Indian Journal of Sleep Medicine

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2021 | April-June | Volume 16 | Issue 2

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Tejas M Suri, J. C. Suri

Chronic Obstructive Pulmonary Disease with Sleep-related Hypoxemia: Nocturnal Oxygen is not the Answer

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:2] [Pages No:19 - 20]

   DOI: 10.5005/jp-journals-10069-0074  |  Open Access |  How to cite  | 



Mahismita Patro

Overlap Syndrome: A Double Trouble

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:2] [Pages No:21 - 22]

   DOI: 10.5005/jp-journals-10069-0075  |  Open Access |  How to cite  | 


Original Article

S Deepa, Avita R Johnson, Nikita Sunny, Shruthi Sasidharan, Lincy M Antony, Geena G Dias, Merlyn Joseph

Determinants of Duration and Quality of Sleep among Pregnant Women in Rural South Karnataka: A Hospital-based Cross-sectional Study

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:6] [Pages No:23 - 28]

Keywords: Pregnant women, Pittsburgh Sleep Quality Index, Quality of sleep, Sleep duration

   DOI: 10.5005/jp-journals-10069-0067  |  Open Access |  How to cite  | 


Introduction: Sleep is a basic essential, and sleep disturbances are common during pregnancy, which is linked to poor maternal and fetal outcomes. Materials and methods: A cross-sectional study was conducted among antenatal women attending a rural maternity hospital in Ramnagara District, Karnataka using consecutive sampling. A predesigned, face-validated structured questionnaire and Pittsburgh Sleep Quality Index (PSQI) were administered. Mean PSQI score of ≥5 was considered as poor sleep quality. Results: Of the 200 pregnant women in the study, 54.5% had poor sleep quality and 76.5% had inadequate duration of sleep (<8 hours a day). The factors found to be significantly associated with poor quality sleep in this study were increased maternal age, joint family, lower socioeconomic status, increased parity, increasing gestational age, presence of complications in the current pregnancy, previous bad obstetric history, exposure to passive smoking, not sleeping on a bed and mattress, use of mobile phone and TV at bedtime, lack of physical activity, and lack of afternoon naps. Women who used mobile phones at bedtime had nine times higher risk of inadequate sleep and five times higher risk of poor sleep quality. Women who did not sleep on a bed with mattress had 10 times higher risk and those exposed to passive smoking had four times greater risk of poor sleep quality. Conclusion: The quality and the duration of sleep among pregnant women were inadequate. There is a need to educate women about the importance of quality sleep during pregnancy and it should be assessed during routine antenatal care.


Original Article

Govind N Srivastava, Ritamvara Oli

Prevalence of Pulmonary Hypertension in Obstructive Sleep Apnea and Overlap Syndrome Patients Living in Rural and Suburban Areas of North India

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:4] [Pages No:29 - 32]

Keywords: Obstructive sleep apnea, Overlap syndrome, Pulmonary hypertension

   DOI: 10.5005/jp-journals-10069-0072  |  Open Access |  How to cite  | 


Introduction: Obstructive sleep apnea (OSA) is a neglected and underdiagnosed disease in rural and suburban India. Chronic obstructive pulmonary disease (COPD) associated with OSA is termed overlap syndrome. OSA and COPD both cause pulmonary hypertension (PH) that further aggravates nocturnal hypoxia. Aim and objective: To estimate the prevalence of PH in OSA and overlap syndrome. Materials and methods: Patients coming to our outpatient department with symptoms of OSA were selected by STOP-BANG criteria for polysomnography (PSG). One hundred patients with apnea–hypopnea index (AHI ≥5) with symptoms and AHI ≥15 without symptoms were taken for pulmonary function test (PFT) and chest X-ray to rule out COPD. Thereafter, 2D echocardiography (2D-echo) was done to check cardiac changes and the assessment of pulmonary artery pressure. Results: Out of 100 patients in the study group, 10% (n = 10) had mild, 12% (n = 12) had moderate, and 78% (n = 78) had severe OSA. Overlap syndrome was present in 60% (n = 60) of the patients. PH was present in 24% (n = 24) of cases--mild (n = 10) and moderate (n = 10) PH each was 10%, and severe (n = 4) PH was present in 4% of the cases. PH was present in 36.67% (n = 22) of the patients with overlap syndrome and only 5% (n = 2) of the patients with OSA. Conclusions: Nearly, one-fourth of the patients with OSA and overlap syndrome have PH. Prevalence of PH is seven times higher in overlap syndrome than in OSA alone.


Original Article

Sharvari R Desai, Rama A Vaidya, Shobha A Udipi, Pallavi S Ullal, Sangeeta A Chokhani, Abha Dharam Pal, Ashok Vaidya

Sleep Deprivation and Disruptors of Sleep among Secondary Schoolchildren and Adolescents from Mumbai City

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:7] [Pages No:33 - 39]

Keywords: Adolescents, Daytime sleepiness, Pittsburgh sleep quality index, Sleep deprivation, Sleep disruption

   DOI: 10.5005/jp-journals-10069-0068  |  Open Access |  How to cite  | 


Aims and objectives: Good sleep quality entails that it is continuous without any interruptions, characterized by early onset of sleep, fewer interruptions or disruptions, and fewer early awakenings. Studies indicate that younger adolescents are perhaps the most sleep-deprived and vulnerable to sleep disturbances. Therefore, the present study examined sleep disruption among Indian school children/adolescents. Materials and methods: This cross-sectional study was conducted in two schools (purposively selected) catering to children from different socioeconomic backgrounds. Overall, 1,974 children aged 10–18 years were studied, 1,083 children belonging to a government-aided school (GAS) and the remaining 891 were from an international school (IS). Sleep quality was assessed using a detailed questionnaire containing questions based on the Pittsburgh Sleep Quality Index. Results: Among the 1,974 participants, 38.5% (n = 759) of children reported that they had disrupted sleep. Almost, one-third (33.9%, n = 125) of the children, whose sleep was disrupted every night, slept for 6 hours or less. Sleep disruption was higher among the children attending the GAS (41.5%) compared to children who were from much better socioeconomic backgrounds and were attending the IS (34.7%). Overall, noise was a major disruptor for more 39.6% of the children, followed by the urge to go the bathroom (33.2%). Half the children (50.3%) with disrupted night sleep listened to music and 46.3% reported that they thought about/were worried about the next day. Thirty-five percent of the students reported that they watched television or used mobiles (34.1%) or played video games (33.1%). Conclusions: The study results indicated that a fairly high percentage of urban students experience sleep disruption and their daily habits before going to bed, technological advancement, social chatting on mobiles as well as their economic background influenced their sleep pattern.


Original Article

Sanjeev Datana, SS Agarwal, Mohit Sharma

Pharyngeal Airway Dimensions Assessed by Acoustic Pharyngometry in a Mixed Indian Population: A Cross-sectional Study

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:4] [Pages No:40 - 43]

Keywords: Acoustic pharyngometry, Mixed Indian population, Upper airway

   DOI: 10.5005/jp-journals-10069-0070  |  Open Access |  How to cite  | 


Background: Acoustic pharyngometry (AP) is a noninvasive modality for the assessment of upper airway dimensions. Early detection of structural narrowing of the upper airway may enable the clinician early detection of upper airway sleep disorders like obstructive sleep apnea (OSA). At present, norms for various airway parameters assessed on AP for the Indian population are not available. Material and methods: This cross-sectional study was conducted on AP records of 560 subjects (428 males and 132 females) in the age-group of 20–40 years. The study included subjects with body mass index (BMI) and neck circumference within normal limits, having a straight facial profile and Angle's class I with no discrepancy in transverse, sagittal, and vertical dimensions. The data were analyzed using a statistical package for social sciences (SPSS version 21.0, IBM Corporation, USA) for MS Windows. Results: The results of the study indicated that the mean volume of the pharyngeal airway in males and females was 27.98 cm3 and 28.5 cm3, respectively. The mean area in males and females was 2.84 cm2 and 2.85 cm2, respectively. The minimum area in males and females was 1.76 cm2 and 1.74 cm2, respectively. Conclusions: The mean values of various airway parameters obtained in the present study can serve as reference values in respect of the mixed Indian population and as a guideline for screening of large number of patients, especially with regard to the detection of the compromised upper airway.


Original Article

SS Agarwal, Nanda Kishore Sahoo, Sanjeev Datana

Efficacy of Distraction Osteogenesis in Management of Obstructive Sleep Apnea Secondary to Temporomandibular Joint Ankylosis

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:5] [Pages No:44 - 48]

Keywords: AHI, Distraction osteogenesis, Obstructive sleep apnea, TMJ ankylosis

   DOI: 10.5005/jp-journals-10069-0071  |  Open Access |  How to cite  | 


Aim and objective: The aim and objective of this study was to evaluate the efficacy of mandibular corpus distraction osteogenesis (MCDO) in the management of obstructive sleep apnea (OSA) secondary to temporomandibular joint (TMJ) ankylosis. Materials and methods: Treatment records of 15 patients (mean age 23.3 ± 5.4 years, 7 males and 8 females) comprehensively managed for severe OSA secondary to TMJ ankylosis with combined orthodontics and MCDO were studied objectively by comparing apnea–hypopnea index (AHI) scores and airway parameters, and subjectively by Epworth sleepiness scale (ESS) survey at pretreatment (T0) and 1-year postsurgery (T1). Change in skeletal parameters at T1 was evaluated by comparison of sella-nasion-point A (SNA), sella-nasion-point B (SNB), and point A-nasion-point B (ANB) angles. Change in AHI per millimeter advancement was also calculated. Results: The mean AHI score at T0 and T1 was 41.71 ± 12.69 and 8.11 ± 3.25, respectively (80.39% reduction, p-value < 0.001). The AHI reduction per mm distraction was 2.59 ± 0.52. The success rate (postsurgical AHI less than 50% of pretreatment) was 100%, and the cure rate (AHI score <05) was 80%. The mean ESS score at T0 and T1 was 18.60 ± 2.5 and 4.67 ± 1.49, respectively (75.05% reduction, p-value < 0.001). The mean ANB at T0 and T1 was 11.6° ± 3.68° and 3.4° ± 2.29, respectively (72.89% reduction, p-value < 0.001). The mean posterior airway space (PAS) at T0 and T1 was 4.00 ± 1.46 mm and 10.00 ± 1.25 mm, respectively (182.44% increase, p-value < 0.001). Conclusions: MCDO is an effective modality for the treatment of severe OSA secondary to TMJ ankylosis. Further studies are recommended for additional evidence in this regard.



Oommen Nainan, Rahul Tyagi

Management and Long-term Follow-up of Severe Obstructive Sleep Apnea with Oral/Nasal Airway Dilator System—An “OASYS” of Possibilities

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:10] [Pages No:49 - 58]

Keywords: Continuous positive airway pressure (CPAP), Mandibular repositioner, Nasal airway dilator, non-compliance, OASYS, Retrognathic profile

   DOI: 10.5005/jp-journals-10069-0073  |  Open Access |  How to cite  | 


Aim and objective: This article aims to highlight the use of OAT (oral appliance therapy) with an oral/nasal airway dilator system in the treatment of patients with severe OSA, exhibiting non-tolerance with CPAP therapy. Background: CPAP is the gold standard for the treatment of OSA. CPAP treatment for OSA is only effective if the patient is cooperative and willing for the therapy. Unfortunately, due to the often uncomfortable and invasive nature of this treatment method, CPAP has a relatively low compliance rate, ranging from 40 to 70%. This is because CPAP has drawbacks, including discomfort from the mask, a dry or stuffy nose, and eye irritation. Case description: This article reports an interesting case of a 61-year old female with severe OSA and non-tolerance/non-compliance with the CPAP therapy, who was referred by the sleep physician to the orthodontic clinic for evaluation and advice concerning OAT for her OSA. Conclusion: Oral/Nasal Airway Dilator System (OASYS) works both as a nasal dilator and mandibular repositioner and acts by targeting multiple areas of the upper airway from the tip of the nose to the back of the throat. Clinical significance: OASYS stands out from the crowd of oral appliances by adding additional actions and targeting multiple areas of the airway with one convenient appliance and thus offers an effective means of treating severe OSA patients who are non-compliant with the CPAP therapy.



Richa Tripathi, Ahmed Osama Javed

Alcohol and Narcolepsy: A Case Report

[Year:2021] [Month:April-June] [Volume:16] [Number:2] [Pages:2] [Pages No:59 - 60]

Keywords: Alcohol, Insomnia, Narcolepsy, Sleep disorders

   DOI: 10.5005/jp-journals-10069-0069  |  Open Access |  How to cite  | 


Alcohol has a varied effect on sleep. It affects daytime alertness and also certain physiological processes during sleep. It affects various parts of the central nervous system including the reticular activating system. Many other sleep disorders besides insomnia have been observed in alcohol-dependent patients. The present article discusses about two cases of narcolepsy caused by alcohol use.


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