Indian Journal of Sleep Medicine

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2011 | April-June | Volume 6 | Issue 2

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REVIEW ARTICLE

Dipti Gothi

Perioperative management of adult and pediatric sleep apnoea

[Year:2011] [Month:April-June] [Volume:6] [Number:2] [Pages:9] [Pages No:35 - 43]

Keywords: Excessive daytime sleepiness (EDS), obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP), apnea hypopnea index (AHI)

   DOI: 10.5005/ijsm-6-2-35  |  Open Access |  How to cite  | 

Abstract

Amongst the various diseases required to be screened preoperatively obstructive sleep apnoea (OSA) is one of the most underdiagnosed conditions. The various screening tools devised to prevent OSA related postoperative complications are: Berlin questionnaire, STOP-BANG questionnaire, American Society of Anesthesiologist checklist and Perioperative Sleep Apnea Prediction Score. Among these, the STOP –BANG questionnaire is validated, sensitive, specific and viable and can even be self administered. Portable sleep study is the most practicable approach to confirm the diagnosis preoperatively in suspected cases. Continuous positive airway pressure (CPAP) administration is recommended for reducing the risk of complications related to OSA during post and or pre operative period although; the data describing the impact of CPAP therapy on adverse outcomes are limited. Also, close monitoring of patients postoperatively; avoiding use of sedatives and awake extubation are important components of postoperative care. Using CPAP in pre and or postoperative period can not only reduce the postoperative complication but also diagnose and sensitize the patients towards the long term management of OSA. The perioperative management of pediatric OSA is also similar to adult OSA, though clinically both are different.

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REVIEW ARTICLE

Garima Shukla

Circadian rhythm sleep disorders

[Year:2011] [Month:April-June] [Volume:6] [Number:2] [Pages:6] [Pages No:44 - 49]

   DOI: 10.5005/ijsm-6-2-44  |  Open Access |  How to cite  | 

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ORIGINAL ARTICLE

Parthasarathi Bhattacharyya, Rantu Paul, Rana Dey, Nirjoo Barooah, Saikat Nag, Saurabh Maji

Prevalence of left ventricular diastolic dysfunction in OSA patients: a retrospective study

[Year:2011] [Month:April-June] [Volume:6] [Number:2] [Pages:4] [Pages No:50 - 53]

Keywords: OSA (Obstructive Sleep Apnea), LVDD (Left Ventricular Diastolic Dysfunction), CPAP (Continuous Positive Airway Pressure), COPD (Chronic Obstructive Pulmonary Disease), ESS (Epworth Sleepiness Score)

   DOI: 10.5005/ijsm-6-2-50  |  Open Access |  How to cite  | 

Abstract

Introduction: OSA has been increasingly implicated in the initiation and progression of cardiovascular diseases. We attempted to find the association of LVDD with OSA in terms of its frequency as well as in terms of several important parameters. Materials and methods: It was a retrospective study where 32 OSA patients diagnosed by polysomnography who also underwent echocardiography were looked for the presence of LVDD. The patients were divided into two groups based on the presence or absence of LVDD and compared them according to different parameters. Results: The overall prevalence of LVDD in our OSA patients has been found to be 46.8%. There has been found to be no significant differences as per the different parameters considered. On the contrary, severity of sleep apnea was found to be higher in the non LVDD group tallying to their higher BMI, higher neck and waist circumference. Conclusion: It has not been possible to associate severity of OSA with risk or prevalence of LVDD as there has been found to be no difference between the two groups, with and without LVDD. This area needs further probing so as to look into the origin of LVDD in certain OSA sufferers.

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ORIGINAL ARTICLE

Anoop Kumar Agarwal, S. Raghunandan, R. S. Anand Kumar, Mohan Kameshwaran

A clinical study of surgical outcomes in patients with obstructive sleep apnoea syndrome

[Year:2011] [Month:April-June] [Volume:6] [Number:2] [Pages:8] [Pages No:54 - 61]

   DOI: 10.5005/ijsm-6-2-54  |  Open Access |  How to cite  | 

Abstract

Introduction: Snoring & Obstructive Sleep Apnea Syndrome (OSAS) is a globally prevalent problem which is increasingly being recognized in recent times. The treatment modalities include medical appliances & surgery. It is mandatory to have a rational approach in the management of Obstructive Sleep Apnoes. Patients are given Continuous Positive Airway Pressure (CPAP) support or advised surgical correction as per the level of obstruction diagnosed by sleep MRI and the severity as per the polysomnography. A judicious selection of cases needs to be done for surgical management. Patients unfit for surgery and those who prefer medical treatment are advised CPAP as the primary modality of treatment. A small group of patients need surgical intervention followed by CPAP support. Objectives: To assess the outcomes of various surgical procedures in the management of OSAS and to define a comprehensive protocol for objective assessment of OSAS with Dynamic MRI and polysomnography. Materials & Methods: A cohort of 100 patients in the age group 27 – 64 years were diagnosed with OSAS and were treated at our institute over a period of one year (January 2010 – January 2011). All patients were evaluated with Epworth sleepiness scale (ESS) and investigated with Dynamic MRI and polysomnography. As per the management protocols defined in the study, surgery was performed in 38 patients with severe compromise of the airway, while the other group of 62 patients, were provided CPAP. The 38 patients selected for surgery were included into this prospective study. Successful outcomes among these 38 patients were analyzed at the end of the study period. Four patients with mixed apnoea required multimodal therapy which included surgery followed by CPAP support. Results: Among the 38 patients, surgical treatment proved successful in 34 patients in whom AHI reduced from 38.27 to 14.54 (62%) and ESS improved by almost 10 points. Four patients among the surgical group had persistence of symptoms due to persistence of mixed apnoea & they were given CPAP support. Inferences derived from the above results proved the success

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ORIGINAL ARTICLE

Rohit K Pradhan, Rashmi Mishra, Chaynika Nag

Actigraphic study of sleep behaviour in sickling patients

[Year:2011] [Month:April-June] [Volume:6] [Number:2] [Pages:7] [Pages No:61 - 67]

Keywords: Autocorrelation, Circadian rhythm, Dichotomy index, Rest-activity rhythm, Sickle cell disease, Sleep

   DOI: 10.5005/ijsm-6-2-61  |  Open Access |  How to cite  | 

Abstract

Present study was an attempt to evaluate sleep parameters and characteristics of circadian rhythm in rest-activity in sickle cell diseased patients. Rest-activity rhythm was studied on ten patients (6 males and 4 females) non-invasively with the help of wrist actigraphy, and compared with 10 age-matched normal subjects (6 males and 4 females). Several sleep parameters, such as time in bed, assumed sleep, actual sleep time, actual wake time, sleep efficiency, sleep latency, and fragmentation index were recorded by selecting fifteen second epoch length for collection of data. The results of the present study validated a statistically significant circadian rhythm in rest-activity for all subjects with drastic alteration in circadian rhythm parameters in sickling patients. Dichotomy index declined significantly in the group of sickling patients. Results of sleep parameters revealed that sickling patients had lower assumed sleep duration, and exhibited less sleep efficiency as compared to that of the control subjects. More sleep latency and higher fragmentation index indicates deterioration of sleep among sickling patients. In conclusion, the results of the present study document disruption of circadian rhythm and sleep impairment in sickling patients. Alterations of circadian rhythm and deterioration of sleep could be attributed to diseased status.

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JOURNAL SCAN

U. C. Ojha

Journal Scan

[Year:2011] [Month:April-June] [Volume:6] [Number:2] [Pages:11] [Pages No:68 - 78]

   DOI: 10.5005/ijsm-6-2-68  |  Open Access |  How to cite  | 

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