Insomnia is an extremely common disorder. The prevalence of insomnia in a study depends on the criteria's selected for determining the prevalence. It is well known that several factors like gender, age, psychiatric disorders among several others are risk factors for insomnia. The stress of modern urban life adds to the factors responsible for an increase in the prevalence. In addition several co-morbid factors can have a significant effect on the prevalence of insomnia. However,what is important is the effect insomnia has on the quality of life of the individual, its social implications like increased loss of work days, accidents, family disorders and the economic impact of this rather common disorder. This review summarizes the burden of this problem in the Indian context.
How to cite this article:
Gupta A, Mehta M, Shukla G, Joseph A, Hazari N, Kumar G, Pandey R, Sagar R. Sleep Quality in Children with Attention Deficit Hyperactivity Disorder: Is one night polysomnography as good as two nights?. Indian Sleep Med 2013; 8 (3):116-122.
Objective: One of the factors that possibly account for conflicting results from research studies examining sleep problems in children with attention-deficit/hyperactivity disorder (ADHD) is sleep lab adaptation. The aim of the present study was to study sleep quality in children with ADHD and investigate the presence of a first night effect in children with ADHD using polysomnography (PSG) in a sleep lab.
Methods: Sleep architecture and sleep quality were assessed in children with ADHD using two consecutive nights of PSG and parent reported sleep questionnaires.
Results: A total of 13 children diagnosed with ADHD were studied over a period of 1 year. Sleep disturbances most frequently reported by parents included bedtime resistance, excessive daytime sleepiness, parasomnias and restless legs syndrome. Comparison of sleep latency, sleep efficiency, wakefulness, REM latency, total sleep time, N1, N2, N3, AHI, arousal index, REM and PLMI revealed no difference between 1st and the 2nd night of polysomnography.
Conclusion: Children with ADHD have disturbed sleep but do not show a first night effect during PSG, and hence, a single night PSG has been shown to suffice in assessment of sleep among patients with ADHD.
Background:Sleep difficulty is a major issue in recent times. The problem is more pronounced in metropolitan areas attributing to more stressful environment. Research indicates that there are different approaches to the management of insomnia and Cognitive behavior therapy (CBT) is one of the preferred treatment modalities.
Objective:To determine the symptoms related to primary insomnia and impact of cognitive behavior therapy.
Method:In the present study a group of 15 participants (Age range 20-30) who fulfilled the criteria of primary insomnia were administered 10 sessions based on cognitive behavior therapy. All the participants were voluntary and informed consent for the study was obtained. Frequency of sessions was once a week. Four components of CBT:Stimulus control instructions, sleep hygiene education, relaxation and cognitive therapy were implemented.
Results:Improvements in insomnia related variables such as sleep onset latency, number of nightly awakenings, total sleep time, wake up after sleep onset, sleep quality and sleep efficiency were measured before and after the intervention. The results indicate improvements in above mentioned insomnia related variables.
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Nagappa M, Nayak C, Sinha S, Philip M, Taly A. Association of sleep related events and arousals during light sleep in healthy individuals. Indian Sleep Med 2013; 8 (3):129-132.
Background: Few studies have assessed impact of sleep related physiological events on arousals.
Methods: Overnight PSG recording of 30 healthy volunteers were analysed for occurrence of various sleep events and arousals during light sleep.
Results: 864 arousals (N1=210; N2=654) were noted during light sleep in 30 patients. Forty-three arousals were de novo (N1=18; N2=25). The mean arousal per patient was 28.8±16.3 (median: 24; range: 9-84). In N1, sleep events associated with arousals included PLM- 157 (74.8%); roving eye movements- 92 (43.8%); vertex transients- 45 (21.4%); desaturation- 5 (2.4%); snore- 9 (4.3%); and apnea- 3 (1.3%). In N2, sleep events associated with arousals included sleep spindle- 570 (87.2%); PLM- 441 (67.4%); K complex- 226 (34.6%); snore - 85 (13%); vertex sharp transients- 57 (8.7%); desaturation - 5 (0.8%); and apnea - 28 (4.3%). The number of arousals in N1 and N2 that occurred de novo, and with single and multiple events were: a) N1 - de novo 18 (8.6%); Single event - 91 (43.3%) and multiple events – 101 (48.1%); b) N2: de novo – 25 (3.8%); single event - 129 (19.7%) and multiple event – 500 (76.5%).
Conclusions: In light sleep, 95.02% arousals were associated with physiological events viz. PLM, roving eye movements, and vertex sharp transients in N1 and sleep spindle, PLM, and K complexes in N2. Comparative studies in health and disease may enhance the understanding of arousal mechanisms.
OBJECTIVE: Estimate the number of awakenings additional to spontaneous awakenings, induced by the
nighttime aircraft movements at an international airport in Montreal, in the population residing nearby in 2009.
METHODS: Maximum sound levels (LAS,max) were derived from aircraft movements using the Integrated
Noise Model 7.0b, on a 28 x 28 km grid centred on the airport and with a 0.1 x 0.1 km resolution. Outdoor LAS,max were converted to indoor LAS,max by reducing noise levels by 15 dB(A) or 21 dB(A). For all grid points, LAS,max were transformed into probabilities of additional awakening using a function developed by Basner et al. (2006). The probabilities of additional awakening were linked to estimated numbers of exposed residents for each grid location to assess the number of aircraft-noise-induced awakenings in Montreal.
RESULTS: Using a 15 dB(A) sound attenuation, 590 persons would, on average, have one or more additional awakenings per night for the year 2009. In the scenario using a 21 dB(A) sound attenuation, on average, no one would be subjected to one or more additional awakenings per night due to aircraft noise.
CONCLUSION: Using the 2009 flight patterns, our data suggest that a small number of Montreal residents are exposed to noise levels that could induce one or more awakenings additional to spontaneous awakenings per night.