Clinical recognition of NREM parasomnias is relatively straightforward but the understanding of the causative factors is equally important in the management of these disorders. Genetic and environmental factors coupled with physiological and psychosocial triggers are the primary mechanism. Electrophysiological studies and functional network analysis has demystified the final common pathway of these events. The presence of hypersynchronous delta slow wave sleep abnormalities and increased cyclic alternating pattern (CAP) instability are widely recognized while the role of excitatory and inhibitory neural pathways and cortical pattern generators are being intensely studied.
Sleep disordered breathing is an emerging disorder with effect on several health conditions. The association of sleep disordered breathing with cerebrovascular disorders has been relatively recent but shows it as a highly prevalent albeit neglected accompaniment in all kinds of stroke. Moreover, its presence has been found to be not just associated with incidence of strokes but also with overall poorer outcomes in stroke survivors. The spectrum of disorders with its special impact on both ischemic and hemorrhagic strokes is reviewed.
Preeclampsia is a common cause of maternal and fetal morbidity. Endothelial dysfunction(ED) is the most important pathophysiologic mechanism for preeclampsia. Sleep-disordered breathing (SDB) is an important underlying mechanismin cardiovascular complications such as hypertension and ischemic heart disease with ED. Physiological changes during pregnancy predisposewomen to increased prevalence of SDB during the third trimester of pregnancy. SDB is seen more often in preeclampsia and ED is seen in preeclampsia and SDB. ED in preeclampsia may be potentiated by SDB. SDB appears to contribute significantly to the severity of ED in preeclampsia leading to more severe maternal and fetal outcomes. Continuous positive airway pressure (CPAP) treatment has shown benefit in reducing the severity of preeclampsia and improving the maternal and fetal outcomes in some studies. Further research is warranted in this area, especially to study the impact of CPAP on the severity of preeclampsia.
Background: Obstructive sleep apnea (OSA) is a common yet unrecognized medical disorder with significant morbidity. Polysomnography (PSG) is considered as the gold standard to confirm the clinical diagnosis of OSA, to assess its severity, and to guide therapeutic choices. Continuous positive airway pressure(CPAP) constitutes the maintreatment option in most of the cases. Under-diagnosis of OSA and under-utilization of treatment options are the main challenges in developing countries and, therefore, identification using simple clinical predictors are important.
Methods: A retrospective study was conducted from January 2012 to August 2015 in a Sleep Clinic based in Chennai. Patients with the symptoms of OSA, present during the study period, were included. Demographic, diagnostic, and comorbidity details of the patients were collected and analyzed with a specific focus on their symptoms as clinical predictors of OSA.
Results and Conclusion: A total of 532 patients with the symptoms of OSA were included in the study (Males-81.8%/Females-18.2%; AverageAge-48.49;BMI-31.53; ESS score-10.37). Based on the prediction of clinical symptoms of OSA, these patients were recommended to PSG to confirm the diagnosis. 408 out of 532 patients (76.69%) underwent PSG or homebased portable study, of which, 97.3% (n=397)were positive for OSA based on the results of PSG. Snoring was the most common symptom followed by fatigue and excessive daytime sleepiness (EDS). Hypertension was the most common co-morbid illness associated with OSA. Profiling patients based on age, sex, symptoms, and comorbidities could increase our clinical index of suspicion of OSA.
Background: Obstructive sleep apnea (OSA) is a breathing disorder that occurs in sleep, which poses many threats more than disturbed sleep. It is associated with major comorbidities. There are insufficient studies in India regarding multiple comorbidities and OSA syndrome. The objective of this studyis to compare the incidence of comorbidities in documented OSA patients with subjects without OSA.
Methods: The study was carried out with a total of 274 patients in tertiary-care hospital for a period of 6 months. The study design used was retrospective case–control study. Patient history was taken from the documented records. SPSS package was used for estimating results.
Results: Mean age of patients was 55.53±11.37 years. Average apnea–hypopnea index was 45.50±24.51. A total of 110 men and 27 women were seen. The age group of 45–65 years recorded the highest number of OSA patients with a greater severity. The prevalence of hypertension (HT) in case group was 38.4%. When the correlation coefficient was calculated, HT correlated the most with OSA (r=0.513, P=0.01) followed by stroke, hypothyroidism, and coronary artery disease. The least correlation was withdiabetes mellitus (r=0.172, P=0.01)withprevalence of 40.15% in case group.
Conclusions: The study showed that prevalence of comorbidities is more in patients with OSA than without OSA.