Volume: 1 Issue: 1
Year: 2013, Page: 22-25,
Obstructive sleep apnea syndrome is far more common than generally believed. The Indian population where obesity rates are also increasing also has a very large population with undiagnosed OSAHS. The association of OSAHS with cardiovascular abnormalities further complicates the disease. Understanding the pathophysiology of OSA in obese and non-obese persons helps in evaluation, diagnosis and management in the individual group. With wider availability of PSG tests and newer treatment modalities, diagnosis and management of OSAHS has become easier. Increasing awareness regarding OSA and OSAHS among the general population and clinicians, wider availability of PSG studies and decreasing the costs of diagnostic tests and treatment can go a long way in identifying and treating these patients.
Keywords: Obstructive sleep apnea hypopnea syndrome,Obstructive sleep apnea, Polysomnography, Obese
1. McNicholas WT. Diagnostic criteria for sleep apnea syndrome: Time for consensus. Eur Resp J 1996; 9: 634-5.
2. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217-39.
3. Sharma SK, Ahluwalia G. Epidemiology of adult obstructive sleep apnea syndrome in India. Indian J Med Res 2010; 131: 171-5.
4. American Academy of Sleep Medicine. International Classification of sleep disorders, 2nd edition. Westchester III: American academy of sleep medicine ; 2005.
5. Michelle TC, Christian G, Clete AK. Clinical features and evaluation of obstructive sleep apnea and upper airway resistance syndrome. In, Kryger MH, Roth T, Dement WC(ed). Principles and Practice of Sleep Medicine, 5th edition. St. Louis, Missouri, Elsevier, 2011; 1206- 18.
6. Redline S, Kapur VK, Sanders MH, Quan SF, Gottlieb DJ, Rapoport DM et al. Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment. Am J Respir Crit Care Med 2000; 161:369-74.
7. Christian G, Riccardo S, Stephen D. Snoring Daytime Sleepiness in Regular Heavy Snorers. Chest 1991; 99:40-8.
8. Bonnet M, Carley D. EEG Arousals: Scoring rules and examples. A preliminary report from Sleep Disorders Atlas taskforce of ASDA. Sleep1992; 15:173–84.
9. American Association of Respiratory CareAssociation of Polysomnography Technologists clinical practice guideline, Polysomnography. Respir Care 1995; 40:1336-43.
10. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of Sleep Apnea. Physiol Rev 2010; 90: 47–112.
11. O'donnell CP, Schaub CD, Haines AS, Berkowitz DE, Tankersley CG, Schwartz AR et al. Leptin prevents respiratory depression in obesity. Am J Respir Crit Care Med 1999; 159:1477-84
12. Phipps PR, Starritt E, Caterson I, Grunstein RR. Ass o c i a t i o n o f s e r um l e p t i n wi t h hypoventilation in human obesity. Thorax 2002; 57:75-6.
13. Minoguchi K, Tazaki T, Yokoe T, Minoguchi H, Watanabe Y, Yamamoto M et al. Elevated production of tumor necrosis factor-alpha by monocytes in patients with obstructive sleep apnea syndrome. Chest 2004 ; 126:1473-9.
14. Yokoe T, Minoguchi K, Matsuo H, Oda N,Minoguchi H, Yoshino G et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 2003 ; 107:1129-34.
15. Neill AM, Angus SM, Sajkov D, McEvoy RD. Effects of sleep posture on upper airway stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med 1997 ; 155:199-204.
16. Mitler MM, Dawson A, Henriksen SJ, Sobers M, Bloom FE. Bedtime ethanol increases resistance of upper airways and produces sleep apneas in asymptomatic snorers. Alcohol Clin Exp Res 1988 ; 12: 801-5.
17. Aggarwal M, Suri JC, Suri S, Sen MK. Maternal and Fetal outcomes of sleep disordered breathing in pregnancy. Indian J Sleep Med 2008;3.1: 25-29
18. Suri JC, Sen MK. Pulmonary functions in OSAHS in a cohort of patients attending a tertiary sleep center. Ind J of Sleep Med.2007; 2.1: 21-7.
19. Agarwal K, Mehta C, Sen MK, Suri JC. Evaulation & workup to detect regions of disproportionate anatomy and its subsequent management in patients of snoring and OSA. Indian J Sleep Med 2006; 1.1: 45-9
20. Suri JC, Sen MK, Ojha UC, Adhikari T. Epidemiology of sleep disorders in the elderly – A questionnaire survey. Indian J Sleep Med 2009; 4.1:12-8
21. World Health Organisation: Global Health Ob s e r v a t o r y (GHO) .Available at: http://www.who.int/gho/ncd/risk_factors/obesi ty_text/en/. Accessed on September 21st , 2013.
22. National Family Health Survey (NFHS-3). National Fact Sheet. INDIA (Provisional data). International Institute for Population Sciences, Mumbai. Ministry of Health and Family Welfare. Government of India. 2005-2006
23. Sachdev SS, Suri JC, Jain AK, Khalid A, Isser HS, Mittal MK. Cardiovascular morbidity in subjects with Obstructive sleep apnea and Its correlation with the severity of disease. Indian J Sleep Med 2009; 4.2:49-60.
24. Garg R, Singh A, Prasad R, Saheer S, Jabeed P, Verma R. A comparative study on the clinical and polysomnographic pattern of obstructive sleep apnea among obese and non-obese subjects. Ann Thorac Med 2012; 7:26-30.
25. Paul R, Dey R, Barooah N, Nag S, Maji S, Bhattacharyya P. Prevalence of left ventricular diastolic dysfunction in OSA patients: a retrospective study. Indian J Sleep Med 2011; 6.2:50-3.
26. Mody KR, Athavale AU, Bhaskar MA, Mohan R, Salgia K. Association of Sleep Disordered Breathing with Systemic hypertension – The Indian perspective. Indian J Sleep Med 2008; 3.4, 138-43.
27. Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med 2004 ;169:168-73.
28. Gupta YK, Jaiswal A, Gupta R, Jain AK, D. Behera D. Pattern of sleep disordered breathing in obese Indians. Indian J Sleep Med 2009; 4.1:19-31.
29. Saxena S, Gothi D, Joshi JM. Prevalence of symptoms and risk of sleep disordered breathing in Mumbai (India). Indian J Sleep Med 2006; 1.1: 27-31.
30. Suri JC, Sen MK, Adhikari T. Epidemiology of Sleep Disorders in the Adult Population of Delhi: A Questionnaire Based Study. Indian J Sleep Med 2008; 3.4 :128-137.
31. Ghoshal AG, Sarkar S, Mondal P, Bhattacharjee SK, Shamim S. A Study of Excessive Day time Sleepiness in Asthma. Indian J Sleep Med 2008;3.3: 93-6.
32. Bhool S, Suri JC, Sen MK, Venkatachalam VP. Clinical, radiological and polysomnographic evaluation of sleep disordered breathing in children. Indian J Sleep Med 2008; 3.3: 85-92.
33. Suri JC, Sen MK, Ojha UC. Acceptance and Compliance issues of nasal CPAP amongst Indian patients of obstructive sleep apnea. Indian J Sleep Med 2006; 1.4: 197-203.
34. Jayan B, Prasad BNBM, Rajput AK, Bhattacharrya R, Dhiman RK, Thampi PS. Management of Obstructive Sleep Apnea with Oral Appliances: Our Experience. Indian J Sleep Med 2006; 1.4: 204-7.
35. Gupta N, Suri JC, Venkatachalam VP, Sen MK. Evaluation of Polysomnographic Patterns with Reference to Various Treatment Modalities in the Management of Patients with Upper Airway Obstruction. Indian J Sleep Med 2006; 1.2: 97- 100.
Prasad CN. Obstructive Sleep Apnea Hypopnea Syndrome – Indian scenario. Perspectives in medical research 2013; 1: 22- 25