ABSTRACT
Background: The interaction of obstructive sleep apnoea (OSA) with vascular risk factors is known as syndrome Z which is also known as the metabolic syndrome or the insulin resistance syndrome and these include the hypertension, central obesity, insulin resistance and hyperlipidaemia. The objective of the present study was to investigate the prevalence and severity of syndrome Z at tertiary care center.Methods: This prospective study was conducted among 40 eligible patients between May and July 2018 at the tertiary care center included adult patients >18years of age. Overnight fasting glucose and lipid levels were measured, and baseline anthropometric data recorded. All sleep studies were scored and reported by a sleep physician. OSA was deemed to be present if the respiratory disturbance index (RDI) was >5, with mild, moderate and severe categories classified according to the Chicago criteria.Results: Mean age of participants was 52.7years, 77.5% were male, Mean BMI and waist circumference were 29.2kg/m2 and 113.8cm respectively. Almost 92.5% participants were known case of HTN, 85.0% were DM and 67.5% Dyslipidemia. Around 60.0% participants were belonged to severe grade of OSAS and 7 (17.5%) patients who fulfilled all five criteria for the diagnosis of the metabolic syndrome had severe OSAS. The prevalence of OSA in the entire group was 95.0%.Conclusions: The prevalence of syndrome Z in present study participants was very high. With the help of history and polysomnogram, metabolic syndrome should be screened for OSA. Early diagnosis and treatment of OSA is the essential part in the treatment of metabolic syndrome and hence CAD.
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
Sleep disordered breathing and obstructive sleep apnea are frequently associated with hyperglycemic disorders. The common pathophysiological factors that link these disorders have been a matter of debate and current research. Abdominal adiposity and high body mass index are considered to predispose individuals to early onset of type 2 diabetes and related metabolic disorders. A young adult presenting with symptoms of obstructive sleep apnea often poses a diagnostic challenge for clinicians especially when multiple risk factors coexist. It is essential to establish the exact diagnosis so that specific treatment can be initiated. The role of a non-aggressive approach in management of severe hyperglycemic conditions has been doubted. We report a case of a 33 year old man presenting to the respiratory outdoor clinic for recent onset loud snoring and increased daytime sleepiness. Routine biochemistry reports revealed hyperlipidemia and severe hyperglycemia. The patient was ambulatory and stable throughout. The subsequent investigations identified multiple stressors and the possibility of a single cause was analysed. A rapid glycemic control and amelioration of symptoms were observed based on consistent monitoring and a conservative clinical approach. The key findings and relevant review of literature are discussed in this article.
ABSTRACT
Background & objectives: The metabolic syndrome (MS) is a risk factor for development of cardiovascular disease and is closely associated with obstructive sleep apnoea (OSA). Co-occurrence of both OSA and MS is called syndrome Z. It has been hypothesized that the OSA may be a manifestation of MS. We collected data on polysomnography (PSG) and biochemical investigations on middle aged urban Indians during a community based study in South Delhi while studying prevalence of obstructive sleep apnoea and analysed to find out the ages at which the OSA, MS and syndrome Z exist in these subjects. Methods: A 2-stage, cross-sectional, population-based study in subjects of either gender between 30-65 yr of age in 4 different socio-economic zones of the South Delhi, India, was performed earlier (from April 2005 through June 2007). In-hospital, supervised PSG studies were performed and biochemical investigations for the MS using National Cholesterol Education Programmme Adult Treatment Panel (NCEP ATP) III criteria were carried out. In this communication, the data were further analysed to estimate the prevalences of MS alone, OSA alone and syndrome Z and average ages of 3 conditions. Results: Three hundred and fifty one subjects had satisfactory PSG studies. The MS alone was present in 105 [29.9%; (95% CI 25.1-34.7)] while OSA alone was present in 24 [6.8%; (95% CI 4.2-9.5)] subjects and the syndrome Z was present in 70 [19.9%; (95% CI 15.8-24.1)] subjects. Median ages of normal subjects, and subjects with MS, OSA and syndrome Z were 40, 43, 43 and 47 yr respectively. Minimum ages of normal subjects, and subjects with MS, OSA and syndrome Z were 30, 30, 32 and 32 yr respectively. Interpretation & conclusions: When body mass index (BMI) was normal, the increasing median ages of these conditions indicated that the MS may be the first event followed by OSA and eventually syndrome Z develops. With BMI >25 or >30 no clear-cut difference was noted, indicating that the BMI itself could have an independent role in MS, OSA and syndrome Z.