How to cite this article:
Anand H, Adhikari T, Bano G. Sleep Disordered Breathing-induced Endothelial Dysfunction and Its Association with Fetomaternal Outcomes in Preeclampsia. Indian Sleep Med 2017; 12 (4):53-59.
Introduction: There is a close association between sleep disordered breathing (SDB) and preeclampsia (PE). Endothelial dysfunction (ED) is the common final pathway in the development of hypertension in both the conditions.
Materials and methods: Totally, 25 women with new-onset hypertension of pregnancy and 25 age-, body mass index (BMI)-, and gestational age-matched normotensive pregnant women were subjected to polysomnography (PSG) and EndoPAT test. The maternal and fetal outcomes of all the subjects were noted.
Results: The SDB and ED occur more frequently in PE (64 vs 24%; p = 0.01 and 72 vs 28%; p = 0.002 respectively) compared with normotensive pregnant women. Mean respiratory distress index (RDI) was higher (8.28 ± 7.9 vs 4.2 ± 2.7) and mean reactive hyperemic index (RHI) lower (1.46 ± 0.33 vs 1.88 ± 7.9; 0.001) in PE. The mean blood pressure (MBP) in cases tended to correlate positively with RDI and negatively with RHI. There was a significant negative correlation between RDI and RHI (r = -0.637; p = 0.001). About 87.5% of the cases who had SDB also had ED, whereas only 12.5% of the cases who did not suffer from SDB had an ED (p = 0.02), and this trend was also observed in the controls (p = 0.001). It was seen on subgroup analysis that the women with PE, who had both SDB and ED, had poorer maternal and fetal outcomes than those who had neither of the conditions.
Conclusion: The SDB and ED are closely associated with PE. The ED occurs more frequently and with greater severity in preeclamptic women who have SDB and is associated with adverse fetomaternal outcomes
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Sah RB, Teotiya A. Evaluation of Sleep Disorders in Chronic Obstructive Pulmonary Disease Patients by Subjective Questionnaire and Their Correlation with FEV1, PaO2, and PaCO2. Indian Sleep Med 2017; 12 (4):60-63.
Introduction/objectives: Sleep disorders are common in chronic obstructive pulmonary disease (COPD). The commonly seen sleep disorders in COPD that can worsen the quality of sleep are insomnia, restless leg syndrome (RLS), obstructive sleep apnea (OSA), and nocturnal oxygen desaturation (NOD). However, these sleep disorders have not been studied in India.
Aim: (1) To determine the prevalence of sleep disorder in COPD patients with global sleep assessment questionnaire (GSAQ). (2) To confirm the presence of insomnia, depression, and RLS. (3) To assess the sensitivity and specificity of GSAQ with respect to insomnia, depression, and RLS. (4) Correlation of GSAQ with age, body mass index (BMI), forced expiratory volume in 1 second (FEV1), and partial pressure of arterial oxygen (PaO2) and carbon dioxide (PaCO2).
Materials and methods: A prospective study of 60 clinically stable COPD patients was undertaken. Patients were screened for sleep disturbances with the help of the GSAQ. All participants were further assessed with the insomnia, Unpleasant Sensation, Rest induced, Gets relieved on movement, Evening (URGE), and patient health quality 4 (PHQ4) questionnaire. Spirometry and arterial blood gas (ABG) analysis were done in all the patients.
Results: In the enrolled 60 patients, male:female ratio was 53:7. 33 (55%) and the patients were found to have positive GSAQ. Among them, 22 (66.67.%), 17 (57.57%), and 23 (69.69%) patients were suspected to have insomnia, RLS, and depression respectively. Some of them had overlap of two disorders. The overall sensitivity and specificity of GSAQ obtained by confirmatory questionnaire were 84.61 and 95.23% respectively. The difference in the mean age, BMI, PaO2, and PaCO2 among GSAQ-positive and egative patients was nonsignificant (p > 0.05). Though low BMI was present, hypercapnea and hypoxia were more commonly present in the GSAQ-positive group. The mean FEV1 (absolute value) in GSAQ-positive group was: 1.23 ± 0.53 L/min, while in the GSAQ-negative group, it was 1.68 ± 0.62 L/min. The difference was statistically significant (p – 0.0003) for FEV1 and its low value was found correlating with high chances of sleep disorders (GSAQ positive).
Conclusion: Sleep disorders are commonly seen in COPD patients. The majority of the patients had sleep disturbance due to insomnia. Patients with lower FEV1 have higher chances of sleep disturbance.
Continuous positive airway pressure (CPAP) is the gold standard for the management of obstructive sleep apnea (OSA). However, studies have shown that only around half use the device at the minimum recommended level of ≥4 hours/night. The compliance further drops to 17% after 5 years. Thus, there is need to develop and apply new modalities for the OSA. Also, if the treatment of OSA is directed toward the mechanism, the results are likely to be better. This review is aimed at mechanismdirected treatment for OSA.
Motor neuron disease (MND) is an umbrella term used to signify an assorted group of progressive neurologic disorders that cripple upper and lower motor neurons with axonal loss and gliosis. The MND classically presents as progressive muscle weakness, muscle atrophy, spasticity, and bulbar symptoms like dysarthria and dysphagia. The disease has a solemn course and a poor prognosis. Respiratory jeopardy is a run-of-the-mill phenomenon in this disease. It culminates from the combination of weakness of the pharyngeal and laryngeal muscles and the major respiratory muscles like diaphragm and intercostals. The upper airway flaccidity engenders the perpetuation of sleep disordered breathing (SDB) while the respiratory muscle weakness triggers lung physio-dynamic alterations and chronic respiratory failure. Hence, spirometry and polysomnography are vital tools in the diagnostic work-up. We hereby present an intriguing case of a patient with MND manifesting both these aspects of SDB and a peculiar spirometry pattern of a “two-can” effect!