Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with a high frequency of gastroesophageal reflux and arousals. Nocturnal gastroesophageal reflux (nGER) is strongly associated with sleep disturbances and disturbed sleep results in increased nocturnal gastroesophageal reflux.
Objectives: It was aimed to study the prevalence of nocturnal gastroesophageal reflux in obstructive sleep apnea (OSA). In our study, we sought to evaluate the correlation between the frequency and type of arousals and episodes of nGER in OSA cases.
Materials and Methods: We conducted an observational study among sixty patients already diagnosed with OSA on the basis of standard sleep criteria. Demographic data, anthropometric measurements, and detailed medical history were recorded. All subjects underwent polysomnography study and filled out the validated Gastroesophagal disease-health related quality of life questionnaire (GERD-HRQL). Statistical analysis was done by the multivariate regression model.
Results: There was a strong significant correlation between apnea-hypopnea index (AHI) and GERD score. (r = 0.544, p = 0.002). Moreover, respiratory arousal index was also significantly correlated with GERD score (r = 0.370, p = 0.040). It was found that AHI was a strong predictor of GERD with a significant regression model (p < 0.002, r2 = 0.0272). Respiratory arousal index (RAI) was responsible for 13.7% (r2 = 0.137) variance which was statistically significant p = 0.040 (p < 0.05). Desaturation index (DI) also predicted significantly about the gastroesophageal reflux (p = 0.005).
Conclusion: The present results suggest that the occurrence of arousals was related to episodes of nGER in OSA.
Funding: This study was part of Short Term Research Studentship (STS) program of the Indian Council of Medical Research (ICMR).
DOI: 10.5005/jp-journals-10069-0020 |
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Dosi R, Jain P, Jain A, Motiwale S, Joshi P. Role of IOS in Assessing the Improvement of Obstructive Component in Moderate to Severe Obstructive Sleep Apnea Hypopnea Syndrome. Indian Sleep Med 2018; 13 (2):25-28.
Introduction: Impulse oscillometry (IOS), a simple, noninvasive method using the forced oscillation technique, requires minimal patient cooperation and is suitable for use in both children and adults. This method can be used to assess obstruction in the large and small peripheral airways.
Aim: To study impulse oscillometry measurements in cases of moderate to severe sleep apnea.
Materials and Methods: A study was performed in Department of Respiratory Medicine, Sri Aurobindo Institute of Medical Sciences. Thirty patients diagnosed with severe sleep apnea underwent home noninvasive ventilation therapy. Pre- and post treatment noninvasive ventilation (NIV) impulse oscillometry was given to these patients.
Results: The pre-NIV spirometry showed predominant mixed pattern of disease with Impulse oscillometry showing reduced R25 and R5 levels. Post 3 months of noninvasive ventilation therapy with > 80% compliance demonstrated improvement in R25 parameters.
Conclusion: Respiratory resistance and reactance measured by Impulse oscillometryare abnormal in preobese and obese obstructive sleep apnea hypopnea syndrome (OSAHS) patients, and these parameters are closely correlated with OSAHS severity. Impulse oscillometrymight be a useful screening tool for detecting OSAHS in clinic based populations.
Sleep disorders are common, multi-factorial and often underrecognized in patients with renal diseases. Sleep disorders have a negative impact on the wellbeing and quality of life. Medical literature in the past few years has documented many definitive associations between kidney diseases and various sleep disorders. Prompt referral to a sleep medicine specialist for further evaluation is warranted in this group of patients at the earliest suspicion of an insidious sleep disorder. In this review, we will discuss the common sleep disorders seen in patients with kidney disorders–the restless leg syndrome/Willis–Ekbom disease (RLS/WED), sleep-disordered breathing (SDB), insomnia disorder, hypersomnolence disorder, circadian rhythm sleep-wake disorders (CRSWDs) and parasomnias.
A 70-year-old non-addict man with the history of diabetes, hypertension and allergic rhinitis was referred for abnormal behavior during the night. The behaviors included shouting, punching, walking during sleep, leaving the house and dream enactment. He also had history of snoring and excessive daytime sleepiness, suspicious of obstructive sleep apnea (OSA). He was suffering from depression for which he was on antidepressants, i.e., mirtazapine, sertraline and olanzapine by a psychiatrist. The abnormal sleep behaviors developed after start of mirtazapine. After ruling out all other causes, he was finally diagnosed to be suffering from drug-induced parasomnia overlap disorder (POD) caused by mirtazapine along with OSA based on international classification of sleep disorders–3rd edition (ICSD-3). He had resolution of the parasomnia episodes after stoppage of mirtazapine.