Obstructive Sleep Apnea in a Referral Population in India

Abstract

There are few published studies of obstructive sleep apnea in the Asian subcontinent. The objectives were to describe the syndrome and evaluate the utility of computed tomography (CT) cephalometry in patients found to have obstructive sleep apnea (OSA) by polysomnography. This article reports on a retrospective case series in a referral population. A total of 880 patients (560 males and 320 females) were seen in a referral center in Hyderabad, South India, during the last 7 years. All patients with suspected obstructive sleep apnea were evaluated with 16-channel polysomnogram by overnight sleep study; 600 subjects (68%; 480 males and 120 females) underwent evaluation with CT cephalometry. Mean age was 51.4 +/- 9.5 years (standard deviation). The mean apnea-hypopnea index (AHI) was 27.93 +/- 3.8. The majority of patients had more than 10 AHI; mean percentage of sleep efficiency was 80.62 +/- 15.38; mean percentage of rapid eye movement (REM) sleep was 13.79 +/- 7.89; mean awake arterial oxygen saturation (SaO2) was 90%; mean sleep SaO2 was 84% +/- 4.4%; mean Epworth Sleepiness Scale (ESS) score was 12.3 +/- 2.8. The tongue base area (TBA) was found to be significantly associated with obstructive sleep apnea (OSA), with mean TBA 1032.8 +/- 427 mm2 compared with normal controls at 561.1 +/- 197.6 mm2 (p < 0.001). Mean gonion-gnathion-hyoid angle (Go-Gn-H) was 28.5 +/- 10.5 in OSA and 16 +/- 16.7 in controls; uvula area was 452.5 +/- 145.8 mm2 in OSA and 221.4 +/- 49.85 mm2 in controls; uvula diameter was 13.8 +/- 2.74 mm in OSA and 10.1 +/- 1.72 mm in controls. A total of 704 patients with OSA (80%) were found to be hypertensive, with daytime mean blood pressure of 160/100 +/- 8.5/4.8 mm Hg. Mean duration of reported hypertension was 2 years. The present study showed moderate to severe OSA in a majority of suspected cases referred for polysomnogram. Mild disease was seen in 20.45% of patients (n = 180). On CT cephalometry, the TBA correlated significantly with OSA; hypertension is common in patients with OSA.

Sleep Quality in Type 2 Diabetes Mellitus Patients Attending a Tertiary Care Hospital in West Bengal: A Cross-Sectional Study

“…Our study reported a mean PSQI score of 6.70 ±3.32 which was more than that of a study conducted in Iran (5.5±4.4) [8] and lesser in comparison to the values reported by Vigg et al (8.3±4.6) [10]. The mean duration of sleep per night as reported by the study subjects (6.3±0.95 hours ) was slightly more than (6.10±166 hours) as reported by Vigg et al [10].…”

“…The result of the present study indicated that 57.3% of the subjects were classified as poor sleepers (PSQI> 5). The value obtained was higher compared to other studies conducted across the globe [8][9] which have reported 38 -48 % 0f their subjects as "poor sleepers" but lesser as compared to a similar study conducted in India by Vigg et al [10].…”

“…After obtaining informed consent from the patients a face-to-face interview was done by trained physicians and public health workers to gather information using a pre-designed and pretested questionnaire [7][8][9][10].…”

Role of Malocclusion and Craniofacial Morphology in Obstructive Sleep Apnea

“…The skeletal craniofacial morphology has also been shown to play a major etiological role in 62% of nonobese Asian OSA population as compared to soft-tissue morphology. 31 A meta-analysis by Miles et al 32 showed that among all the craniofacial risk variables, mandibular body length is the strongest risk factor exhibiting greater associations with OSA.…”

Sleep habits and associated phenomenon in Indian adults

“…On the corollary, it is influenced by multiple factors such as physiological, psychological, environmental and sociocultural factors. In the recent past there has been an increase in awareness of normal sleep and sleep disorders in India 3,4,5 . The field, however, still remains in its infancy.…”