Indian Journal of Sleep Medicine

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2013 | April-June | Volume 8 | Issue 2

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M Nagappa, C Nayak, S Sinha, M Philip, AB Taly

Relation of sleep related events and spontaneous arousals during slow wave & REM sleep in healthy individuals

[Year:2013] [Month:April-June] [Volume:8] [Number:2] [Pages:5] [Pages No:51 - 55]

Keywords: Arousals, N3, REM, phasic sleep event

   DOI: 10.5958/j.0974-0155.8.2.007  |  Open Access |  How to cite  | 


Background & purpose: Focussed studies about association between arousals and phasic sleep events are few. We analyzed the association between arousals and sleep events during slow wave (N3) & REM (R). Methodology: Overnight PSG recording of 30 healthy adults were analyzed using AASM manual (2007). Occurrence of various sleep events and arousals were analyzed. Results: There were 405 arousals, only 45 were de novo. In N3, sleep events associated with arousals included PLM-110 (88.7%); sleep spindles-48 (38.7%); desaturation-4 (3.2%); snore-13 (10.5%); and apnea-3 (2.4%). During R, sleep events associated with arousals included PLM- 203 (72.2%); rapid eye movement-99 (35.2%); snore-53 (18.9%); desaturation- 2 (0.7%); and apnea-12 (4.3%). Number of arousals in N3 and R that occurred de novo, and with single and multiple events were: a) N3-de novo 9 (7.3%); single event-61 (49.2%) and multiple events-54 (43.5%); b) REM: de novo-36 (12.8%); single event-132 (47.0%) and multiple event-113 (40.2%). Conclusions: Majority of arousals (88.9%) in normal individuals are associated with phasic sleep events. Such studies might unravel the understanding of arousals in sleep and its mechanism.



Kenichi Honma, Satoko Hashimoto, Akiyo Natsubori, Satoru Masubuchi, Sato Honma

Sleep-wake cycles in Humans

[Year:2013] [Month:April-June] [Volume:8] [Number:2] [Pages:7] [Pages No:56 - 62]

Keywords: Sleep wake cycle, circadian phase, internal desynchronization, circadian, oscillation.

   DOI: 10.5958/j.0974-0155.8.2.008  |  Open Access |  How to cite  | 


Sleep-wake cycles in human are unique in several aspects. First, human sleep and wakefulness are mostly consolidated except for the infantile and senile periods. Second, the sleep-wake cycle is synchronized because of the circadian rhythms in plasma melatonin and deep body temperature. Third, the polysomnography-based structure as well as the length of sleep depends on the circadian phase. The sleep-wake cycle is entrained by nonphotic time cues independent of the circadian pacemaker. Some of these characteristics are easily understood by assuming that the specific oscillator in the circadian domain regulates sleep and wakefulness. The animal model for the human circadian system is advanced and the brain dopaminergic mechanism is strongly suggested to be site of the oscillator(s) regulating the sleep-wake cycle.



Matthew W. O Malley, Subimal Datta

REM Sleep Regulating Mechanisms in the Cholinergic Cell Compartment of the Brainstem

[Year:2013] [Month:April-June] [Volume:8] [Number:2] [Pages:9] [Pages No:63 - 71]

Keywords: REM Sleep, Neurotransmitters, Receptors, Intracellular signal transduction, Cholinergic cell, Brainstem.

   DOI: 10.5958/j.0974-0155.8.2.009  |  Open Access |  How to cite  | 


Rapid eye movement (REM) sleep is a highly evolved yet paradoxical behavioral state (highly activated brain in a paralyzed body) in mammalian species. Since the discovery of REM sleep and its physiological distinction from other sleep states1, a vast number of studies in neurosciences have been dedicated toward understanding the mechanisms and functions of this behavioral state. Collectively, studies have shown that each of the physiological events that characterize the behavioral state of REM sleep is executed by distinct cell groups located in the brainstem. These cell groups are discrete components of a widely distributed network, rather than a single REM sleep center. The final activity within each of these executive cell groups is controlled by the ratio of cholinergic neurotransmission emanating from the pedunculopontine tegmentum (PPT) to aminergic neurotransmission emanating from the locus coeruleus (LC) and raphe nucleus (RN). In this review, we summarize the most recent findings on the cellular and molecular mechanisms in the PPT cholinergic cell compartment that underlie the regulation of REM sleep. This up-to-date review should allow clinicians and researchers to better understand the effects of drugs and neurologic disease on REM sleep.



Mathangi , Y Sriteja, K Mathangi, R Shyamala, DR Hillman, PR Eastwood

The Impact of Obstructive Sleep Apnea on Self-Reported Work Disability among Software Professionals

[Year:2013] [Month:April-June] [Volume:8] [Number:2] [Pages:5] [Pages No:72 - 76]

Keywords: Work efficiency, Work productivity, Stress.

   DOI: 10.5958/j.0974-0155.8.2.010  |  Open Access |  How to cite  | 


Objective: Information technologies (IT) professionals might be predisposed to obstructive sleep apnea (OSA) due to the obesity and sedentary nature of their work. Hence the objective of this study was to assess work disability among the IT professionals with OSA. Methods: This cross-sectional study was performed using self-reported questionnaire on sleep disturbances and work disability. Objective measurement of OSA was made using a portable home based type 4 sleep study. Results: A total of 74 male IT professionals completed all aspects of the study. Thirty per cent (n=22) were found to have OSA. Those with OSA reported greater work disability as reflected in a decreased work efficiency (89% vs 67%., p<0.05) and more frequent change in job (33% vs 9%, p<0.03). OSA was most common in individuals who described their job as a supervisor. Conclusion: OSA is highly prevalent and associated with significant work disability among IT professionals.



R. Dosi, P. Kejariwal, Ravi A. Dosi, Prateek Kejriwal

Comparison of Hindi version of Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ) to established English version for analysis of Sleep disturbed breathing (SDB)

[Year:2013] [Month:April-June] [Volume:8] [Number:2] [Pages:5] [Pages No:77 - 81]

Keywords: SDB, ESS, Berlin Questionnaire, OSA, PSG.

   DOI: 10.5958/j.0974-0155.8.2.011  |  Open Access |  How to cite  | 


Background Obstructive Sleep Apnea (OSA) is a highly prevalent but under diagnosed condition in India. Polysomnogram (PSG) is the diagnostic test but poses several limitations in our country due to prohibitive cost, requirement of admission, skilled and trained staff. Objective 1. To validate the Hindi version of Epworth Sleepiness Scale (ESS) and Berlin Questionnaire. 2. Comparison of Hindi and English version of the same Questionnaire. 3. Usefulness of the Hindi Questionnaire to evaluate SDB in Hindi speaking English illiterate population. Methods 1. A Hindi version of ESS and Berlin Questionnaire was prepared by the Authors. 2. On the basis of random selection using a double blind technique we distributed the Hindi and English version to patients referred to us for evaluation of SDB. 3. If patient was illiterate in either of the language; questionnaire in other language was given. 4. Data recording and analysis of the sleep interview was performed for 430 patients over a period of 18 months. Results 1. Hindi literate patients and illiterate patients – 200 2. Bilingual patients – 180 3. Non Hindi non English speaking patients – 50 (18- Kannad; 19- Telgu; 13- Marathi) 4. Correlation of Hindi sleep interview to overnight PSG – 85% Conclusion Sleep interview in the mother tongue of the subject is a cheap and effective alternative to the standard English counterpart. Routine screening of patients in Hindi dominant belt, patients should be subjected to the Hindi sleep study questionnaire on an OPD basis.



D Gothi, R Gupta, U. C. Ojha, RS Pal, N Saxena, SK Raju, C Omkar

Observational study of sleep patterns in industrial workers employed in the Organised Sector

[Year:2013] [Month:April-June] [Volume:8] [Number:2] [Pages:11] [Pages No:82 - 92]

Keywords: Sleep disturbance, Organised sector, Insomnia.

   DOI: 10.5958/j.0974-0155.8.2.012  |  Open Access |  How to cite  | 


Introduction: Industrial workers are exposed to various aspects of sleep deprivation resulting into accidents and other morbidities. This pilot survey was done to see the status of sleep and other effects in the organized sector industrial population of India. Objective: Paucity of data from our country in organized sector from a social security scheme ESIC (Employees State Insurance Corporation) on this important but neglected topic prompted us to conduct this study. Methodology: Observational questionnaire based study. Results: This questionnaire-based survey of non-shift organized factory workers (N=179; male - 65, female-114, age ranging from 21 to 68 years) revealed that two-thirds of this study population was suffering from some type of sleep-related disorder. Snoring was found to be significantly associated with day time tiredness (p=0.016) and excessive daytime sleepiness (EDS) (p=0.0035). Workers with frightening dreams were significantly suffering from EDS [out of 9 (5.03%) subjects with frightening dreams, 5 had EDS (p=0.041)]. Grinding teeth during sleep was significantly associated with snoring (out of 11 (6.15%) of the subjects who has bruxism, 7 (63.64%) reported to have snoring (p=0.003)). Bruxism was also associated with EDS significantly (EDS was present in 9 (81.82%) p=0.00006). Conclusion: To the best of our knowledge, this is probably the first such sleep survey of workers who are earning there monthly wages < Rs.15000. The findings of the study clearly outlines that despite normal body weight /body mass index ; sleep related breathing disorders and other sleep ailments are a genuine problem. Effect on day time activity; because of sleep, has a great bearing in the industrial production and harmony between workers and supervisors of the industrial population. Thus this could be a starting point in translational research to be undertaken in this nascent field amongst this susceptible and vulnerable population. Considering the large population of our country these data are substantial and triggers the need for increasing the awareness, among the patients as well as health professionals, about this neglected but very significant medical health problem which leads to development of several other medical diseases



U. C. Ojha

Journal Scan

[Year:2013] [Month:April-June] [Volume:8] [Number:2] [Pages:7] [Pages No:93 - 99]

   DOI: 10.5005/ijsm-8-2-93  |  Open Access |  How to cite  | 


Background: The severity of obstructive sleep apnea increases by influence of conditions that are more frequent in winter. The hypothesis that the apneahypopnea index (AHI) of different patients undergoing polysomnography may be seasonally affected was tested. Methods: The retrospectively analyzed database included 7,523 patients of both sexes who underwent in-laboratory baseline polysomnography to investigate any complaint of disordered sleep, during 1 decade, between January 2000 and December 2009. Data on climate and air pollution were obtained from official organizations. AHI was the main outcome variable. Cosinor analysis, a statistical method for the investigation of time series,was used to detect seasonality. Results: The cosinor analysis confirmed the existence of a circannual pattern of AHI, with acrophase in winter and nadir during the summer. The seasonality is significant even after adjusting for sex, age, BMI, neck circumference, and relative air humidity. Median (25-75 interquartile range) AHI in the 6 months with colder weather was 17.8 (6.5-40.6/h), and in the warmer weather was 15.0 (5.7-33.2/h). The AHI correlated inversely with ambient temperature and directly with atmospheric pressure, relative air humidity, and carbon monoxide levels. Correlations with precipitation,particulate air matter < 10 ìm, sulfur dioxide, and ozone were nonsignificant. Conclusions: More sleep-disordered breathing events were recorded in winter than in other seasons. Cosinor analysis uncovered a significant seasonal pattern in the AHI of different patients undergoing polysomnography,independent of sex, age, BMI, neck circumference, and relative air humidity. This finding suggests that obstructive sleep apnea severity may be associated with other seasonal epidemiologic phenomena.


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