Indian Journal of Sleep Medicine

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2010 | October-December | Volume 5 | Issue 4

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REVIEW ARTICLE

Preeti Devnani

Paediatric sleep medicine

[Year:2010] [Month:October-December] [Volume:5] [Number:4] [Pages:6] [Pages No:105 - 110]

   DOI: 10.5005/ijsm-5-4-105  |  Open Access |  How to cite  | 

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REVIEW ARTICLE

Jyoti Krishna, Ai-Ping Chua, Prakash Kotagal, Chua Ai Ping

Revisiting Kleine-Levin Syndrome – a case report and review

[Year:2010] [Month:October-December] [Volume:5] [Number:4] [Pages:5] [Pages No:111 - 115]

Keywords: Hypersomnia, Episodic, Recurrent, Multiple sleep latency test, Polysomnogram, Carbamazepine, Hyperphagia, Kleine-Levin Syndrome.

   DOI: 10.5005/ijsm-5-4-111  |  Open Access |  How to cite  | 

Abstract

A 15 year-old girl who was previously well presented with severe recurrent episodic hypersomnia associated with abnormal behavior and hyperphagia after recovery from a mild upper respiratory tract infection (URTI). Physical examination was unremarkable with normal blood tests, brain imaging and electroencephalogram (EEG). A multiple sleep latency test (MSLT) during a typical episode showed moderate hypersomnolence in contrast to a normal MSLT performed an the interval between episodes. Clinical features were consistent with Kleine-Levin syndrome (KLS). She was started on carbamazepine treatment after failing a trial of methylphenidate and is currently being followed up for her symptoms.

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REVIEW ARTICLE

Prachi Gupta, Ram Thombare, Sameer Singhal, A J Pakhan

Obstructive sleep apnea and edentulism – role of complete dentures/oral appliance from prosthodontics perspective : a review

[Year:2010] [Month:October-December] [Volume:5] [Number:4] [Pages:4] [Pages No:116 - 119]

Keywords: OSA, Oral appliances, Edentulism, Retropharyngeal space

   DOI: 10.5005/ijsm-5-4-116  |  Open Access |  How to cite  | 

Abstract

Background: Edentulism results in decrease in size and tone of the pharyngeal musculature and may be an important risk factor for development of Obstructive Sleep Apnea (OSA). Epidemiological studies estimated that edentulism has been found to be present in about 18% of patients older than 60 years of age and that such prevalence would remain constant over the next 30 years. Considering the high prevalence of obstructive sleep apnea in the advanced age, it is conceivable that a consistent number of elderly people are at risk of edentulism induced worsening of obstructive sleep apnea and, consequently of morbidity and mortality due to this condition. Although cranio-mandibular abnormalities are well recognised risk factors for this manifestation, the role played by edentulism has never been investigated at length. The literature available on this issue was critically reviewed for the occurrence, etiology and prosthodontist's involvement in treating this condition Objective: The authors reviewed medical and dental literature dealing with edentulism and development of OSA and effect of complete denture/ oral appliances on the retropharyngeal space (smallest linear distance between anterior and posterior pharyngeal wall) and reduction in theincidence of OSA among apnea hypoapnea index (AHI). Results: Edentulous patients tends to be higher than that of the general population. Loss or absence of teeth produces prominent anatomical changes that may influence upper airway size and function, such as loss of the vertical dimension of occlusion resulting into reduction of height of the lower face and mandibular rotation. Rehabilitation of edentulous patients with complete dentures is an integral part of prosthodontic treatment. A denture not only provides aesthetics and improves the phonetics but also restores the desired function of mastication and also provides adequate support to oro-facial structures by restoring altered vertical dimension of face. Besides, it also improves OSA/hypopnea.

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ORIGINAL ARTICLE

Geeta Kampani, J. C. Suri, Manish Sharma

Prevalence and profile of sleep disordered breathing amongst patients with congestive heart failure

[Year:2010] [Month:October-December] [Volume:5] [Number:4] [Pages:8] [Pages No:120 - 127]

Keywords: sleep disordered breathing, central sleep apnea, Cheyne-Stokes respiration, congestive heart failure

   DOI: 10.5005/ijsm-5-4-120  |  Open Access |  How to cite  | 

Abstract

Introduction: It has been observed that since heart failure is highly prevalent and central sleep apnea (CSA) is common in patients with a failing heart, heart failure is the commonest cause of CSA in the general population. Aims & Objectives: The present study was undertaken with the purpose of finding prevalence of sleep disordered breathing (SDB) in patients of heart failure and also to find the association of severity of SDB with severity of heart failure. Material & Methods: Forty patients suffering from systolic heart failure were selected on random basis. All these patients underwent complete evaluation of history, physical examination and overnight polysomnography. The patients were divided into two groups, namely group 1 and group 2, on the basis of polysomnography. Group 1 consisted of 17 patients who did not have sleep disordered breathing i.e. AHI (central or obstructive) < 5. Group 2 consisted of 23 patients who had sleep disordered breathing i.e. AHI (central or obstructive) > 5. Comparison of biochemical profile and sleep parameters was made between group 1 and group 2 and results analyzed. Observations: Aetiology of heart failure was ischemic heart disease in 34 patients, viral myocarditis in 3 patients and postpartum cardiomyopathy in 3 patients. Total prevalence of CSA in heart failure was 57.5%.Prevelance in males and females was 47.6% and 68.42% respectively. There was a significant difference in O2 desaturation index, minimum O2, arousal index, total sleep time, AHI (central), sleep efficiency and wake O2 amongst the two groups. A negative correlation was observed between ejection fraction and O2 desaturation index, AHI (central), and arousal index. A positive correlation was found between ejection fraction and wake O2. Conclusions: A fairly high prevalence of sleep-disordered breathing (57.5%) was found in patients of heart failure in the present study. With increasing severity of HF a significant worsening of CSACSR was observed. The treatment of CSA-CSR may prevent the worsening status of HF. Hence long term randomized and controlled interventions are required to further substantiate these fact.

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ORIGINAL ARTICLE

Snehal Jadhav

Craniofacial deformities and obstructive sleep apnoea syndrome (OSAS) in the young

[Year:2010] [Month:October-December] [Volume:5] [Number:4] [Pages:5] [Pages No:128 - 132]

   DOI: 10.5005/ijsm-5-4-128  |  Open Access |  How to cite  | 

Abstract

Background: Obstructive sleep apnoea syndrome (OSAS) shows a strong association with obesity. However, OSAS is also associated with craniofacial deformities irrespective of body weight, particularly in the young. Surgery represents the best therapeutic option for OSAS patient with craniofacial deformities. This study was undertaken to evaluate OSAS caused by craniofacial deformities and to study the effect of surgical correction in these cases. Methods: Thirty one patients with symptoms of OSAS and craniofacial deformity who attended our outpatient department or were referred for pre-operative evaluation prior to corrective surgery were included in this retrospective study. Details of demography, history and clinical examination were obtained. Polysomnography (PSG) performed was level III (cardio-respiratory or limited channel study). The diagnostic criteria were symptoms suggestive of sleep apnoea and apnoea hypopnoea index (AHI) of > 1 in children and > 5 in adults. Surgical treatment consisted of release of the temporo-mandibular joint (TMJ) ankylosis, mandibular distraction osteosis (DO) and maxillomandibular advancement (MMA) either alone or a combination of surgeries. Patients were reassessed with repeat PSG to document improvement post intervention. Those patients who did not show improvement with surgery alone were treated with CPAP therapy. CPAP therapy was advised in cases that refused surgery. One case of retrognathia was treated with oral prosthesis. Results: Of the 31 cases were included in this study, age range from 6-27 years, the mean age was 15.10 years and 17 (54.8%) were males while 14 (45.2%) were females. The mean body mass index (BMI) was 16.72 kg/m2. Snoring and excessive day time sleepiness (EDS) were the predominant symptoms in 27 (87.1%) and 20 (64.5%) cases respectively. The other symptoms included choking during sleep in 16 (51.6%), scholastic backwardness in 15 (48.4%) irritability in 14 (45.2%), non refreshing sleep in 13 (41.9%), enuresis in 12 (38.7%) and early morning headaches in 11 (35.5%) cases. In most cases symptoms were present since early childhood. The predominant craniofacial deformity associated with OSAS in this study group was bilateral TMJ ankylosis with micrognathia/ retrognathia.in 14 (41.9%) and unilateral TMJ ankylosis with micrognathia/ retrognathia in 8 (25.8%). Other deformities were retrognathia 4 (12.9%) and micrognathia 2(6.5%). Surgery was performed in 25 (80.6%) cases, 5 (16.1%) refused surgery and opted for CPAP and 1 (3.2%) case was treated with oral prosthesis. Symptoms improved significantly in 96.8% of the patients following surgery. Conclusion: OSAS with craniofacial deformity is caused by compromised upper airway space. Bilateral or unilateral ankylosis with retrognathia/ micrognathia of TMJ is the most common craniofacial deformity causing OSAS in the young. Syndromic associations of craniofacial deformities also cause OSAS. Surgical methods TMJ ankylosis release, mandibular DO and MMA, either alone or in combination show good success rate. The consequences of untreated OSAS in the young are neuro cognitive disorders and cardiac consequences seen later in life. Hence it is important to recognize and treat OSAS associated with craniofacial deformities as early as possible to avoid these consequences.

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JOURNAL SCAN

U C Ojha

Journal Scan

[Year:2010] [Month:October-December] [Volume:5] [Number:4] [Pages:7] [Pages No:133 - 139]

   DOI: 10.5005/ijsm-5-4-133  |  Open Access |  How to cite  | 

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