Indian Journal of Sleep Medicine

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2014 | April-June | Volume 9 | Issue 2

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Restless legs syndrome: Common yet an under recognized entity

[Year:2014] [Month:April-June] [Volume:9] [Number:2] [Pages:9] [Pages No:41 - 49]

Keywords: Restless legs syndrome, periodic limb movements during sleep.

   DOI: 10.5958/0974-0155.2014.01103.6  |  Open Access |  How to cite  | 


Restless legs syndrome (RLS) or Willis–Ekbom disease is a common yet an underrecognized disease despite the fact that awareness is the only equipment required to diagnose this condition. The RLS is diagnosed with four essential criteria that can be abbreviated as “URGE,” that is, urge to move, rest induced, gets better with activity, and evening and night accentuation. Periodic limb movementsduring sleep (PLMS), a component of RLS, in 90% cases needs to be differentiated from RLS as PLMS may also be seen with disorders such as obstructive sleep apnea, upper airway resistance syndrome, narcolepsy, and rapid eye movement sleep disorder in 70% cases. Diagnosis of PLMS contrary to RLS requires sleep study. This review was aimed at increasing awareness about RLS; differentiating RLS from PLMS; and pathogenesis, management options, and recent advances for RLS.



Pathophysiological mechanisms associated with sleep disorder breathing and their influence on treatment

[Year:2014] [Month:April-June] [Volume:9] [Number:2] [Pages:9] [Pages No:50 - 58]

   DOI: 10.5958/0974-0155.2014.01104.8  |  Open Access |  How to cite  | 


This article summarizes the anatomical basis as well as the various pathophysiological mechanisms that are considered to be crucial in development of sleep-disordered breathing. The anatomic factors that predispose to the occurrence of pharyngeal collapse are considered. The collapsible tube model for understanding the behavior of human pharyngeal airway, transmural pressure, intraluminal pressure, surrounding tissue pressure, closing pressure of pharyngeal airway, and critical closing pressure are discussed. The role of nose in snoring and obstructive sleep apnea (OSA) is also touched on. The role of obesity on upper airway is outlined. These include the mechanical consequences of fat deposition within the maxillomandibular enclosure on pharyngeal collapsibility and possible influences of visceral fat on OSA. An overview of pharyngeal anatomy and musculature, pharyngeal muscle activity during wake/sleep, and neural regulation of sleep and breathing is given. Factors pertaining to the loss of pharyngeal dilator muscle activation, change in central respiratory drive, and OSA-induced neuropathy/myopathy are discussed. Abnormalities of central neuronal output and control of breathing are explained. The impact of end-expiratory lung volume on upper airway resistance is also discussed. The use of computational modeling to predict responses to upper airway surgery in OSA is discussed. Novel methods such as manipulation of the arousal threshold and measures to reduce a high loop gain (oxygen therapy, acetazolamide) are also briefly discussed.



Shrinivas Desai, Preeti Devnani, Raju Khubchandani, Rahul Motwani, Ankit Bajpai

Crouzon Syndrome and Obstructive Sleep Apnea

[Year:2014] [Month:April-June] [Volume:9] [Number:2] [Pages:3] [Pages No:59 - 61]

   DOI: 10.5958/0974-0155.2014.01105.X  |  Open Access |  How to cite  | 


In children with Crouzon syndrome, craniofacial dysmorphism predisposes them to sleeprelated breathing disorders. In this review, we have discussed the clinical manifestation, consequences, and need for management with both temporary and definitive measures of Obstructive sleep apnea syndrome (OSAS).



Vinaya S. Karkhanis

Prevalence of Metabolic Syndrome in Obstructive Sleep Apnea Syndrome

[Year:2014] [Month:April-June] [Volume:9] [Number:2] [Pages:6] [Pages No:62 - 67]

Keywords: OSAS, Metabolic syndrome, Prevalence.

   DOI: 10.5958/0974-0155.2014.01106.1  |  Open Access |  How to cite  | 


Background: Obstructive sleep apnea syndrome (OSAS) and metabolic syndrome have a strong association with each other. There is also evidence, of varying strengths, from epidemiologic and clinical studies about the independent association between OSAS and individual core components of the metabolic syndrome. Objectives: To estimate the prevalence of metabolic syndrome and its individual components in patients with OSAS. Methods: An observational hospital-based study was conducted where 53 patients with symptoms of OSAS were included. Limited sleep study was conducted for each patient and OSAS was diagnosed if apnea–hypopnea index was 5 or more. Metabolic syndrome was diagnosed as per the definition by National Cholesterol Education Program, Adult Treatment Panel III. Analysis was then carried out to find out the prevalence of metabolic syndrome and its individual components in OSAS. Results: Of the 53 patients recruited, 42(79%) had OSAS. Among this group of 53 patients, 38 patients (71.6%) had metabolic syndrome, 35 patients (66.03%) had systemic hypertension, 25 patients (47.2%) had diabetes mellitus or an impaired glucose tolerance, 42 patients (79.2%) had dyslipidemia, and 47 patients (88.6%) had abdominal obesity. With the exception of diabetes mellitus/impaired glucose tolerance, the prevalence of remaining conditions was found to be higher in those with moderate-to-severe OSAS than in those with mild OSAS. Conclusion: There is a high prevalence of metabolic syndrome as well as its individual components among OSAS patients and the prevalence increases with the severity of OSA.



Atif Mahmood, Kiran Punjwani, Asima Faisal

Effects of shift work on the quality of sleep and psychological health of the professional nurse

[Year:2014] [Month:April-June] [Volume:9] [Number:2] [Pages:6] [Pages No:68 - 73]

Keywords: Nurses, Shift schedule, Mental health status, GHQ, PSQI.

   DOI: 10.5958/0974-0155.2014.01107.3  |  Open Access |  How to cite  | 


Introduction: In modern society, shift work is very common, and health professionals, especially nurses, are bound to work in shift duties to provide round-the-clock health care to their patients throughout the year. Shift work disorder is a circadian rhythm disorder that is associated with sleep problems and sleepiness that usually occurs with the shift work. Objective: To identify the effects of shift work on the quality of sleep and psychological health of professional nurses. Methodology: The research was conducted in different public and private hospitals of Karachi, Pakistan, on nurses with shift schedules. Results: Presently around 65.8% nurses performed eight night shifts per month and around 34.2% do more than eight night shifts per month. Various problems come across by nurses during shift work, which include physical, social, economic, psychological, and physiological health issues. Problems vary from individual to individual. Sleep quality of nurses was evaluated by using Pittsburgh Sleep Quality Index and majority of nurses (56.3%) experienced poor sleep quality due to night shifts. Conclusion: The results of the study suggest that shift duties caused physiological and psychological stress to nurses who work in shifts. Only few nurses preferred to work in shift duties. Thus, it was concluded that sleep evaluation strategies should be formulated to improve the quality of sleep and improve the process in delivering of quality of care to sick patients.



U. C. Ojha

Journal Scan

[Year:2014] [Month:April-June] [Volume:9] [Number:2] [Pages:13] [Pages No:74 - 86]

   DOI: 10.5005/ijsm-9-2-74  |  Open Access |  How to cite  | 


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