Sleep is essential to maintain quality of life. Restless legs syndrome (RLS) is a disorder which is characterized by uncomfortable feeling in legs, irresistible urge to move them and compromised sleep quality. It is a common problem but is usually under diagnosed or misdiagnosed. It can be easily diagnosed by using criteria proposed by International Restless Legs Society. Though no specific investigations are require for diagnosis, investigations are required to discern the cause. Treatment of the cause relieves the symptoms of secondary RLS. In case of primary RLS most patients improve with non-pharmacological treatment. Those who require drug treatment should be classified as per frequency and severity of symptoms. Dopamine agonists are first line drugs, however, the treatment needs to be individualized depending upon the symptoms of the patients. This review aims at comprehensive overview of RLS including diagnosis and management.
The quest to learn about the need, organization and the functions of sleep has led to basic understanding of physiology of human sleep. Just like wakefulness, different stages of sleep exert unique influence on organ systems of the body. The amount and quality of sleep seems to be in part, controlled by the competing endogenous rhythms. The autonomic system demonstrates characteristic changes with each sleep cycle of non - rapid eye movement and rapid eye movement sleep. Cardiovascular physiology provides evidence of “rest and relaxation” during most of the sleep. While behavioral and wakefulness drive to breathe ceases during sleep, respiratory mechanics and ventilatory responses change predictably. Sleep influences most hormone secretion and their actions. Thermoregulation is linked to the sleep wake cycle. Thorough understanding of sleep physiology not only facilitates the approach to diagnosis and management of clinical sleep disorders but also serves to stimulate inquiry, discovery and innovation.
The impact of obstructive sleep apnea syndrome on cardiovascular morbidity and mortality is phenomenal. There is a strong evidence base in terms of several longitudinal as well as cross-sectional studies in support of this fact. However, the evidence in favor of its association with hypertension is stronger than with coronary artery disease, arrhythmias and stroke. Prevalence studies on OSAHS have demonstrated an increased odds ratio for hypertension above the background population. Also, prevalence of hypertension is known to increase proportionate to the severity of sleep disordered breathing. Cross-sectional prevalence studies on cardiovascular disease and OSAHS have shown an increased risk of coronary artery disease (CAD) amongst patients with OSAHS. Prevalence of OSA is significantly higher in patients with atrial fibrillation (AF) than in patients without past or current AF. Pulmonary arterial hypertension, congestive heart failure and sudden cardiac death are also commonly associated with OSAHS. Interventional studies clarify the role of effective treatment of this disorder with CPAP. Therapy with CPAP, therefore, should be expected to impact the prognosis of cardiovascular consequences of this syndrome.
Abhijit G Deshpande,
Prajakta A Deshpande,
Prasad C Karnik,
Gurpreet Kaur Aurora
Introduction: Sleep disorders are common but remain undiagnosed due to lack of awareness among masses as well as physicians. There is a need for a sleep questionnaire which is specific to Indian population, quick to understand as well as is a reliable screening device.
Objective: To validate a sleep questionnaire as a basic screening tool.
Material and Method: The questionnaire was prepared taking different situations into consideration, translated into Marathi as well as English. Ten subjects were randomly chosen and the test was administeredover an interval of one month by two experts to determine its intra-observer as well as inter-observer reliablity. The validity was further confirmed with NPSG (Nocturnal Polysomnogram) as a gold standard.
Results: The kappa statistic was 0.92 for intra as well as inter-observer reliability. Validity was determined by evaluating fifty five subjects by way of self administered questionnaire followed by a NPSG (Nocturnal Polysomnogram). The sensitivity and specificity were found to be 80% and 75% by Baye's rule.
Conclusion: The reliability of the questionnaire is excellent. By Landis method there is almost perfect agreement between Expert 1 and Expert 2.Also there is good sensitivity and specificity observed. It appears to be useful screening tool for identifying presence of sleep disorders.
R.S Anand Kumar
DOI: 10.5958/j.0974-0155.8.1.006 |
Open Access |
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Kameswaran M, Raghunandhan S, Raghunandhan S, Kumar RA. A clinical study of surgical outcomes in patients with obstructive sleep apnoea syndrome. Indian Sleep Med 2013; 8 (1):25-32.
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 andPolysomnography.
Materials & Methods: A cohort of 100 patientsin 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, surgeries were performed in 38 patients with severe compromise of the airway, while the other group of 62 patients,and 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 apnoearequired multimodal therapy which included surgery followed by CPAP support.
Results: Among the 38,patients, surgery proved successful in 34 patients in whom AHI reduced from 38.27 to 14.54 (62%) and ESS improved by almost 10 points. FourPatients among the surgical group had persistence of symptoms due to persistence of mixedapnoea & they were given CPAP support. Inferences derived from the above results proved the success of various surgical interventions in the management of OSAS.
Conclusion:A critical analysis of the anatomical & physiological factors inducing obstructive episodes & an appropriate treatment plan is vital, to produce successful outcomesin patients with OSAS. Failure of surgical procedures, are often due to improper case selection. A small group of patients may require multimodal therapy with surgery and CPAP.
Background: OSA is a rising problem amongst the Indian population in part due to adaptation of western lifestyle and in part to increasing awareness about the condition.
1. To analyze epidemiological risk factors of Sleep Disordered Breathing (SDB).
2. To analyze prevalence, type of sleep apnea, preferred therapeutic options in obese SDB.
Methods: A prospective observational study of 400 patients done in a Medical College Hospital in Central India in admitted patients for elective bariatric surgery.
Results: 90%, of the obese population irrespective of severity suffers from SDB, mostly in middle ages with asthma, hypothyroidism & type II diabetes mellitus being commonly associated conditions.
Conclusion: Obese patients have an extremely high incidence of SDB in the form of OSA.