Screening Parameters for COPD-OSA Overlap Syndrome in COPD Patients: Indian Perspective

Introduction: As Indian patients have different predisposing morphological characteristics, we undertook this study to evaluate the clinical profile of overlap syndrome and compare them with COPD patients to find out the screening tools for obstructive sleep apnea (OSA) in Indian chronic obstructive pulmonary disease (COPD) patients. Aims and objectives: • To study the clinical profile of patients with overlap syndrome. • To compare them with COPD patients. • To develop screening tools for overlap syndrome in COPD. Materials and methods: A prospective case-control study was carried out in a tertiary care center. Overnight pulse oximetry was carried out for all COPD patients. Those having snoring or saw-tooth pattern on overnight oximetry were subjected to level 1 polysomnography. About 30 patients of overlap syndrome were compared with 65 COPD patients. Results: The mean age in overlap syndrome group (56.9 ± 6.86 years) was significantly lower (p < 0.01). The daytime PaO2 and lowest nocturnal saturation were significantly lower in overlap group. PaCO2 and forced expiratory volume at 1 second (FEV1) were significantly higher. For diagnosing overlap syndrome, the positive and the negative predictive values of snoring were 84.42 and 100%; of body mass index (BMI) ?25 kg/m2 were 86.67 and 98.88%; and of excessive daytime sleepiness were 37.57 and 97.86%, respectively. Conclusion: Absence of snoring and BMI <25 kg/m2 virtually rules out overlap syndrome. The EDS has a high false-positive rate for predicting OSA. Patients having overlap syndrome have poor daytime and nocturnal oxygenation despite good lung functions.

Obstructive Sleep Apnea with Insomnia Overlap: An Under-recognized Entity

Introduction: The association between obstructive sleep apnea (OSA) and insomnia is relatively common but is underrecognized. There are important diagnostic and therapeutic implications of comorbid OSA杋nsomnia overlap but there is no data available from India. Objectives: (1) To find out the prevalence of insomnia among patients with OSA; (2) To compare the demographic characteristics, Epworth sleepiness scale (ESS) scores and the presence of comorbidities among patients of OSA with insomnia vs OSA without insomnia. Materials and methods: It was a prospective observational study involving 250 patients with suspected OSA. A total of 189 patients had OSA based on type I polysomnography and were further analyzed. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Results: The prevalence of insomnia among OSA was 15.34% (29/189). Overlap was seen in 22.45 and 12.86% of women and men respectively among patients with OSA. The prevalence of overlap increased with decreasing severity of obesity and OSA. Those with OSA杋nsomnia overlap had significantly lower ESS scores as compared to OSA without insomnia (12.31 vs 15.24; p = 0.019). A total of 10.34% (3/29) of patients of overlap had depression whereas none from OSA alone had depression. Conclusion: There is a high prevalence of insomnia among patients with OSA (15.34%), similar to findings worldwide. Insomnia is more common among women with OSA. Overlap patients have lower ESS scores and are likely to be depressed.

Interstitial Lung Disease due to Siderosis in a Lathe Machine Worker.

Since its first description in 1936, siderosis of lung has been considered a benign pneumoconiosis due to absence of significant clinical symptoms or respiratory impairment. Subsequently, authors have questioned the nonfibrogenic property of iron. However, siderosis causing interstitial lung disease with usual interstitial pneumonia (UIP) pattern has not been described in the past. We report a case of UIP on high resolution computed tomography, proven to be siderosis on transbronchial lung biopsy in a lathe machine worker.

Pulmonary rehabilitation in resource poor settings.

Pulmonary rehabilitation is an important component in the management of chronic obstructive pulmonary disease (COPD) and other chronic respiratory diseases. The goal of rehabilitation is to evaluate various systems, treat optimally, improve dyspnoea and health-related quality of life. It is a multi-disciplinary approach and involves a physician, a psychiatrist, a dietician and a physiotherapist. However, in a resource-poor setting, even an experienced physician alone may suffice. Exercise training is the backbone of pulmonary rehabilitation, which may be hospital-based or home-based. Though, the previous trials have shown benefit with hospital-based rehabilitation, several recent studies have demonstrated significant improvement in the 6-minute walk test and quality of life even with unsupervised, home-based pulmonary rehabilitation. In the resource-poor settings, the goal of rehabilitation may be achieved by incorporating regular unsupervised exercise in daily routine. This is not only better accepted and more suitable but is also more feasible for the lifelong maintenance of rehabilitation.

Clinical profile of diseases causing chronic airflow limitation in a tertiary care centre in India.

SETTING: Pulmonary department of a tertiary health care centre in India. OBJECTIVES: To study the clinical profile of diseases causing chronic airflow limitation (CAL). DESIGN: Standard criteria were used for the diagnosis for various diseases causing CAL. Severity of CAL was graded using forced expiratory volume in one second (FEV1)% predicted. Pulmonary hypertension (PH) was confirmed by 2-dimensional echocardiography with colour Doppler. RESULTS: Two hundred sixty eight consecutive patients of CAL, age range 12-75 years, 172 men and 96 women were included in the study. Sixty three percent had asthma, 17% had chronic obstructive pulmonary disease (COPD), 6% had bronchiectasis, 13% had obliterative bronchiolitis (OB) and 1% had occupational airway disease. 98% of COPD was caused by tobacco smoking, of which 84% were bidi smokers. Ninety-two percent cases of OB were post infectious, 78% being post tuberculosis. 37% of COPD, 33% of bronchiectasis, 53% of OB and 22% of asthma had severe airflow limitation. PH was observed in 15%, 19% and 13% cases of COPD, OB and bronchiectasis, while none with asthma had PH. CONCLUSION: Although, asthma was the leading cause of CAL, it caused least functional impairment. CAL due to OB was as common as COPD. Bidi smoke was an important cause of COPD, while respiratory infection was common cause for OB.

Sleep apnea.

OBJECTIVE: To study clinical presentation of sleep disordered breathing (SDB) in children, their causative factors and response to treatment. METHODS: A retrospective study of clinical data nd results of overnight polysomnography done at baseline and after therapy were reviewed in 56 patients under 18 years of age. RESULTS: Of the 56 patients included in the study 23(41%) cases were positive for SDB. 12 (52.1 %) patients had craniofacial abnormalities, 4 (17.3%) had neuromuscular and skeletal disorders, 2 (8.6%) had adenotonsillar hypertrophy, 1(4.3%) had bilateral vocal cord palsy and 3 (13%) had sleep apnoea associated with multisystemic disorders. Post-operative data showed improvement in all 6 cases of craniofacial abnormalities and both cases of adenotonsillar hypertrophy. Positive airway pressure treatment was useful in cases with obstructive sleep apnea (OSA) due to vocal cord palsy, thoracic scoliosis, systemic disorders and central hypoventilation. CONCLUSION: 41% of suspected cases were detected to have SDB. Craniofacial abnormality was the leading cause of OSA in the present study. Surgical correction improved symptoms apnea-hypopnea index (AHI) and desaturation in cases of craniofacial disorders and adenotonsillar hypertrophy. Vocal cord palsy, thoracic scoliosis, hypoventilation and systemic disorders associated OSA responded to positive airway pressure ventilation.

Late onset hypoventilation syndrome: is there a spectrum of idiopathic hypoventilation syndromes?

We report a case of late onset central hypoventilation syndrome (LO-CHS) with hypothalamic dysfunction (HD) and ganglioneuroma presenting at the age of ten years. LOCHS-HD is now a well-established syndrome; the key is to investigate each child's history and presentation to expeditiously offer the most accurate diagnosis and optimal management.

Acromesomelic dysplasia with bronchiectasis.

We report a rare case of acromesomelic dysplasia with bilateral bronchiectasis and obstructive sleep apnoea. Diagnosis of acromesomelic dysplasia was based on radiographs of whole skeleton.

Hemorrhagic pleural effusion due to pleural hemangioma.

We report a rare case of isolated pleural hemangioma presenting as recurrent, haemorrhagic pleural effusion. Chest radiograph and computed tomography of chest was suggestive of left apical tumour. Diagnosis of hemangioma was revealed only after thoracotomy and excision of the tumour mass.