Introduction: There is very little data of Indian children with sleep disordered breathing (SDB), regarding the common clinical presentation, etiological factors, radiological and polysomnographic features. We therefore carried out a study to evaluate these factors in Indian children presenting to a tertiary care hospital. Material And Method: Forty consecutive children were referred from the ENT outpatient for overnight polysomnography because of symptoms suggestive of sleep disordered breathing (SDB). A complete general, physical and systemic examination, including height, weight, BMI, was conducted. ENT examination was performed to include craniofacial characteristics such as mid face hypoplasia, micrognathia and occlusal relationships. Radiological examination of the airway was performed. Digital skiagram of soft tissue neck in lateral view was obtained and A-N ratio (adenoid:nasopharynx ratio), H-MP (H-MP = distance from mandible to hyoid) and PAS (PAS= Posterior airway space) were assessed. Results: The age of the children varied from 1 to 15 years. A male preponderance was noticed (72.5%). Maximum number of the children was underweight (82.5%). All the children complained of snoring and mouth breathing. The other symptoms noted were disturbed sleep (65%); frequent cold and difficult swallowing (62.5%). Poor school performance was seen in 30%; Enuresis in 22.5% and aggressive behaviour in 7.5%. Analysis of the behavioural symptoms showed that 30% of the children had poor school performance, 22.5% had bedwetting, 7.5% had aggressive behaviour, 2.5% each had sleep terror and sleep walking respectively. The upper airway examination (clinical and endoscopic) showed that adenotonsillar enlargement was the most common cause of upper airway obstruction among these children. The other findings were adenoid enlargement (7.5%), tonsil enlargement (22.5%), deviated nasal septum (2.5%), deviated nasal septum with adenoid (2.5%), polyp (7.5%) and rhinitis (2.5%). Cephalometric analysis showed that The S-PAS value in controls was 15-20 mm whereas that of the cases was only 2-5mm. The distance from mandible to hyoid (H-MP) value was also found to be increased, thus indicating a low position of the mandible in 67.5% of cases. A:N ratio (A N ratio=adenoid:nasopharynx) was abnormal in 65% of the children. Polysomnography showed that 60% children had severe SDB (RDI>10 per hour) and 30% of them had moderately severe SDB (RDI 5-10/hr). About 50% children showed significant oxygen desaturation. Conclusions: In conclusion it can be said that every child who snores is a suspected case of SDB. So there should be proper evaluation and management at the earliest to prevent potentially serious complications.

A study was conducted in the Department of Respiratory Medicine, Nil Ratan Sircar Medical College, Kolkata over a period of two years on 120 uncomplicated stable adult asthmatics selected by random sampling to assess the incidence of Excessive Daytime Sleepiness (EDS) in patients with asthma, and to find out its correlation with the severity and the level of control of asthma. Diagnosis of asthma and its severity and level of control were assessed clinically, by peak flow meter and by spirometry. EDS was assessed by (Epworth Sleepiness Scale score > 10). We found incidence of EDS was 30.8% where as EDS in general population of Kolkata was 11.3% (Z = 4.627, P = < 0.05). We also found a definite correlation between EDS with the severity of asthma (5.9% in intermittent, 19.4% in mild persistent, 39.3% in moderate and 83.3% in severe asthmatics) and the level of control (none in good level of control, 25.5% in fair level of control and 58.9% in poor level of control of asthma). However there was no correlation between the mode of diagnosis of asthma and EDS (31.8% in asthmatics diagnosed clinically, 25% by peak flow meter and 31.6% by spirometry).

Mandibular advancement appliances (MAD) have long been used to treat OSA. Most of the international sleep medicine societies recommend MAD in mild and moderate OSA. Most studies with MAD exclude patients with severe OSA and include patients who failed other treatment modalities with significant source of bias. Cephalometric and BMI factors are often not factored while prescribing MAD. So we undertook a pilot study to evaluate the therapeutic efficacy of Thornton adjustable positioner (TAP), a titratable MAD in severe adult OSA cases. We have observed significant (p< .0001) improvement in Apnea-Hypopnea index and Epworth sleepiness scale. We concluded that factoring predictable cephalometric measurements, BMId ≤30 Kg/m2, and mandibular protrusion of 70%; severe OSA can be effectively managed with TAP.

Objective: Validity studies on scales of sleep-related habits and problems for pediatric population are few, and cross-validation with Indian population has not been reported. This study was designed to assess the psychometric properties of a parent-rated measure of sleep habits i.e. Children Sleep Habits Questionnaire (CSHQ) in Indian school going children Methods: Cross-sectional data were examined for 371 primary school going children from Pre - Nursery to 3rd class. Reliability testing and psychometric validation using principal component analysis was carried out. Results: Our study cohort achieved a mean score of 49.35 (S.D. 7.6).Though CSHQ scale items had a good overall internal consistency (Cronbach's alpha 0.77), its subscales had poor reliability. Data analysis conducted by excluding the youngest school children (class Pre-Nursery) significantly improved the internal consistency alphas of the various subscales, indicating better reliability of CSHQ subscales in the older age groups in our setting. On comparison with Visual Analogue Scale (VAS) for global sleep rating, CSHQ showed good concurrent validity. Construct validity of CSHQ was evaluated by principal factor analysis which extracted 8 underlying latent factors (with eigen value >1) matching original CSHQ domains. However, these latent factors explained only 48.2% of total variance in the data. Principal Component Analysis (PCA) of CSHQ in our study cohort also favors shortening of original 33-item scale to a shorter 23-item scale with better acceptability for parents. Conclusions: The CSHQ is a reliable and internally consistent scale, and it is useful optional tool for assessing sleep problems in Indian school children.