Chandigarh, March 15: “A good laugh and a long sleep are the two best cures for anything” thus goes a well-known Irish proverb. That the importance of a proper and hygienic sleep in healthy living has been grossly understated is a sad fact. The inability to switch one’s mind off of all the day’s and life’s mundane affairs can have grave psychological and physiological effects.
It took approximately 120 years more for the medical science to identify and start working on sleep disorders, after the sharp observer in Dickens vividly described what has now been identified as “Obesity Hypoventilation Syndrome or Pickwickian Syndrome”.
“Obstructive Sleep Apnoea is characterized by repetitive narrowing/ collapse of the upper airway during sleep despite breathing efforts.” The patients usually present with loud snoring, observed episodes of breathing cessation during sleep, abrupt awakenings accompanied by gasping or choking, excessive daytime sleepiness, awakening with a dry mouth/ sore throat/ morning headache, difficulty in concentrating during the day, mood changes such as depression or irritability, high blood pressure, night time sweating, decreased libido, impaired cognition, poor quality of life, hypertension, heart failure, stroke. Such complaints are ignored assuming this to be a manifestation of improper sleep hygiene rather than the real culprit being “sleep fragmentation. Such patients need to be clinically, endoscopically and radiologically evaluated and should undergo an overnight PSG or mini sleep study to rule out central causes of apnoea and measure AHI. But the patient profile is so diverse now that “Joe is not always a fat boy!” Variations have been seen in terms of gender, age, weight, and lifestyle.
The prevalence is 0.3–5.1% for western population. For Indian population the prevalence of OSA was found to be 13.74%. OSA in Indian males varied from 4.4 % to 19.7% and in females it was between 2.5% to 7.4%. Among patients with a body mass index greater than 28, OSA is present in 41%. The prevalence of OSA can be as high as 78% in morbidly obese patients. Up to 93% of women and 82% of men may have undiagnosed moderate to severe OSA, emphasizing the importance of vigilant evaluations for signs and symptoms of OSA.
Even Children affected would present with severe failure to thrive and growth retardation, right-sided heart failure, cor pulmonale, permanent neurological damage, behavioural disturbance, hypersomnolence and developmental delay. Adenotonsillectomy provides a cure in the great majority of children with OSA but in syndromic children and those with neuromuscular diseases it can present a real therapeutic challenge.
In the background of hypertension, obesity and thyroid issues, patient is at a constant risk for pulmonary hypertension thereby there is a long way to go before the patient actually reaches for definitive management.
We hereby by the way of this walkathon and public forum on the ‘World Sleep Day’ (15th March) want to spread awareness on snoring and sleep apnoea and thereby atleast addressing the old culprit-OBESITY by the FUN RUN from Sukhna lake at 7am on 17th March 2019.
This would be followed by the upcoming 7th Annual Conference of Indian Association of Surgeons for Sleep Apnoea from 29th to 31st March 2019 at PGIMER, Chandigarh to spread the necessary awareness about this silent killer. With eminent international and national faculty confirming their participation, we wish to offer you one of the biggest enrichment experiences in Sleep Apnoea Management.
