The intricate interplay between circadian and ultradian processes and rhythms that determine sleepiness and wakefulness in normal human adults has been widely studied and has been excellently presented in the form of mathematical models interweaving homeostatic, circadian, and ultradian processes. The evolution of knowledge about these and the clinical applications of this view about sleep regulationhave been discussed in this review.
Sleep is a basic biological function of the brain, which is essential for physical, mental, and emotional well-being. In aging, there is a progressive constriction of homeostatic reserves of the body. Many factors influence the aging process. Aging produces architectural changes in sleep that affect its quality and quantity. Sleep alterations of aging coupled with several body system changes exert their influences on the aging process. There is a close association between insomnia, sleep-disordered breathing, cytokines, insulin resistance, atherogenesis, and aging. It is important to recognize and treat sleep disorders in the elderly, as these interventions may help in retarding the aging process.
Complex sleep apnea is increasingly recognized as an emerging entity with improved awareness and treatment of obstructive sleep apnea (OSA). This condition may cause continuous positive airway pressure (CPAP) intolerance and persistent symptoms of sleepiness. An high index of suspicion is required to diagnose these subset of patients both during titration and on CPAP therapy. Early recognition of the condition and institution of proper treatment and follow-up measure will improve the CPAP therapy in OSA.
DOI: 10.5958/0974-0155.2014.01111.5 |
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Shukla G, Gupta A, Goyal V, Srivastava A, Behari M. Clinical and polysomnographic features of patients with OSAHS versus patients of stroke detected to have OSA. Indian Sleep Med 2014; 9 (3):107-112.
Objective: Obstructive sleep apnea (OSA) is commonly found in patients with stroke; however, most of these patients are undiagnosed because they do not seekhelp for the same. As part of a prevalence study, we conducted polysomnography (PSG) recordings in consecutive patients of stroke presenting to our department. We conducted this comparative study to assess for any clinical and PSG differences between these patients and those directly presenting to our sleep disorders clinicfor OSA.
Methods: We analyzed various clinical and PSG features of consecutive patients of stroke with sleep-disordered breathing admitted between September 2009 and February 2010 consecutively. PSG was carried out after 6 weeks or more of the stroke for all patients. An equal number of patients presenting with sleep apnea at our sleep disorders clinic, during the same period, formed the control population.
Results: We included 12 male patients of stroke with sleep-disordered breathing[apnea– hypopnea index (AHI) >5] on PSG and compared them with 12 male patients who had presented for OSA, confirmed on PSG (AHI>5).We found no significant difference in sleep architecture and respiratory parametersbetween these two groups. However, we found more patientswith body mass index of >24 kg/m2among those seeking help for OSA (n=8) versus those with stroke and OSA (n=3). The former also had significantly higher Epworth sleepiness scale score(p =0.006).
Conclusion: Patients of stroke found to have OSA are less sleepy in daytime as compared to those presenting for OSA and less likely to be as obese as the latter, despite the severity of sleep apnea and associated sleep disturbances being similar.
Sleep disorders are widespread and a public health concern. Common sleep disorders encountered in sleep clinics include sleep deprivation, insomnia, snoring and sleep apnea, circadian rhythm disturbances, restless legs syndrome, parasomnias, and rare disorders such as narcolepsy. In addition to modern medicine, other forms of clinically effective and patient acceptable holistic treatments are also on the rise.
Yoga is a widely accepted holistic therapy and proclaimed to have positive effect on sleep disorders, mental health, and an overall sense of well-being. This article attempts to summarize existing evidence of impact of yoga on sleep. Although close to 2720 articles were found on “yoga,” only a few of these have evaluated the effect of yoga on sleep. Existing scientific evidence suggests that yoga may be effective as a complementary therapy for improving sleep quality and for specific sleep disorders.
There is a paucity of studies evaluating effect of yoga on most of the common sleep disorders underscoring the need of further research in this field.
Namita V. Nasare,
Pramod K. Medirattaa,
Basu D. Banerjee,
Pravin S. Deshmukh,
Ashok K. Saxena,
Sambit N. Bhattacharya,
Rafat S. Ahmed
Sleep scores, Global perceived effect, Tramadol, CYP2D6, Postherpetic neuralgia
DOI: 10.5958/0974-0155.2014.01113.9 |
Open Access |
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Nasare NV, Medirattaa PK, Banerjee BD, Deshmukh PS, Saxena AK, Bhattacharya SN, Ahmed RS. Neuropathic pain and sleep disturbances with special reference to patients with postherpetic neuralgia. Indian Sleep Med 2014; 9 (3):119-127.
Objective: The impacts of postherpetic neuralgia (PHN) on patients’ quality of sleep and global perceived effects (GPEs) are poorly documented. Our main aim of the study was to determine the improvement of sleep and GPE after 4 weeks of tramadol (50–200 mg) treatment with rescue analgesia in the form of topical cream containing 3.33% doxepin and 0.05% capsaicin in patients with PHN in relationship with CYP2D6 polymorphism.
Methods: This study mainly comprised 246 patients with PHN including 123 nonresponders and 123 responders undergoing tramadol treatment. The sleep interference was assessed on 0–10 scale using Daily Sleep Interference Scale. The subjects’ overall impression (global evaluation) of the study medication was recorded by subjects’ answering the question. All samples were analyzed for CYP2D6*4 and CYP2D6*10 polymorphism using polymerase chain reaction–restriction fragment length polymorphism method.
Results: Clinically significant (p<0.001) results were obtained in both the groups when compared with baseline between the Numerical Rating Scale (NRS) sleep scores and GPE scores whereas no associations were found between NRS sleep scores and GPE scores when compared with CYP2D6*4 and *10 polymorphisms (p > 0.05).
Conclusions: Treatment with tramadol 50–200 mg/day was found to be significantly associated with reduced sleep interference and improved GPEs of patients with PHN. CYP2D6 (*4 and *10) polymorphisms with respect to NRS sleep and GPE may not be a sleep and GPE predictor for patients with PHN.