Indian Journal of Sleep Medicine

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2012 | April-June | Volume 7 | Issue 2

REVIEW ARTICLE

Mohankumar Thekkinkattil

Sleep Disorders in Chronic Fatigue Syndrome

[Year:2012] [Month:April-June] [Volume:7] [Number:2] [Pages:3] [Pages No:33 - 35]

Keywords: *

PDF  |  DOI: 10.5958/j.0973-340X.7.2.007  |  Open Access |  How to cite  | 

Abstract

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REVIEW ARTICLE

B Jayan, Kadu A

Upper Airway Sleep Disorders in Children: Orthodontist's Role

[Year:2012] [Month:April-June] [Volume:7] [Number:2] [Pages:6] [Pages No:36 - 41]

Keywords: *

PDF  |  DOI: 10.5958/j.0973-340X.7.2.008  |  Open Access |  How to cite  | 

Abstract

Significant component of craniofacial development occurs within the first four years of life. A total of 90% of the craniofacial development is complete by the age of 12 years. Therefore, it can be concluded that morphometric features that puts an adult at risk of obstructive sleep apnoea(OSA)or sleep disordered breathing (SDB) were probably present at the age of 12 years. Class II malocclusions, narrow maxilla, mandibular deficiency, retrognathia, long face problems, inferiorly and posteriorly placed hyoid bone are all considered as craniofacial anomalies that predisposes a child to SDB. Craniofacial anatomy can influence the upper airway and environmental factors, like adenotonsillitis, nasal allergy, pernicious oral habits (prolonged pacifier use, thumb sucking, tongue thrusting and mouth breathing), and can also influence the growth and development of the craniofacial complex. It has been stated that mouth breathing as an ongoing pattern may be a sign of impending sleep apnoea. So it is of paramount importance for the healthcare professionals to keep a close eye on the risk factors and make appropriate referrals for requisite preventive, interceptive and corrective treatment. Promotion and propagation of breast feeding in infants, adeno-tonsillectomy, maxillary expansion and functional appliances aimed at posturing the mandible in forward position/optimal position, habit breaking appliances and maxilla-mandibular distraction osteogenesiss are the preventive, interceptive and corrective treatment options at our disposal. This communication is aimed at providing an overview of orthodontist\'s role in the management of upper airway sleep disorders in children in the back drop of craniofacial risk factors, environmental influences and appropriate orthodontic and dentofacial orthopaedic intervention strategies.

REVIEW ARTICLE

Ravindra PN, Bindu M Kutty

Functional Importance of Sleep: An Overview

[Year:2012] [Month:April-June] [Volume:7] [Number:2] [Pages:3] [Pages No:42 - 44]

Keywords: *

PDF  |  DOI: 10.5958/j.0973-340X.7.2.009  |  Open Access |  How to cite  | 

Abstract

Sleep and dreams fascinated people from different walks of life. Though sleep has been investigated over a century, questions such as ‘what physiological functions are carried out by sleep’ or why do we need to sleep? still remain to be debated. We need 7–8 h of sleep to keep us active throughout the day without feeling sleepy. Such constant daily quota of sleep is maintained through a balance between sleep duration and intensity by sleep homoeostasis. Sleep is important for energy conservation, immune regulation, learning and memory etc. and, hence, important for health and survival. Sleep disturbances during development have been correlated to the poor psychological and cognitive functions. Sleep deprivation on the other hand can be fatal too. This mini review provides the reader a bird\'s eye view on the functions of sleep.

ORIGINAL ARTICLE

N Ramakrishnan, Vijay Viswanathan, S Sunaina, A Vigneswari, K Satyavani

Subjects with Type 2 Diabetes may have Obstructive Sleep Apnoea even at Lower BMI Values

[Year:2012] [Month:April-June] [Volume:7] [Number:2] [Pages:3] [Pages No:45 - 47]

Keywords: Epworth Sleepiness Scale, Obstructive sleep apnoea, type 2 diabetes, BMI

PDF  |  DOI: 10.5958/j.0973-340X.7.2.010  |  Open Access |  How to cite  | 

Abstract

Aim was to evaluate subjects with type 2 diabetes at risk of obstructive sleep apnoea (OSA) using Epworth Sleepiness Scale (ESS). A total of 436 subjects (M/F=273:163) were evaluated and categorised as those unlikely to have significant OSA (ESS score <10; absence of snoring) and likely to have significant OSA (ESS score >10; presence of snoring). Body mass index (BMI), HbA1c and micro- and macrovascular complications were recorded. Among 436 subjects, 242 were unlikely to have significant OSA, of which 20% were randomly selected (n=58; Group 1) and compared with subjects (8.3%) likely to have OSA (n=36; Group 2). In all, 50% in Group 2 and 36% in Group 1 had hypertension (P=0.27). In Group 2, 2.8% had BMI (kg/m2) <23, 5.6% had 23–23.9, 19.4% had 24–24.9, 25% were between 25 and 26.9, and 47.2% had e”27. Diabetic subjects even with normal BMI were at risk of OSA and more likely to have macrovascular comorbidity.

ORIGINAL ARTICLE

MS Barthwal, B Jayan, Oommen Nainan, SS Chopra, M Mukherjee

Predictive Morphometric Model Value Estimation and its Correlation with Severity of Obstructive Sleep Apnoea in a Mixed Indian Population: A Pilot Study

[Year:2012] [Month:April-June] [Volume:7] [Number:2] [Pages:7] [Pages No:48 - 54]

Keywords: apnoea/hypopnoea index, polysomnography, clinical rule, predictors,Obstructive sleep apnoea, morphometric model

PDF  |  DOI: 10.5958/j.0973-340X.7.2.011  |  Open Access |  How to cite  | 

Abstract

Background: The morphometric model (MM) provides a rapid, accurate and reproducible method for predicting whether patients in an ambulatory setting are at risk for obstructive sleep apnoea (OSA). Introduction: The aim of this study was to estimate mean MM scores in a mixed Indian population and to investigate its correlation with the severity of OSA as determined by apnoea/ hypopnoea index (AHI). Materials and Methods: A total of 60 subjects were included in the study and were divided into two groups of 30 subjects each; Group 1: Patient group; Group 2: Control group. A comparative cross-sectional study design was employed and MM value as suggested by Kushida et al. was estimated by applying their clinical rule. To determine the correlation between OSA severity as indicated by AHI and MM values, linear and multiple regression models were applied. Results: The comparison of MM values between OSA and non-OSA groups showed an extremely statistically significant difference. There was no significant correlation between the severity of OSA and MM values in this sample of Indian OSA patients. Conclusions: The results of this study could facilitate the early recognition of OSA and support the available diagnostic setup.

ORIGINAL ARTICLE

Poulomi Chatterjee, M. K. Sen

Prevalence of Depression and Anxiety in Patients with Sleep-Disordered Breathing and its Correlation with Disease Severity

[Year:2012] [Month:April-June] [Volume:7] [Number:2] [Pages:7] [Pages No:55 - 61]

Keywords: GAD-7 score, RDI,OSA, Depression, Anxiety, PHQ-9 Score

PDF  |  DOI: 10.5958/j.0973-340X.7.2.012  |  Open Access |  How to cite  | 

Abstract

Objective: Primary objective of the study was to assess the prevalence of depression and anxiety among obstructive sleep apnoea (OSA) patients presenting to the sleep clinic of Safdarjung Hospital. Secondary aim was to study the correlation between and severity of depression, anxiety and respiratory disturbance index (RDI) and to see any relation with gender. Study design: Case–control study. Materials and Methods: One hundred seventy-two patients with OSA were evaluated before treatment and compared with controls by using the Patient Health Questionnaire-9 (PHQ-9) and anxiety on the basis of General Anxiety Disorder Assessment-7 score (GAD-7). Based on these scores, depression and anxiety were categorised as mild, moderate and severe, respectively. OSA was assessed by Epworth Sleepiness Scale, and polysomnography was used for sleep scoring and classified to mild, moderate and severe OSA by RDI. RESULTS: Depressive symptoms were identified in 14% (25 of 172) of controls, and 36.4% (62 of 172) of patients with OSA by using PHQ-9 screening (P<0.006). Anxiety was identified in 19.2% (33 of 172) OSA patients as compared to 6.7% of controls. Evaluation of the patients with OSA compared to the control group showed depression and anxiety to be significantly more common in OSA patients than in controls (P-values 0.006 and 0.01, respectively). Overall, 41.9% and 58.1% of men and women, respectively, with OSA had elevated PHQ-9 scores; 05% and 11% of male and female control patients, respectively, exhibited depressive symptoms (P<0.001). In all, 75.75% patients were female OSA cases with symptoms of anxiety (25 of 33), while 24.25% were male (P<0.02) as screened by GAD- 7 scores. Analysis of depression scores by OSA disease severity category found significant difference in depressive symptoms between participants with mild OSA, moderate OSA and severe OSA (P-value <0.006). In this study, the association between OSA disease severity (as determined from the RDI) and PHQ-9 on univariate analysis (P ¼ .OO) was significant, with association found (P-value<0.003) on multivariable analysis, after controlling for sex. Partial linearity was noted. Analysis of anxiety scores by GAD-7 scores found no significant difference in anxiety symptoms between subgroups with mild, moderate and severe OSA (P-value <0.23) on univariate analysis, association between disease severity 0f OSA and GAD-7 scores was not significant, however, on multivariate analysis ruling out confounding factors like sex was significant (P-value <0.003). CONCLUSIONS: Patients with OSA and daytime sleepiness are more likely to have depressive and anxiety symptoms as compared with controls. OSA disease severity, as measured with the RDI score, is a predictor of PHQ-9 score, but no correlation was seen between the severity of OSA and GAD-7 scores. These data suggest that OSA patients with symptoms of excessive sleepiness have the highest risk of associated depressive symptoms and may benefit most from depression screening.

JOURNAL SCAN

U. C. Ojha

Journal Scan

[Year:2012] [Month:April-June] [Volume:7] [Number:2] [Pages:7] [Pages No:62 - 68]

Keywords: *

PDF  |  DOI: 10.5005/ijsm-7-2-62  |  Open Access |  How to cite  | 

Abstract

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