ABSTRACT
Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or >15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
ABSTRACT
Background: Cognitive impairment, an age-related condition, is often considered a precursor to more serious diseases such as depression/dementia/Alzheimer’s disease. Alzheimer’s disease, which is characterized by cognitive impairment, could have a devastating impact on low- and middle-income countries whose populations are ageing rapidly. The disease has, so far, largely remained neglected by researchers and national health services in India. In view of the growing elderly population and diverse sociocultural and geographical milieu of India, epidemiological data for the condition are desirable for different populations. Moreover, there is a dearth of population-based epidemiological studies on cognitive impairment in the Punjab state of India. Methods: Three thousand and thirty-eight consenting elderly adults aged over 60 years, of both sexes, residing in Ludhiana, Punjab state, India were examined for cognitive functioning, using a modified Hindi Mental State Examination, and a score of ≤25 was considered to be indicative of cognitive impairment. Data analysis included calculations of proportions; odds ratio and their 95% confidence intervals (CIs) were also calculated. The chi-square test and multiple logistic regression model were used to determine the association of cognitive impairment with various sociodemographic parameters. Results: The prevalence of cognitive impairment in the study population was 8.8% (95% CI = 8.06 to 9.54). Increasing age, unmarried/widowed status, illiteracy, unemployment and poverty were found to be independently associated with cognitive impairment. Conclusions: The prevalence of cognitive impairment in this north Indian population of elderly individuals is higher than that found in northern India. With emerging focus on geriatric health services, cognitive impairment, which is a precursor of Alzheimer’s disease/dementias, needs to be included in priority care within the national primary health-care framework.