CPAP Compliance in Obstructive Sleep Apnea The article “CPAP Compliance in Obstructive Sleep Apnea” written by Manvir Bhatia, was originally published electronically on the publisher’s internet portal (currently SpringerLink) on August 10, 2019 with open access. With the author(s) decision to step back from Open Choice, the copyright of the article changed to © Springer Nature Singapore Pte Ltd. 2019 and the article is forthwith distributed under the terms of copyright.

A Case of Severe Delayed Sleep–Wake Phase Disorder and Simultaneous Restless Legs Syndrome Abstract Patients with delayed sleep–wake phase disorder (DSWPD) have an extremely delayed endogenous circadian rhythm. They are unable to sleep until late at night and therefore need to sleep for at least the first half of the day. This in turn often results in major problems with school and work. The symptoms of restless legs syndrome (RLS) follow the circadian rhythm. According to the definition, patients with RLS have worse symptoms in the evening or night than during the day. We present a case of DSWPD where sleep begins at 8 a.m. and the symptoms of RLS begin one or more hours beforehand, which could support the theory that RLS symptomatology is under circadian control.

Impact of Electronic Gadgets on Sleep Spindle and Memory in Paediatric Population Abstract Purpose To critically analyse the link between effect of electronic gadgets/smartphone on sleep spindles and memory in paediatric population. Methods Articles showing use of smartphones and their link between sleep spindles and memory alterations were searched in various standard databases. They were analysed and hypothesis was generated that how excessive use of smartphones can lead to alteration in generation of sleep spindle and memory consolidation. There are very few if any clinical studies mentioning such correlation. Hence, physiological basis of spindle generation in early developmental life and associated alteration in memory development was discussed. Results No specific study showed such correlation; however, few studies supported the hypothesis. Conclusion The results are inconclusive and require more clinical study to substantiate the hypothesis in paediatric population.

“Sleep Well, Sleep on Time” and Insufficient Sleep: A Need for More Research and Public Health Policies

Appropriate BMI Criteria for Indian Population: Does It Help Stratify Obstructive Sleep Apnea (OSA) Patients Better? Abstract Introduction Obstructive sleep apnea (OSA) is a common yet unrecognized medical problem with significant morbidity. It is commonly considered an obesity-related problem, although not uncommon in non-obese patients of Indian origin. Currently, the World Health Organization (WHO) Western BMI criteria are widely used to classify obesity levels. Indian population has a different association between body mass index (BMI), percentage of body fat, and health risks compared to the western population. Due to these ethnic variations, applying the appropriate criteria—the WHO recommendation for appropriate BMI for Asian population—would be more suitable for identifying obesity in Indians, and, hence, to identify those at risk for OSA. We aimed to explore the discrepancy that could arise by applying the WHO Western BMI criteria to the Indian population which might misclassify and exclude those who are at risk for obesity-related OSA. Methods This is a retrospective study of patients who presented to Nithra Institute of sleep sciences, Chennai, India, from May 2015 to May 2017. Patients who underwent polysomnography and diagnosed with OSA were included. Data pertaining to demographics, BMI, and severity of OSA were collected and analyzed. Patients were classified into different weight bands based on both the Western and Asian BMI criteria and compared. Stratification based on severity of OSA and its association with both the BMI classification was also analyzed. Results During the study period, 904 patients were clinically suspected to have OSA, of whom 787 patients underwent polysomnography. Of these, 754 patients were confirmed to have OSA and were included in the study. [626 males (83%)/128 females (16.9%); mean age—50.7 ± 28.6 years]. 735 (97.5%) patients were classified as overweight/obese as per Asian BMI, whereas only 695 (92.2%) patients were classified as overweight/obese as per Western BMI classification. With respect to the association of the BMI categories with the severity of OSA, there were significant differences between the numbers of severe OSA patients in each weight band of Asian BMI when compared to Western BMI. Conclusion OSA may be underestimated clinically in Indian population when Western BMI criteria is applied. Asian BMI as recommended by WHO is more suitable in reflecting the correlation between obesity and OSA than the western BMI criteria.

Prevalence of Obstructive Sleep Apnoea in Patients with Metabolic Syndrome: A Prospective Observational Study from a Tertiary Care Centre in North India Abstract Purpose To find the prevalence of obstructive sleep apnoea (OSA) in patient of metabolic syndrome (MS). Methods This is a prospective study conducted in the Department of Pulmonary Medicine at IGMC, Shimla. Total 54 patients (32 males and 22 females) with MS who fulfilled inclusion criteria were enrolled for the study over a period of 1 year. The patients who had symptoms of OSA were subjected to overnight polysomnography. Results In this study, total prevalence of OSA was 90.74%. Male and female prevalence were 93.75% and 86.36%, respectively. The prevalence of hypertension was 59.25% and 24.49% of the patients were diabetic. An increased neck circumference (corrected for height) has been suggested as a better sign of obstructive sleep apnoea than other clinical indices. We compared male patient of non-OSA with severe OSA and found significant difference in high-density lipoprotein and triglyceride level. Conclusion All patients of metabolic syndrome should be screened for OSA because of sheer high prevalence of this disease. Whether the treatment of OSA can have positive impact on MS patients needs to be further studied in Indian settings.

Efficacy of Yoga and Pranayama on Sleep Disorders Abstract Sleep is one of the basic and indispensable physiological requirements like eating, breathing and excretion, and a very important autogenic health source which can help you eat less, think better and which affects directly the quality of life and well-being. It is also known to be a period of regeneration that prepares the whole body for daily life. Because of having such important tasks and functions, sleep efficiency is vitally important. Sleep disorders affect the quality and/or quantity of sleep and lower many psychological and physical functions like performance, learning, metabolism and immunity. The various side effects of pharmacological products increase the use of yoga as a safe, effective, non-pharmacological, self-regulating and supportive practice in Western therapeutical approach to sleep disorders.

Clinical and Polysomnographic Correlates of Subjective Sleepiness in Mild Obstructive Sleep Apnea Abstract Purpose The decision to treat mild obstructive sleep apnea (OSA) often hinges on the presence of subjective daytime sleepiness. This study was done to identify clinical and polysomnographic features which correlate with subjective sleepiness in mild OSA. Methods Utilizing data from the Apnea Positive Pressure Long-term Efficacy Study, 199 participants with mild OSA were identified. Participants were grouped as “sleepy” or “non-sleepy” based on their responses to a question regarding excessive daytime sleepiness, and Epworth Sleepiness Scores. We compared demographic, clinical, and baseline polysomnographic data between the groups. Results The prevalence of subjective sleepiness was 74.4%. The sleepy group was younger (46.1 ± 12.6 vs. 53.3 ± 13.1 years, p = 0.001), reported lower quality of life (4.5 ± 0.69 vs. 4.9 ± 0.61, p = 0.0002), had higher depression scores (5.4 ± 4.7 vs. 3.1 ± 3.5, p = 0.003), and reported more naps per week (2.6 ± 2.9 vs. 1.3 ± 1.9, p = 0.01). Total sleep time and sleep efficiency were notably higher in the sleepy (254.2 ± 106 vs. 220.4 ± 114 min, p = 0.08) and (80.2 ± 12.6 vs. 75.7 ± 14.9%, p = 0.06), approaching statistical significance. The non-sleepy group had slightly higher apnea–hypopnea index (AHI 12.2 ± 1.5 vs. 11.2 ± 2.4 events/h, p = 0.01) and worse desaturation indices. Conclusions Subjective sleepiness in mild OSA is associated with younger age, worsened mood and quality of life. This study suggests that evidence of increased sleep drive on polysomnography may correlate with subjective sleepiness in mild OSA.

Impact of Cranial Electrostimulation on Sleep: A Systematic Review Abstract Purpose This paper aimed to systematically review the effectiveness of cranial electrostimulation (CES) to improve sleep. Methods Electronic databases such as MEDLINE, CENTRAL and EMBASE were systematically searched from inception up to December 2018 to retrieve relevant literature. Randomized controlled trials (RCTs), crossover studies, quasi-experimental non-randomized controlled trials and pre–post-single-group experimental design investigating the effect of cranial electrostimulation on sleep assessed by either objective or subjective parameters were included in the present systematic review. Result Twenty-three articles were found to be relevant and were then assessed for their characteristics. Out of the 23 studies, only 6 were RCTs. All the identified RCTs underwent quality assessment for their methodology using 11-point PEDro scale. Fifteen out of 23 studies (5 out of 6 RCTs) demonstrated that CES is beneficial to induce and improve sleep in various populations as assessed by both subjective and objective outcome measures. Conclusion After critically analyzing the literature, it is concluded that cranial electrostimulation treatment leads to positive improvements in sleep parameters in various diseased and healthy population; however, further studies are needed to support the use of CES for sleep problems.

CPAP Compliance in Obstructive Sleep Apnea Abstract OSA is a common sleep-related breathing disorder, characterized by frequent interruptions of breathing during sleep and leading public health problem both in the developed and developing nations. However, awareness regarding diagnostic options, management, and consequences of untreated OSA remains inadequate. In developing nations, the resources for adequate sleep medicine facilities are scarce. Therefore, there is a need for low cost, simple and accurate diagnostic and therapeutic modalities. The most effective treatment for patients with significant OSA has been a CPAP device which delivers positive air pressure to the airway. Despite the efficacy of CPAP for the treatment of OSA, compliance with therapy remains suboptimal. This acts as a physiological splint, thus preventing collapse of the upper airway. Compliance rates were 30−80% from different parts of the globe. The adverse effects of untreated OSA were well documented and have been shown to be reversible with therapy. Therefore, an increase in CPAP compliance is considered clinically relevant. It is important that adherence to CPAP therapy continues to be improved. Increase CPAP compliance is essential thus it is important that adherence to CPAP therapy is enforced. Measures for good CPAP compliance are patient education, a good doctor−patient relationship, role of partner/family, and an intensive follow-up program, which can be addressed through a multidisciplinary team approach.