Current Issue Volume 13, Number 4 , October-December 2018

ORIGINAL ARTICLE
Divya Devaraj, Uma Devaraj, Mark Bothello, Priya Ramachandran, Uma Maheswari, George A D’Souza

Prevalence of Restless Leg Syndrome in Pregnancy—A Follow-up Study (PEARLS Study)

[Year:2018] [Month:October-December] [Volumn:13 ] [Number:4] [Pages:17] [Pages No:57-61]



Background: Restless leg syndrome (RLS) is a sensorimotor sleep disorder. The prevalence of RLS during pregnancy is 2 to 3 times more than in the general population.

Objectives: To estimate the prevalence of RLS in pregnancy in Indian population and its association with serum ferritin levels.

Materials and methods: Three hundred twenty-five pregnant women were enrolled. Subjects were grouped as RLS positive (49 subjects) and controls (276) based on the personal interview and were followed 6 months later by telephonic interview.

Results: The subjects’ mean age was 25.15 ± 3.86 years (range 18 to 38 years). The mean BMI of the subjects was 26.22 ± 5.31 kg/m2. The prevalence of RLS was 15.1% (49 subjects), 30 of whom were primigravida. Three, 6 and 40 subjects were in their first, second and third trimester of pregnancy respectively.
The distribution of age, body mass index (BMI), diabetes, and hypertension were similar in the two groups. The number of hours of sleep was significantly less in the RLS positive group (7.93 vs. 7.5 hours; p-value = 0.017). The levels of hemoglobin, oral iron supplements and serum ferritin and baby’s birthweight did not differ significantly between the two groups.
Forty-five women reported resolution of RLS symptoms, while two women had persistent RLS symptoms, six months after delivery. Two women were lost to follow-up.

Conclusion: The prevalence of RLS in pregnant Indian women is 15.1%, which was previously undiagnosed. RLS was more prevalent in the third trimester of pregnancy. Neither multiparity or low serum hemoglobin or ferritin were associated with RLS in pregnancy.

Keywords: Brain iron deficiency, Pregnancy, Restless leg syndrome, Serum ferritin.

How to cite this article: Devaraj D, Devaraj U, Bothello M, Ramachandran P, Maheswari U, D’Souza GA. Prevalence of Restless Leg Syndrome in Pregnancy—A Follow-up Study (PEARLS Study). Indian Sleep Med 2018;13(4):57-61.

Source of Support: Each author states that they have not received any grants or funding and not involved in any personal relationships, interests, and affiliations over the past three years, that could be perceived as a potential conflict of interest. None of the authors have received any industry related grants or funding, employment, affiliations, patents, inventions, honoraria, consultancies, royalties, stock options/ownership, or expert testimony.

Conflict of interest: None

Current knowledge/Study rationale: The RLS is an important sleep disorder during pregnancy. There are no data available on RLS in pregnancy from India.

Study impact: The prevalence of RLS in pregnancy in this study was 15.1%, and there was no correlation between the presence of RLS and serum iron studies- such as serum ferritin and hemoglobin levels. Further studies are needed to explore the causation of RLS in pregnancy.


ORIGINAL ARTICLE
Mayank Saxena, Dipti Gothi, Rambabu Sah, Umesh C Ojha, Tanushree Gahlot

Utility of Combining Epworth Sleepiness Scale, STOPBANG and Perioperative Sleep Apnea Prediction Score for Predicting Absence of Obstructive Sleep Apnea

[Year:2018] [Month:October-December] [Volumn:13 ] [Number:4] [Pages:17] [Pages No:62-66]



Aims and objective: To correlate and predict obstructive sleep apnea with the help of 3 sleep questionnaire-perioperative sleep apnea prediction score (PSAP), STOP-BANG, Epworth sleepiness scale score (ESS).

Materials and methods: Prospective study of 69 patients were subjected to 3 sleep questionnaire (PSAP, STOP-BANG, and ESS), then they all were subjected to polysomnography. Obstructive sleep apnea (OSA) was defined for AHI>15, and all these three questionnaires final score was correlated with apnea-hypopnea index (AHI), and their utility in predicting OSA was calculated (separately as well as when three questionnaire score taken together) using receiver operating characteristic (ROC) curves.

Results: Total 69 patients with the mean age of 50.29 ± 11.37 years, and male: female of 2:1 and mean body mass index (BMI) of 31.27 ± 7.253 kg/m2, mean AHI was calculated to be 19.63 ± 22. 49 and it significantly correlated with PSAP 4.52 ± 1.596 (r = 0.376,p = 0.001), STOP-BANG 4.493 ± 1.711 (r = 0.303, p = 0.011), ESS 13.00 ± 6.782 (r = 0.395, p = 0.001). PSAP (area under curve (AUC) = 0.761) had a better prediction for OSA than STOP-BANG (AUC = 0.697) and ESS (AUC = 0.669) according to Receiver operating curve. Cut off values for diagnosis of OSA from our data was calculated to be 4 for PSAP (sensitivity: 81% specificity: 59%), 4 for STOP-BANG (sensitivity: 65.4%, specificity: 60%) and 11 for ESS (sensitivity: 73.1%; specificity: 48.8%). Based on these cut off value 18 patients were found to be having all questionnaire positive of which 11 had OSA (AHI>15) and rest seven non-OSA. A total of 11 patients were all questionnaire negative of which 10 were non-OSA (AHI < 15). So when three questionnaires were combined to predict OSA their sensitivity was 91.66% and specificity was 58.8%, a positive predictive value of 61% and negative predictive value of 90.11%.

Conclusion: Perioperative sleep apnea prediction score (PSAP), STOP-BANG, ESS when taken together can be very helpful in screening for OSA and if all scores are negative it virtually rules out OSA.

Keywords: Epworth sleepiness scale, Obstructive sleep apnea, Perioperative sleep apnea prediction score, Prediction, STOP-BANG.

How to cite this article: Saxena M, Gothi D, Sah R, Ojha UC, Gahlot T. Utility of Combining Epworth Sleepiness Scale, Stop-Bang and Perioperative Sleep Apnea Prediction Score for Predicting Absence of Obstructive Sleep Apnea. Indian Sleep Med 2018;13(4):62-66.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Jaseetha Sasidharan, Aditya Bhargava, Harsh Vardhan, Amit Gupta

Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: A Novel Surgical Approach (A Review of Literature)

[Year:2018] [Month:October-December] [Volumn:13 ] [Number:4] [Pages:17] [Pages No:67-70]



Introduction: Obstructive sleep apnea (OSA) is associated with considerable health risks. Continuous positive airway pressure (CPAP) is the gold standard treatment, but its efficacy is reduced by inadequate adherence to treatment. Surgical treatment for OSA has evolved to neuromodulation with the advent of hypo-glossal nerve stimulation.

Objectives: To evaluate the efficacy of hypoglossal nerve stimulation in the treatment of OSA syndrome.

Methods: Studies were included that evaluated the efficacy of hypoglossal nerve stimulation to treat OSA. Six prospective studies were included in this trial.

Results: Six studies with a total of 242 patients were included in this review. All the studies demonstrated a reduction in apnoea hypopnoea index (AHI), Oxygen desaturation index (ODI), and Epworth sleepiness scale (ESS). Despite using different hypoglossal nerve stimulators in each subgroup analysis, no significant difference was found in any of the comparisons, suggesting equivalent efficacy regardless of the system in use.

Conclusion: Hypoglossal nerve stimulation (HGNS) therapy has so far proved to be an effective alternative treatment of obstructive sleep apnea in CPAP intolerant selected group of patients.

Keywords: Continuous positive airway pressure, Hypoglossal nerve stimulation, Obstructive sleep apnea.

How to cite this article: Sasidharan J, Bhargava A, Vardhan H, Gupta A. Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: A Novel Surgical Approach (A Review of Literature). Indian Sleep Med 2018;13(4):67-70.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Dipti Gothi, Sonam Spalgais

Shift Worker Disease with Obstructive Sleep Apnea

[Year:2018] [Month:October-December] [Volumn:13 ] [Number:4] [Pages:17] [Pages No:71-73]



Shift work employment involves guidelines to be followed to protect employees from getting adverse effects on health. There are no proper guidelines that are made and followed in India about the same. Our patient who was covered under employee State Insurance Scheme was required to work continuously during the night for 5 years. He not only developed shift work disease but also had an overlap of obstructive sleep apnea (OSA). The adverse consequences made him suffer from severe depression for 2 years even after quitting the night shift. Strict guidelines are required to be laid down and followed for companies, which require night shift working.

Keywords: Circadian rhythm, Obstructive sleep apnea, Shift worker disease.

How to cite this article: Gothi D, Spalgais S. Shift Worker Disease with Obstructive Sleep Apnea. Indian Sleep Med 2018;13(4):71-73.

Source of support: Nil

Conflict of interest: None


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