Indian Journal of Sleep Medicine

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2022 | July-September | Volume 17 | Issue 3

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Original Article

Tehmina Parveen Syed, Samar Faheem, Ayesha Batool Haque

Assessment of Maternal Sleeping Habits and Knowledge among Pakistani Pregnant Women

[Year:2022] [Month:July-September] [Volume:17] [Number:3] [Pages:5] [Pages No:67 - 71]

Keywords: Adverse pregnancy outcomes, Left lateral position, Maternal sleep positions, Sleep disorders, Sleeping habits, Supine position

   DOI: 10.5005/jp-journals-10069-0102  |  Open Access |  How to cite  | 


Introduction: The sleeping position of pregnant women can influence the outcome of their pregnancy, leading to an increased risk of stillbirth, low birth weight, and other adverse fetal outcomes. Sleeping in the supine position is associated with negative effects, while the ideal maternal sleeping position is sleeping on the left lateral side. Pregnant women should be made aware of this so they can make an informed decision to change their sleeping habits. Aim: To assess the current knowledge possessed by Pakistani pregnant women on the effects of maternal sleeping positions, and determines their maternal sleeping habits. Materials and methods: This cross-sectional study included 300 pregnant women that were visiting the outpatient department of Gynaecology, Hamdard University, Karachi, Pakistan. They were asked to fill out a questionnaire regarding demographics, pregnancy, sleep advice, and sleep habits. The data was analyzed using IBM Statistical Package for Social Sciences (SPSS) software, version 26. Pearson's, Chi-squared, and Fisher's exact tests were used to compare gestational age with advice about sleeping positions, and parity with advice about sleeping positions, respectively. A p-value of below 0.05 was considered significant. Results: 22 (7.3%) women in our study reported sleeping in the supine position. 58.7% of women reported not receiving advice on sleep positions by anyone, and only 7.0% said they were advised by a doctor. Gestational age above and below 25 weeks was associated with receiving advice about sleeping positions (p = 0.043). Multiparity was also found to have an association with having received advice on sleeping positions (p <0.001). Conclusion: Women should be made aware of the effects of sleep positions by doctors so they can modify their sleep habits accordingly. Clinical significance: A decrease in supine sleep and an increase in left-sided sleep position, in early and late pregnancy, may contribute to a reduction in adverse pregnancy outcomes.


Original Article

Khadijeh Alizadeh Feremi, Nouraddin Mousavinasab, Zahra Gholipour

Relationship between Insomnia and Blood Oxygen Levels in COVID-19 Patients Admitted to the Intensive Care Unit

[Year:2022] [Month:July-September] [Volume:17] [Number:3] [Pages:5] [Pages No:72 - 76]

Keywords: COVID-19, Insomnia, Intensive care unit, Oximetry

   DOI: 10.5005/jp-journals-10069-0103  |  Open Access |  How to cite  | 


Introduction: It seems that inadequate sleep affects the oxygen levels in patients infected with coronavirus disease-2019 (COVID-19). However, few studies have worked on the effect of insomnia on the blood oxygen level. Therefore, this study aimed to determine the effect of insomnia on the blood oxygen level in patients admitted to the intensive care unit (ICU) due to infection with COVID-19. Materials and methods: This study was performed on 100 patients with COVID-19 referred to Imam Khomeini Hospital, affiliated with Mazandaran University of Medical Sciences, Sari, Iran. The insomnia severity index (ISI) was used to assess the severity of insomnia in the patients. They were then divided into four groups of patients with no insomnia, subthreshold, moderate, and severe insomnia. The patient's oxygen saturation was measured repeatedly at different times of day after hospitalization. Results: The findings demonstrated no significant differences between the four study groups regarding gender, marital status, education level, and occupational status (p >0.05). Moreover, no significant difference was observed between the four groups concerning lung involvement (F = 0.64; p = 0.58) and hospital stay (F = 1.23; p = 0.29). The mean of oxygen saturation in patients without insomnia was higher than in those who had insomnia before the study and on days 1–5 after hospitalization (F = 30.97; p <0.001). Conclusion: The results confirm the association between oxygen saturation and sleep disorder. The oxygen saturation level decreases in patients with different levels of insomnia (i.e., severe, moderate, and threshold insomnia) and patients affected by COVID-19 with acute pulmonary involvement. These patients are more susceptible to being hospitalized in specialized departments and mortality.


Original Article

Sucheta Sunil Bhalerao, Dhiraj Bhatkar

Comparison of Various Pretest Probability Scores in Obstructive Sleep Apnea Syndrome

[Year:2022] [Month:July-September] [Volume:17] [Number:3] [Pages:6] [Pages No:77 - 82]

Keywords: Apnea–hypopnea index, Continuous positive airway pressure, Daytime sleepiness, Epworth sleepiness scale, Metabolic syndrome, Obesity, Obesity hypoventilation syndrome, Overlap Syndrome, Sleep-disordered breathing, Syndrome Z

   DOI: 10.5005/jp-journals-10069-0105  |  Open Access |  How to cite  | 


Background: In Obstructive sleep apnea (OSA), there is upper airway collapsibility, and obstruction to the flow of air thereby leading to arousal. In view of the rising prevalence of OSA, there is a need for precise tools which are less complicated to identify patients with sleep disorder for early diagnosis and to prevent serious complications. Therefore, it is of utmost importance to classify patients depending on their clinical symptoms and examination and risk factors to identify patients at higher risk and the need for polysomnography (PSG) and further management. Materials and methods: This was a prospective study conducted with institutional ethics committee (IEC) permission, which included 100 patients referred to the Department of Pulmonary Medicine of our tertiary care center, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, Maharashtra, India. Specificity, sensitivity, and negative and positive predictive values of each pretest probability score [sleep apnea clinical score (SACS), snoring, tiredness, observed apnea, blood pressure, body mass index (BMI), age, neck size, gender (STOP-BANG) questionnaire, Berlin questionnaire (BQ), and four-variable tool (4-VT) questionnaire] were calculated. These scores were plotted against apnea–hypopnea Index (AHI) and the correlation coefficient of these pretest probability scores were compared with each other. Results: Among the 100 patients screened, 93 patients had OSA. Epworth sleepiness scale (ESS) classified that 87% of patients were at risk of OSA. Also, 70, 93, 93, and 49% were at higher risk by SACS, STOP-BANG, BQ, and 4-VT questionnaires, respectively. Conclusion: There is a need for screening patients with sleep-disordered breathing (SDB) to find out such patients and to refer such patients to higher centers where diagnostics facilities are available. Our study showed that various pretest probability questionnaires can be used to screen patients in resource-limited settings, such as primary and non-primary healthcare settings, where there was a limited number of sleep laboratories available.



Gaurav Pratap Singh, Balakrishnan Jayan, Abhijeet Kadu, Neetu Kadu, Uday R Kamat

Correlation of Tonsillar Grading, Adenoid Grading, and Combined Adenotonsillar Hypertrophy with Various Inter- and Intra-arch Dental Parameters: An Early Predictor for Pediatric Sleep Apnea

[Year:2022] [Month:July-September] [Volume:17] [Number:3] [Pages:9] [Pages No:83 - 91]

Keywords: Adenoids, Craniofacial growth, Dental arch parameters, Interceptive orthodontics, Tonsils

   DOI: 10.5005/jp-journals-10069-0104  |  Open Access |  How to cite  | 


Context: Enlargement of lymphoid tissue, in particular, the palatine tonsils and adenoids, has been associated with developmental aberrations in the craniofacial structures as well as a leading cause of pediatric obstructive sleep apnea (OSA). This correlation has been well documented in orthodontic literature but as yet remains subjective and variable. Aims: In view of the above, a study is proposed to objectively correlate tonsillar grading, adenoid grade, and combined adenotonsillar hypertrophy with various intra- and inter-arch dental parameters. Settings and design: A cross-sectional study design was utilized with the sample including 150 children reporting to the Department of Orthodontics and Dentofacial Orthopedics of Military Dental Facility and screened at the Department of Otorhinolaryngology of Military Hospital. Methods and materials: The study subjects were subdivided into five groups based on an objective evaluation of tonsillar and adenoid grading. The dental arch measurements were recorded from study models. Statistical analysis used: A Chi-square test was used for comparison between categorical variables (demographic). The strength of the association between the tonsillar grade, adenoid grade, combined adenotonsillar hypertrophy, and the quantitative dental measures were assessed by using Spearman's correlation coefficient (ρ). A Chi-square test was used to measure the strength of association of qualitative dental arch variables with the tonsillar grade, adenoid grade, and combined adenotonsillar hypertrophy. The significance threshold was set at p <0.05. Results: Enlarged adenoids are significantly and negatively correlated with intercanine, inter-premolar, and intermolar widths. The total depth of the palatal vault and the ratio of total depth of the palatal vault to maxillary interfirst molar width were significantly and positively correlated. Grade III/IV tonsils are strongly associated with an increased prevalence of Class III canine and molar relationship. Combined adenotonsillar hypertrophy is associated with the most significant changes in dental arch parameters. Conclusions: The study highlights the paramount importance of the evaluation and screening of enlarged lymphoid tissue. Timely intervention can enhance nasal breathing and prevent potential, or reverse existing, abnormal facial growth and/or deleterious effects of pediatric OSA.


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