Arun Grace Roy, Siby Gopinath, Dinesh Singh, Sheela Nampoodiri, Vinayan K P, Mali A. Einen, Emmanuel Mignot

Clinical Profile of Narcolepsy in Children in India

[Year:2015] [Month:April-June] [Volume:10] [Number:2] [Pages:5] [Pages No:74 - 78]

Keywords: Hyper somnolence, Sleep Attacks, Cataplexy, Narcolepsy, Hypnagogic-hallucination

PDF  |  DOI: 10.5958/0974-0155.2015.00011.X  |  Open Access |  How to cite  | 

Abstract

Objective/Background: Narcolepsy is a chronic disorder characterized by excessive daytime somnolence (EDS), sleep paralysis, hypnagogic or hypnopompic hallucinations and cataplexy. Symptoms of narcolepsy typically start in childhood and young adult and clinical picture can be variable. In this article, the clinical picture, and investigations of 19 children with diagnosis of narcolepsy are described. The objective of this study is to describe the clinical profile, polysomnography (PSG) and multiple sleep latency test (MSLT) features and investigations in 19 children (<18years). Materials and Methods: This is a descriptive retrospective study reporting on the clinical and biological features of children diagnosed with narcolepsy in the sleep center. All children underwent overnight PSG followed by MSLT. HLA analysis and CSF hypocretin assay were part of protocol but HLA analysis was done only in 13 children and CSF hypocretin assay in 6 cases. Inclusion criteria: Children less than 18 years satisfying the diagnostic criteria proposed by the International Classification of Sleep Disorders for narcolepsy with cataplexy (narcolepsy type 1) and narcolepsy without cataplexy (narcolepsy type 2) were taken. Exclusion criteria: Children with day time somnolence due to causes other than narcolepsy were excluded (Hypothyroidism, Obstructive sleep apnea, systemic diseases). Results/Conclusion: Nineteen children (14 males and 5 females) were there in cohort. All 19 children had excessive day time somnolence. Nine children (47.3%) had hypnagoic hallucinations, 7 (36.84%) had cataplexy and none had sleep paralysis. Overnight PSG showed shortened sleep latency in 15 children, while normal sleep latency was seen in 4 children. MSLT showed shortened sleep latency and more than two SOREM in all children. HLA DQB1*0602 was positive in 13 patients and CSF hypocretin levels were measured in 6 cases, values were below 100 pcg/ml. This is the largest case series of narcolepsy in children from India. Presentation of narcolepsy in children is similar to that reported in adults although typical cataplexy may not be present at the onset. Narcolepsy is a chronic disorder that remains under-diagnosed till adulthood with a significant impact on behavior and performance.

JOURNAL SCAN

U. C. Ojha

Journal Scan

[Year:2015] [Month:April-June] [Volume:10] [Number:2] [Pages:7] [Pages No:79 - 85]

PDF  |  DOI: 10.5005/ijsm-10-2-79  |  Open Access |  How to cite  | 

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