Obstructive sleep apnoea (OSA) is the major underlying co-morbidity in many of the noncommunicable diseases (NCD) due to obesity as a common risk factor. Incidence and prevalence of OSA is on the constant rise ever since this entity came to forefront three decades ago. Precise treatment of underlying OSA is extremely important in major NCDs like diabetes mellitus, hypertension, endocrine disorders and vascular diseases. OSA is subcategorized in to mild, moderate and severe based of apnoea-hypopnea index (AHI). Based on the severity grading, treatment of OSA ranges from life style modifications to oral appliances, continuous positive airway pressure (CPAP) and surgeries. AHI system of severity grading in OSA has several inherent shortcomings and using AHI system for severity grading as the holy grail is likely to be counter-productive. AHI system equates apnoea and hypopnea as equal events, whereas physiological effects vary significantly. AHI system does not account duration of apnoea or body position during apnoeic events. We discuss at length the pitfalls of AHI system of severity grading in OSA.

Hypokalemia is defined as serum potassium level less than 3.5 mEq/L. When the serum level of potassium is less than 3 mEq/L, intravenous potassium supplementation is warranted. A 23 yr old adult female with complaints of dyspnoea (NYHA II) since 6 yrs, dyspnoea (NYHA III) and paroxysmal nocturnal dyspnoea on and off since 2 months, diagnosed with severe mitral stenosis, was posted for mitral valve replacement. After the release of ACC, ECG revealed sine wave pattern, Transesophageal echocardiographic examination revealed global hypokinesia and ABG showed potassium of 2.3 mEq/L. Hypokalemia in cardiac patients can occur due to the effect of poor oral intake, increased renal loss by the secondary hyperaldosteronism in congestive heart failure, loss due to use of digoxin and diuretics like thiazide diuretics, loop diuretics etc. Hypokalemia should be avoided while weaning off cardiopulmonary support as it can lead to atrial and ventricular arrhythmias. Potassium ion is very important for the normal contractility of the heart. Hypokalemia if refractory to intravenous potassium supplementation, concomitant magnesium deficiency should be suspected and treated.

Introduction Obstructive sleep apnea (OSA) is sleep-disordered breathing characterized by repetitive episodes of partial or complete upper airway collapse in sleep leading to apnea and/or hypopnea, desaturations, sleep disruptions, and cardiovascular changes. OSA is a known cause for difficult airway, especially mask ventilation. Daytime sleepiness is one of the hallmark symptoms of OSA. So, we used the Epworth sleepiness score (ESS) in patients suspected of OSA undergoing a sleep study. Methods Overall, 44 subjects suspected to have OSA and undergoing polysomnography were included in the study. The socio-demographic details and the complaints were recorded and the Epworth sleepiness questionnaire was administered. The severity of OSA was graded as per the American Academy of Sleep Medicine using the apnea hypopnea index. Results A total of 44 patients were included in the study. Out of these, 19 were mild, 13 moderate, and 12 severe OSA cases, respectively. ESS of more than 10 showed a positive predictive value of 81.25% and specificity of 85% in screening patients with moderate and severe OSA. But the sensitivity and negative predictive value was only 54.16 and 60.71%, respectively. Conclusion ESS being a simple questionnaire can be easily used preoperatively. A score of more than 10 effectively diagnoses moderate and severe OSA, but less than 10 cannot rule out OSA

Introduction: Obstructive Sleep Apnoea (OSA) is major Non Communicable Disease (NCD) which is becoming very common worldwide. The OSA results in day time hypersomnolence, nocturnal hypoxia and snoring. Repeated desaturation events during sleep results in aerobic metabolism at tissue level changing to anaerobic metabolism, which results in cellular inflammation and insulin resistance further complicating metabolic syndrome. Aim: To study correlation between degree of desaturation and severity of obstructive sleep apnoea. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary medicine at KS Hegde Medical Academy (tertiary care hospital), Mangaluru, Karnataka, India, from March 2018 to February 2021. Total 54 patients who underwent overnight polysomnography and diagnosed to have OSA were included in the study. The minimum recorded oxygen saturation (SpO2 ) defined as maximum desaturation was noted. Relative desaturation was defined as drop in saturation by 3% or more from the pre-event baseline. Correlation between total number of relative desaturation and Apnoea Hypopnea Index (AHI) was analysed. The correlation between two variables were analysed by Pearson’s correlation and the coefficient was calculated. The p-value was calculated by regression analysis and Analysis of Variance (ANOVA). Results: Total of 54 patients was included in the study. Out of which, 22 were mild, 14 moderate and 18 severe OSA respectively. Number of relative desaturations recorded was from 0 to 636. The correlation between AHI and mean SpO2 in sleep was r-value=-0.4542 (p-value=0.001) and the correlation between AHI and minimum SpO2 was r-value=-0.45577 (p-value=0.001) respectively. Correlation between mean SpO2 and minimum SpO2 was r-value=0.747266 (p-value<0.001) and the correlation between AHI and relative desaturation was r-value=0.876698 (p-value=0.001). Conclusion: As the severity of the obstructive sleep apnoea worsened, there was greater degree of desaturation in sleep and the lowest SpO2 was also observed during severe obstructive sleep apnoea.

Narcolepsy, a sleep disorder, has its onset in childhood and early adulthood but rarely in older adults. This case report focuses on a man in his late fifties who was noticed to have excessive daytime sleepiness during his stay in our hospital for an unrelated medical ailment. He was further evaluated with overnight polysomnography and next day multiple sleep latency test which confirmed the diagnosis of narcolepsy.