In the natural world, the light/dark cycle entrains our rhythm. Light is a very effective “zeitgeber.” In the presence of environmental time cues, sleep–wake physiology and gene expression continue to exhibit a near-24-hour circadian rhythm regulated by the suprachiasmatic nucleus in the hypothalamus. Phototherapy is an accepted modality for the non-pharmacological management of circadian disorders, such as delayed sleep phase syndrome, insomnia, and mood disorders. This review discusses the clinical repercussions of circadian rhythm disorders, the physiological principle of phototherapy, and its application across the spectrum of sleep disorders.
Insomnia is a major public health hazard. Complexity of insomnia patho-physiology is intriguing and is an exciting subject of inquiry. The current article summarizes the recent developments in our understanding of insomnia. Although the early models of insomnia were unidirectional, they provided foundation for development of more integrative models. Sleep- wake regulation and more specifically conceptual understanding of sleep homeostasis, circadian influence, and hyperarousal further added new dimensions to our understanding of insomnia. However, there is more appreciation than ever of the fact that a lot more work must be done before even thinking about finding a conclusive evidence of what causes insomnia and what maintains it. Some of the legendary work is cited in the reference section to develop an understanding of intricate interplay of multiple systems within the body that cause sleep and lack of it.
This study aimed to find out different patterns of sleep disturbances in pregnancy and their effect on mother and fetus. A questionnaire-based prospective observational study was conducted at the Department of Gynaecology and Obstetrics, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Women with sleep disturbances at start and during pregnancy included in the study were interviewed and examined at recruitment, at 24–32 weeks of gestation, and at term. Of 103 enrolled patients, 99 were followed up till delivery. All the recruited patients developed insomnia. “Changes in sleep-disordered breathing status” was associated with development of hypertension (p = 0.003), albuminuria (p = 0.037), and gestational diabetes mellitus (p = 0.012). It was also associated with 1-min APGAR score of <7 in newborns (p = 0.013). Association between sleep parameters and other fetomaternal outcomes, labor, and delivery is statistically insignificant. Insomnia is the most common sleep problem among women having sleep disorders. Little short-term effect on babies’ health (such as low 1-min APGAR score) was found in women having sleep disorders, but no comment can be made on the longterm effects as these were not assessed in this study.
Background: Systemic hypertension is a common condition affecting middle aged and elderly individuals. Studies have shown that about half of the patients who have essential hypertension have OSA and half of the patients having OSA have essential hypertension. Therefore, this study was conducted to study OSA in hypertensive patients (untreated and treated).
Material and Methods: Subjects with history of Hypertension (with or without treatment) were included in the study. Sleep questionnaire was administered, anthropometric measurements taken and patients were subjected to whole night polysomnography.
Observation and Results : 40% of untreated hypertensives and 38% of treated hypertensives had AHI greater than 5. Further it was found that severity of OSA increased as the Systolic, Diastolic Blood pressure increased. BMI, Male sex and treated-untreated hypertension were associated with sleep apnea.
Conclusion: Study demonstrated clear association between OSA and hypertension with upto 40 % hypertensives showing OSA.
Anil C Mathew,
Jenit A Osborn,
Senthil Kumar Rajasekaran,
Suresh R Prabu,
How to cite this article:
Mathew AC, Benny E, Osborn JA, Rajasekaran SK, Prabu SR, Yunsheng M. Association Between Sleep Duration and Glycemic Control Among Patients with Type 2 Diabetes Mellitus in India. Indian Sleep Med 2014; 9 (1):22-28.
Context: An increasing prevalence of type 2 diabetes mellitus is a growing public health concern in India. The problem of chronic partial sleep loss due to changes in lifestyle is also rapidly increasing.
Aim: The aim of the present study was to examine the association between sleep duration and glycemic level (HbA1c) in type 2 diabetic patients.
Settings and design: This was a tertiary care hospital based cross-sectional study in India.
Materials and methods: A total of 202 patients with type 2 diabetes mellitus aged 20 years and above attending an endocrinology outpatient clinic during the month of July 2013 were studied. Information on glycosylated haemoglobin (HbA1c) value, sleep duration, age, gender, duration of diabetes, total energy intake, current smoking, current alcohol consumption, insulin use, depressive symptoms and Body Mass Index (BMI) were obtained.
Results: The adjusted mean (95% Confidence Interval (CI)) HbA1c values for subjects who slept less than 4.5 hours (h) was 9.90% (8.76, 11.19), for subjects who slept 4.5 – 6.4 h was 8.42% (8.04, 8.81), for subjects who slept 6.5 – 8.4 h was 8.18% (7.77, 8.63) and for subjects who slept more than 8.5 h was 8.28% (7.04, 9.74). Log mean HbA1c between those who slept less than 4.5 h was significantly higher compared to the subjects who slept 6.5-8.4 h (P = 0.011) and the subjects who slept 4.5-6.4 h (P = 0.013). Significant interactions were observed between sleep duration and age (<50 years and e”50 years) (P for interaction = 0.026). On the other hand, there was no significant interaction between sleep duration and gender, the presence or absence of obesity and depressive symptoms. However a significant interaction was observed between sleep duration and use of insulin therapy (P for interaction = 0.001) in predicting HbA1c.
Conclusion: This is the first epidemiological study in India to investigate the U-shaped associations of sleep duration with glycemic level in patients with type 2 diabetes mellitus. Our observations suggested that the patients with short sleep duration particularly among the elderly without insulin use should be considered high risk patients for poor glycemic control. Future studies can look into the optimal sleep duration required which may be considered as an important modifiable factor for the clinical management of patients with type 2 diabetes mellitus.
BACKGROUND: Amyotrophic lateral sclerosis (ALS)is a neurodegenerative disease that leads to progressive weakness of the respiratory and limb muscles.Consequently, most patients with ALS exhibit progressive hypoventilation, which worsens during sleep. The aim of this study was to evaluate the relationship between nocturnal hypoxia and cognitive dysfunction and to assess the pattern of nocturnal hypoxia in patients with ALS.
METHOD: Twenty-five patients with definite or probable ALS underwent neuropsychologic testing,
nocturnal pulse oximetry, and capnography. Patients were grouped according to the presence of nocturnal hypoxia (SpO2<95% for e”10% of the night) and their clinical characteristics and cognitive function were compared.
RESULTS: Compared to patients without nocturnal hypoxia, those with nocturnal hypoxia (n = 10, 40%)had poor memory retention (p = 0.039) and retrieval efficiency (p = 0.045). A cluster-of-desaturation pattern was identified in 7patients (70%) in the Hypoxia Group.
CONCLUSIONS: These results suggest that nocturnal hypoxia can be related to cognitive dysfunction in ALS.In addition, a considerable number of patients with ALS may be exposed to repeated episodes of deoxygenation reoxygenation (a cluster-of-desaturation pattern) during sleep, which could be associated with the generation of reactive oxygen species. Further studies are required to define the exact causal relationships between these phenomena, the exact manifestations of nocturnal clusterof-
desaturation patterns, and the effect of clusters of desaturation on ALS progression.