Indian Journal of Sleep Medicine

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2022 | January-March | Volume 17 | Issue 1

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Divya A Varghese, Vinitha Prasad

Prevalence of Pediatric Sleep Disorders and their Relationship with Vitamin D Levels in Indian Children

[Year:2022] [Month:January-March] [Volume:17] [Number:1] [Pages:4] [Pages No:1 - 4]

Keywords: Age, Daytime sleepiness, Excessive daytime sleep, Gender, Insomnia, Obstructive sleep apnea, Restless legs syndrome, Sleep apnea, Sleep-related breathing disorders

   DOI: 10.5005/jp-journals-10069-0095  |  Open Access |  How to cite  | 


Sleep disorders in children are often unrecognized and underreported in India. Aims and objectives: Our study aims to find the prevalence of sleep disorders among children aged 5–15 years and to determine the relationship between serum 25 (OH) vitamin D levels and sleep disorders in children. Materials and methods: This is a cross-sectional prospective study conducted in the pediatric OPD of a tertiary care hospital in Kochi, India. Fifty children satisfying the inclusion and exclusion criteria were taken up for the study. Data were collected using the Pediatric Sleep Questionnaire (Chervin, University of Michigan). A blood sample was collected for serum 25-hydroxy vitamin D estimation using the chemiluminescent protein binding assay. Comparison between the vitamin D levels and sleep disorders was made by the Fischer's exact test and Wilcoxon rank-sum test. Results: The prevalence of sleep disorders in our study was 88% with parasomnias being the most common sleep disorder. Vitamin D deficiency was seen in 78% of children and 22% had vitamin D insufficiency. The mean vitamin D level was much lower in children with sleep-related breathing disorder (SRBD) (p = 0.02), excessive daytime sleepiness (p = 0.031), and restless leg syndrome (RLS) (p = 0.007) when compared to children without these disorders. The prevalence of vitamin D deficiency was more among children with SRBD when compared to children without SRBD (p = 0.04). Conclusion: The study concludes that there is a high prevalence of sleep disorders in studied children and vitamin D deficiency is an associated risk factor for sleep disorders.



Pushkar Andhare, Sanjeev Datana, SS Agarwal, Sukhbir S Chopra, ID Roy

Upper Airway Post-planned Positioning of Maxillary Anterior Teeth: An Acoustic Pharyngometric Study

[Year:2022] [Month:January-March] [Volume:17] [Number:1] [Pages:5] [Pages No:5 - 9]

Keywords: Acoustic pharyngometry, Intrusion and retraction, Upper airway

   DOI: 10.5005/JP-JOURNALS-10069-0096  |  Open Access |  How to cite  | 


Introduction: The effect of the retraction of anterior teeth on the upper airway as a response to orthodontic tooth movement is a less explored area in orthodontic literature, which requires deliberation in order to avoid undesired effects. The present study evaluates the change in upper airway dimensions post-intrusion and retraction of maxillary anterior teeth using Acoustic Pharyngometry, a noninvasive, chair-side diagnostic modality. Materials and methods: The upper airway dimensions (mean area and volume) changes were assessed during pretreatment and 3 months post-intrusion and retraction of anterior teeth in a sample of 30 patients by using Eccovision(R) Acoustic Pharyngometer (Sleep Group Solutions, Florida, USA), a noninvasive diagnostic modality. Result: A reduction in mean area (0.11 cm2) and volume (1.15 cc) of upper airway was observed following intrusion and retraction of maxillary anterior teeth, although the results obtained were not statistically significant (p >0.05). Conclusion: As the results of this study suggest, there is reduction in mean area and volume of upper airway following intrusion and retraction of maxillary anteriors; it is essential to assess the pretreatment dimensions of upper airway. Nonionizing and noninvasive modalities like acoustic pharyngometry can be utilized as an efficient and convenient diagnostic modality to assess the upper airway in orthodontic clinics.


Original Article

Govind N Srivastava, Aiyush Jain, Aparna Suresh, Deepanjali Sharma, Kanchi Sravani, Soumya S Dash, B Gowthami

Anthropometric Indices and Obstructive Sleep Apnea Severity in Syndrome Z

[Year:2022] [Month:January-March] [Volume:17] [Number:1] [Pages:5] [Pages No:10 - 14]

Keywords: Apnea–hypopnea index, Metabolic syndrome, Obstructive sleep apnea, Syndrome Z

   DOI: 10.5005/jp-journals-10069-0093  |  Open Access |  How to cite  | 


Background: Syndrome Z is the coexistence of two chronic diseases, obstructive sleep apnea (OSA) and metabolic syndrome. It is one of the under-recognized public health issues in the Indian subcontinent. Syndrome Z is associated with multiple risk factors and cardiometabolic abnormality, which increases its severity. In this study, we assess anthropometric indices and OSA severity in patients with syndrome Z. Materials and methods: We evaluated 100 patients aged more than 50 years in chest outpatient department (OPD), who met the screening criteria for OSA using the Snoring, Tiredness, Observed apnea, Blood pressure, Body mass index (BMI), Age, Neck size, and Gender (STOPBANG) Questionnaire and the Epworth Sleepiness Scale (ESS). All patients underwent overnight level 1 polysomnography (PSG) using Alice 6 PDx Philips Sleep System. Parameters of metabolic syndrome and OSA were noted using National Cholesterol Education Program—Third Adult Treatment Panel (NCEP ATP III) and American Academy of Sleep Medicine (AASM) guidelines. We did a comparative study using baseline anthropometric indices, metabolic syndrome parameters, and apnea–hypopnea index (AHI) level in PSG in patients with syndrome Z and OSA using various correlations. Results: Syndrome Z was present in 60% of patients with OSA. Among syndrome Z patients, male subjects were 60% and female subjects were 40%. OSA was severer in patients with syndrome Z, i.e., AHI levels in the PSG were higher in patients having both OSA and metabolic syndrome (p <0.001). Other parameters that were found to be associated in patients with syndrome Z were higher BMI, larger waist circumference (p <0.003), deranged lipid profile, hyperglycemia (p <0.001), and hypertension (p <0.001). Conclusion: Anthropometric indices, obesity (BMI), parameters of metabolic syndrome, and AHI level should be a part of routine checkups in follow-ups of patients with syndrome Z, which will help in better management. Treating each factor individually can increase the quality of life and decrease the morbidity associated with syndrome Z.



Maryam RA Altuhafy, Ravi Yadav, Sandeep Talluri, Luay Jabr, Mythili Kalladka, Junad Khan

The Efficacy of Botulinum Toxin in the Management of Restless Leg Syndrome: A Systematic Review of Randomized Control Trials

[Year:2022] [Month:January-March] [Volume:17] [Number:1] [Pages:7] [Pages No:15 - 21]

Keywords: Botox, Botulinum, Pain, Restless leg syndrome, Toxin

   DOI: 10.5005/jp-journals-10069-0097  |  Open Access |  How to cite  | 


Background: Restless legs syndrome (RLS) is a sleep-related movement disorder characterized by an irresistible urge to move the legs, occasionally associated with unpleasant sensations in the leg. Emerging evidence suggests that botulinum neurotoxin may be effective in reducing the symptoms of RLS. Objective: The objective of the present review was to assess the effectiveness of botulinum toxin in patients with RLS. Methods: The focused question was “Is botulinum neurotoxin effective in reducing the severity of RLS?” Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) model, indexed databases were searched up to and including February 2021. Joanna Brigg's critical appraisal tool was used to evaluate the risk of bias (ROB) for the included studies. Result: Four clinical studies were included in the systematic review and processed for data extraction. Three studies reported that the botulinum neurotoxin type A (BoNT/A) had an impact in reducing the severity and improving RLS. One study reported that BoNT/A provides no effectiveness in managing RLS. Overall risk of bias was low in two and moderate in two studies. Conclusion: The present review suggests the need of more robust high-quality evidence for recommending the management of RLS with BoNT/A on reducing the severity and improving the overall symptoms of RLS.



Dhruv Jain, Sanjeev Datana, SS Agarwal, Indranil D Roy

Management of Severe Obstructive Sleep Apnea in Pediatric Patients with Pycnodysostosis: A Report of Two Cases

[Year:2022] [Month:January-March] [Volume:17] [Number:1] [Pages:10] [Pages No:22 - 31]

Keywords: Obstructive sleep apnea, Oral appliance therapy, Pycnodysostosis

   DOI: 10.5005/jp-journals-10069-0091  |  Open Access |  How to cite  | 


Pycnodysostosis (PKND) is a rare autosomal recessive disorder caused by molecular mutation in cathepsin K (CTSK) gene, resulting in decreased bone turnover with enfeeblement of bone structure. This report addresses an array of systemic and craniofacial features of two siblings affected with PKND with an association of severe obstructive sleep apnea (OSA), managed conservatively with an oral mandibular advancement appliance.



Rahul Kumar, Anshul Jain, Mahismita Patro

Stabilizing Rib Cage Destabilizes Breathing!!

[Year:2022] [Month:January-March] [Volume:17] [Number:1] [Pages:3] [Pages No:32 - 34]

Keywords: Central sleep apnea, Loop gain, Pulmonary mechanics

   DOI: 10.5005/JP-JOURNALS-10069-0094  |  Open Access |  How to cite  | 


Central sleep apnea (CSA) is characterized by intermittent episodes of decreased ventilation due to lack of drive to breathe while asleep. It is due to an abnormal carbon dioxide control of ventilation which may be due to blunted or enhanced ventilatory response to carbon dioxide. An increased CO2 sensitivity, an important factor in the development of central sleep apnea, precipitates it when associated with unstable breathing, i.e., high loop gain. The combination of speed of feedback gain, plant gain, and controller gain leads to high loop gain. We hereby report a case of central sleep apnea precipitated after coronary artery bypass grafting (CABG) performed via midline sternotomy. Factors responsible for sleep apnea in this case were cardiac failure, postsurgery low cardiac output syndrome, and decreased thoracic cage movement due to sternotomy. Normally these postsurgical cases resolve on their own, but our patient had very severe symptoms and hence he reported.



Aishwarya Aggarwal

Mechanisms that Link Obstructive Sleep Apnea to Stroke

[Year:2022] [Month:January-March] [Volume:17] [Number:1] [Pages:2] [Pages No:35 - 36]

Keywords: Obstructive sleep apnea, Stroke

   DOI: 10.5005/jp-journals-10069-0092  |  Open Access |  How to cite  | 


Obstructive sleep apnea (OSA) is a chronic sleep-related breathing disorder characterized by recurrent episodes of partial or complete collapse of the upper airway during sleep, despite an ongoing effort to breathe. OSA has been demonstrated to be an independent risk factor for ischemic stroke, atrial fibrillation, arterial hypertension, coronary artery disease, and myocardial infarction. The mechanisms that link OSA to stroke include cardiac arrhythmias, autonomic dysfunction, hypertension, hypoxia, inflammation, and dyslipidemia. Treatment of OSA can lead to primary prevention of stroke and can secondarily reduce other vascular risk factors causing stroke.


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