Indian Journal of Sleep Medicine

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2009 | January-March | Volume 4 | Issue 1

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Anuradha A Shah

Sleep and Sugar: Diabetes and associated sleep problems

[Year:2009] [Month:January-March] [Volume:4] [Number:1] [Pages:3] [Pages No:1 - 3]

   DOI: 10.5005/ijsm-4-1-1  |  Open Access |  How to cite  | 



J. M. Joshi

Sleep staging: Good old R & K! Do we need a revised AASM criteria?

[Year:2009] [Month:January-March] [Volume:4] [Number:1] [Pages:2] [Pages No:4 - 5]

   DOI: 10.5005/ijsm-4-1-4  |  Open Access |  How to cite  | 



Actigraphy, does it add value?

[Year:2009] [Month:January-March] [Volume:4] [Number:1] [Pages:6] [Pages No:6 - 11]

Keywords: Actigraphy, validity, circadian rhythm sleep disorders, intervention studies.

   DOI: 10.5005/ijsm-4-1-6  |  Open Access |  How to cite  | 


Actigraphy (activity-based monitoring) has become an essential tool in sleep research and sleep medicine. The validity and limitations of actigraphy in documenting sleep-wake patterns are discussed. Some normative data exists across groups. Actigraphy has been used in a variety of clinical sleep disorders such as circadian rhythm sleep disorders, both in terms of diagnosis and in follow-up as well as in intervention studies. Limitations of actigrapghy exist. Controlling artifacts by using sleep logs and diaries will improve the efficacy. It is not sufficient as a stand-alone device to diagnose sleep-disordered breathing and any disorder which cause motion artefact limits its utility.



U. C. Ojha, Tulsi Adhikari, J. C. Suri

Epidemiology of sleep disorders in the elderly – A questionnaire survey

[Year:2009] [Month:January-March] [Volume:4] [Number:1] [Pages:7] [Pages No:12 - 18]

Keywords: elderly, snoring, sleep-disordered breathing (SDB), Excessive daytime sleepiness, Restless leg syndrome (RLS), sleepwalking, nightmares, bruxism, Disorders of initiation and maintenance of sleep (DIMS), SES (Socio economic strata)

   DOI: 10.5005/ijsm-4-1-12  |  Open Access |  How to cite  | 


A questionnaire based survey was conducted to determine the prevalence of common sleep-related disorders in the elderly population of Delhi. The study population included in this analysis comprised 1240 grandparents of school-going children. The overall prevalence of SDB was 10.3%.; (9.9% in males and 10.8% in female subjects) It was found to correlate with increasing BMI (p< 0.064) The overall prevalence of snoring was found to be 41.4% (Males=41.6%, Females =41.2%). It correlated positively with body mass index (BMI) (p<0.033), age (p<0.076), and excessive daytime sleepiness (p<0.036). Habitual snoring was found to be prevalent in 27.2% of the elderly subjects and was found to correlate with BMI (p<0.03), and rising socio-economic strata (p<0.014). Approximately 41.5% of the elderly population was seen to suffer from excessive daytime sleepiness. It correlated significantly with lower socio-economic strata The overall prevalence of symptoms suggestive of restless leg syndrome was 14.3%. It was found to correlate significantly with BMI (p<0.018), and female gender (p<0.052) The overall prevalence of sleepwalking in the elderly population studied was 6.9%. It was found to correlate negatively with increasing BMI (p<0.041) and age and positively with rising socio-economic strata (p<0.076). The prevalence of nightmares in the elderly population studied was 21.7%. It was found to correlate inversely with age (p<0.019). Bruxism was observed to be present in 9.2% of the elderly population studied. It correlated significantly with rising socio-economic strata (p<0.017) and snoring (p<0.002). Approximately 8% of the entire elderly study population admitted that they consumed sleeping pills. Its use correlated with rising socio-economic strata (p<0.033) and symptoms suggestive of disorders of initiation & maintenance of sleep (DIMS) (p<0.072).



Y. K. Gupta, A. Jaiswal, R. Gupta, A. K. Jain, D. Kumar, D. Behera

Pattern of sleep disordered breathing in obese Indians

[Year:2009] [Month:January-March] [Volume:4] [Number:1] [Pages:13] [Pages No:19 - 31]

Keywords: Obese, SDB, AHI, polysomnography, India

   DOI: 10.5005/ijsm-4-1-19  |  Open Access |  How to cite  | 


Introduction: Obesity has become a major health problem worldwide due to high comorbidity and an increasing prevalence. It is the greatest risk factor for obstructive sleep apnea (OSA). Owing to lack of data on the association of obesity and OSA within the country, the present study was designed to evaluate the pattern of sleep disordered breathing (SDB) among obese Indian subjects. Material and Method: The study was prospectively carried out in Sleep Laboratory of LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi. 30 obese [having body mass index BMI > 27.5 kg/m2] and 10 non-obese (having BMI < 27.5 kg/m2) subjects were consecutively enrolled into the study (obesity) and the control (non-obese) groups respectively as per the World Health Organization (WHO) Criteria of Obesity for Asians. Detailed clinical history including that of sleep was taken, a physical examination along with anthropometric measurements like neck circumference (NC), waist circumference (WC) and hip circumference (HC) was done and laboratory investigations were performed in all subjects, who thereafter, underwent an overnight polysomnography (PSG) on Compumedics E-Series sleep software. Sleep was staged as per Rechtshaffen and Kales (R & K) rules and SDB evaluated as per standard criteria. Data was subjected to statistical analysis. Results: There were 16 obese, 8 severely obese & 6 morbidly obese subjects. Respective characteristics of the obesity and the control group subjects showed a mean age of 47.73 and 40.90 years, a male-female ratio of 19: 11 and 7:3, and a mean BMI of 33.46 and 23.73 kg/m2. Mean Apnoea-Hypopnoea Index (AHI) was significantly higher among the subjects of the obesity group as compared to the controls. Similarly, mean AHI was significantly higher among the obese males, those having NC between 35 to < 45 cms, symptomatics, those having 4 to 6 number of symptoms, and those having co-morbidities as compared to the respective non-obese counterparts. Mean value of sleep latency was higher, while that of Total Sleep Time (TST) & sleep efficiency lower in the obesity than the control group. Oxygen De-saturation Index (ODI) and indices of arousal, Periodic Limb Movement (PLM) in Sleep (PLMS) & PLM with arousals were significantly higher in the obesity as compared to the control group respectively. No significant differences were noticed between the groups with regard to sleep stage percentages. SDB was present in 86.6% (26/30) of obesity subjects, of whom 80% (24/30) had mild, moderate and severe OSA (with 2/3rd having moderate to severe OSA and more than half having severe OSA), and 6.6% (2/30) had Upper Airway Resistance Syndrome (UARS) or Respiratory Effort Related Arousal (RERA). Obesity Hypoventilation Syndrome (OHS) co-existed in 37.5% (9/24) of subjects with OSA constituting one-third of total cases. PLMS co-existed in 7 subjects with OSA. All 6 morbidly obese subjects had some form of SDB with OSA in 5 and RERA in 1 of them. Among the control subjects, 50% had a normal sleep study and others had only mild (40%; 4/10) and moderate OSA (10%; 1/10), while none had severe OSA. Further, OSA coexisted with PLMS in only 1 subject. Conclusions: Mean AHI is higher among the subjects of obesity group as compared to nonobese subjects. Mean AHI is also higher among the obese males, those having NC between 35 to < 45 cms, symptomatics, those having 4 to 6 number of symptoms, and those having co-morbidities in comparison to the respective non-obese subjects. The obese subjects sleep for less time taking longer time to sleep, have higher number of arousals and PLMS per hour, and have greater nocturnal oxygen de-saturation (NOD) than the non-obese. OSA is present in 80% of subjects with obesity and SDB exists in all morbidly obese subjects. A need exists for all obese subjects to undergo a thorough clinical assessment with inclusion of a sleep history, a polysomnographic evaluation and an arterial blood gas analysis to detect and manage SDB early.



U. C. Ojha

Journal Scan

[Year:2009] [Month:January-March] [Volume:4] [Number:1] [Pages:5] [Pages No:32 - 36]

   DOI: 10.5005/ijsm-4-1-32  |  Open Access |  How to cite  | 


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