Both obstructive sleep apnea and bronchial asthma are diseases associated with systemic inflammation. The patho-physiology of both these diseases is interlinked and multiple links have been elucidated between their development. How, the development of one of these diseases leads to the worsening of the other one, is poorly understood. This overlap, deserves further research and guidelines need to be crystallized for the management of this condition, as delay in diagnosis and treatment is associated with an adverse outcome.
The recent epidemiological studies have shown that the obstructive sleep apnea (OSA) and type 2 diabetes mellitus are independently associated. There exist real and potential links between the risk factors for and comorbidities associated with diabetes and sleep apnea. There is a common occurrence of obesity, hypertension and disorders of metabolism in the two disorders. While the occurrence of sleep apnea with glucose intolerance or insulin resistance could present sampling bias, an alternative hypothesis is that the events in OSA trigger different, perhaps unique, adaptations in metabolic processes involving insulin action and glucose regulation. Impaired glucose tolerance and worsening insulin resistance can lead to further weight gain, exacerbating the severity of disordered breathing during sleep. This review aimed to define the extent and potential mechanisms for alterations in insulin and glucose levels in OSA.
Inadequate sleep is a burning issue in today\'s modern world. Sleep and cognition are closely interrelated. Sleep deprivation negatively affects various aspects of cognition including working, short-term and long-term memories, attention, reaction time, visuomotor performance, reasoning ability, and judgment. Disorders with cognitive abnormalities also have negative impact on sleep. This review studies the clinical aspects of interplay between sleep and cognition. We have also focused on the assessment of sleep and cognition. Researchers are required in the field of sleep and cognition. Sleep has potential to become future diagnostic and therapeutic marker in cognitive disorders.
Aloke Gopal Ghoshal,
Mita Roy Sengupta
How to cite this article:
Kundu S, Sarkar S, Roy D, Ghoshal AG, Patra A, Ghoshal A, Sengupta MR. CPAP acceptance and adherence among patients diagnosed with obstructive sleep apnea: A long-term study from eastern India. Indian Sleep Med 2014; 9 (4):172-178.
Background: Continuous positive airway pressure (CPAP) is considered to be the gold standard for the management of obstructive sleep apnea (OSA). But poor CPAP adherence is the main limiting factor of the OSA treatment.
Objectives: To find out the acceptance and adherence of CPAP use in patients with OSA and the association of personal and disease characteristics of the patients with patterns of CPAP use.
Methods: A cross-sectional retrospective study was conducted between June 2014 and December 2014 at the PULSAR, a sleep laboratory in Kolkata, India. Patients diagnosed with OSA between July 2007 and June 2011 at the PULSAR were included and analyzed applying a telephonic questionnaire.
Results: A total of 523 patients had undergone polysomnography. Of them, 514 (98.3%) patients were prescribed CPAP; 40(7.6%) were dead, and 36 (6.9%) could not be contacted. of the 438 (83.7%) patients contacted over the phone, 25 (4.8%) refused to participate in the study. The rest, that is, 412 (79%) patients, that agreed to be interviewed were divided into three groups-group I: never used CPAP (134, 25.6%);group II: ever used CPAP (27, 5.2%);and group III: currently using CPAP (252, 48.2%). The mean age of the patients was 50.5 ± 11.2 years; the mean body mass index of the group was 30 ± 5.3. The mean apnea–hypopnea index was 62.3 ± 20.1, with a range of 8.5–127.9. The mean duration of use in ever-used group was 21.6 ± 8.4 months and in current-user group was 54.8 ± 16.0 months. Mechanical discomfort (34.3%) is main cause of non-adherence.
Conclusion: About one-third patients prescribed CPAP never initiated the treatment, and those who started reported a high incidence of adherence during the period of this study. A significant correlation was observed between disease severity and the duration of CPAP use.
Paradoxical vocal cord motion (PVCM) is a condition characterized by abnormal adduction of the vocal cords during inspiration. Diagnosis is often challenging owing to its heterogeneous presentation. Nocturnal symptoms are relatively uncommon. Associated comorbidities include gastroesophageal reflux disease or laryngopharyngeal reflux, allergic sinus disease, and possibly obstructive sleep apnea (OSA).We report two cases of PVCM presenting with predominant nocturnal symptoms owing to coexisting OSA.
The present case refers to a patient who had complaints of loud snoring, excessive daytime sleepiness with skin lesions in legs and feet and uncomfortable itchy sensation in eyes. The skin lesions were compatible with a diagnosis of Schamberg\'s disease and the ophthalmic complaints were possibly a variant of floppy eyelid syndrome. Application of overnight bilevel positive airway pressure therapy resulted in dramatic improvement in the ophthalmic complaints. Further on after regular use of bilevel positive airway pressure therapy no new capillary hemorrhages were observed.
How to cite this article:
Singh A, Sen MK, Chakrabarti S. Failure of adaptive servo-ventilation to correct central sleep disorder breathing in a patient with congestive heart failure. Indian Sleep Med 2014; 9 (4):186-189.
We report a patient with congestive heart failure secondary to dilated cardiomyopathy who demonstrated central sleep apnea with Cheyne–Stokes breathing (CSA-CSB) on polysomnography. He was put on positive airway pressure therapy with adaptive servoventilation (ASV), which failed to correct the CSA-CSB condition. A backup rate was added with ASV, which eliminated apnea but periodic breathing persisted. Finally, enhanced expiratory rebreathing spacewas added and titrated with ASV to achieve normocapniausing transcutaneous CO2 monitoring that successfully stabilized the patient\'s breathing.