Air leak is common in patients using positive pressure airway therapy. Intentional leak is deliberately allowed to eliminate carbon di oxide. Unintentional leak generally occurs at the mask interface and causes a wide spectrum of complications and leads to poor CPAP adherence. This article reviews the interpretation of the leak profile. Many positive pressure systems have different algorithms to respond and quantitatively record the air leak. Once the high air leak is confirmed then variety of interventions are discussed to resolve the air leak and improve its efficacy. Two case examples are provided to fully understand the complex interplay amongst airflow; positive pressure ventilation to open the airway, volume of air leak and its impact on arousals and sleep is discussed.
Insomnia is one of the commonest sleep disorders encountered in primary care as well as sleep medicine practice. In this review article, the nosology of insomnia is outlined in the light of the recently published International Classification of Sleep Disorders-3rd Edition. A standardized schema is then described as to how to approach a patient presenting with insomnia symptoms. The various tools that may be utilized in this work-up are briefly discussed.
Obesity is recognized as one of the predominant risk factor for Obstructive Sleep Apnea (OSA). Even moderate reduction in weight and body mass index (BMI) could reduce the severity of OSA and is recommended as part of comprehensive therapeutic approach in patients who are prescribed Positive Airway Pressure (PAP) therapy. However, this remains a challenge for most patients and some may even report weight gain. In this article, we report a case history highlighting weight gain while on PAP therapy and review the literature on this phenomenon.
Background & objectives: Insomnia is a common disorder of the present times. However, insomnia in the context of poor sleep quality has not been widely explored. It has mostly been in the domain of mental health and considered as a symptom. The aim of this study was to investigate the association of sleep quality among insomniacs and to determine their socio-demographic and health correlates.
Methods: A total of 134 (85 males and 49 females) subjects suffering from insomnia with chief complaint of poor sleep quality/unfreshing sleep were included. Participants were apparently healthy adults, visiting a tertiary care hospital of Delhi as attendants of patients between March-May 2012.Respondents were consecutively selected and clinically evaluatedfor study variables including socio-demographics, substance use (excessive and harmful use of alcohol, cocaine and narcotics), and sleep quality through interview and questionnaire.
Results: Insomnia with poor sleep quality was reported by 76% (n=101) of respondents. Multivariate analyses showed that demographic factors, social support, socioeconomic status (SES), and substance use were positively associated with insomnia and poor quality of sleep. Logistic multivariate regression analyses revealed that it was independently associated with marital status, residence in urban area, middle SES, and alcohol use.
Conclusion: Insomnia with poor quality of sleep is common in the selected sample and is associated with socio-demographic factors, as well as use of alcohol. The study revealed that the most productive population of India i.e. middle aged people from middle socioeconomic status are silently grappling with this overlooked and undiagnosed issue. We recommend screening and intervention programs to be introduced at the organizational level in order to curb this emerging public health issue at its root.
Background: Gender related differences may be an important reason for underreporting of OSA in females.
Objectives: To study the gender related differences in clinical presentation of patients with Obstructive Sleep Apnoea confirmed with Polysomnography.
Method: A prospective observational study was conducted over a period of one year from September 2011 to August 2012 in the Department of Pulmonary Medicine, King George's Medical University U.P., Lucknow on 44 patients (37 males and 7 females) of Obstructive sleep apnoea confirmed with Polysomnography. Results were analysed for gender related differences in symptoms.
Results: Overall, males had a significantly higher frequency of snoring, excessive day time sleepiness, and history of smoking and alcoholism than females. In contrast, females had a higher BMI and HAD score (for anxiety and depression) than males. No significant difference was found between the two in neck circumference and Mallampati grading.
Conclusion: This study showed that there is significant difference in clinical presentation between males and females with obstructive sleep apnoea and this may be the reason for lesser prevelance of Obstructive Sleep Apnoea reported in Females and must be taken into consideration while evaluating patients with suspected OSA.
BACKGROUND: Annoying snore is the principle symptom and problem in obstructive sleep apnea syndrome (OSAS). However, investigation has been hampered by the complex snoring sound analyses.
OBJECTIVE: This study was aimed to investigate the energy types of the full-night snoring sounds in patients with OSAS.
PATIENTS AND METHOD: Twenty male OSAS patients underwent snoring sound recording throughout
6 hours of in-lab overnight polysomnogragphy. Snoring sounds were processed and analyzed by a new sound analytic program, named as Snore Map®. We transformed the 6-hour snoring sound power spectra into the energy spectrum and classified it as snore map type 1 (monosyllabic low-frequency snore), type 2 (duplex low-&mid-frequency snore), type 3 (duplex low- & highfrequency snore),and type 4 (triplex low-, mid-, & highfrequency snore). The interrator and test-retest reliabilities of snore map typing were assessed. The snore map types and their associations among demographic data, subjective snoring questionnaires, and polysomnographic parameters were explored.
RESULTS: The interrator reliability of snore map typing were almost perfect (ê = 0.87) and the test-retest reliability was high (r = 0.71). The snore map type was proportional to the body mass index (r = 0.63, P = 0.003) and neck circumference (r = 0.52, P = 0.018). Snore map types were unrelated to subjective snoring questionnaire scores (All P>0.05). After adjustment for body mass index and neck circumference, snore map type 3-4 was significantly associated with severity of OSAS (r = 0.52, P = 0.026).
CONCLUSIONS: Snore map typing of a full-night energy spectrum is feasible and reliable. The presence of a higher snore map type is a warning sign of severe OSAS and indicated priority OSAS management. Future studies are warranted to evaluate whether snore map type can be used to discriminate OSAS from primary snoring and whether it is affected by OSAS management.