30 sufferers with sleep disorder OSA obtained each month at PGI: Doctor

About 30 new patients with Obstructive Sleep (OSA) are received every month at PGIMER, says Professor Sandeep Bansal, who is incharge of sleep services at ENT department of PGI. Around one in five adults have mild symptoms of OSA while one in 15 have moderate-to-severe symptoms.
World Sleep day will be observed on Friday.

Citing the sudden demise of singer Bappi Lahiri, PGI doctors state that there is a need to create awareness about this disease which people often dismiss as ‘didn’t get any sleep at night’ that may turn serious.

“After Bappi Lahiri’s death, the question that arose was — can a person succumb to death in his/her sleep? Well, the answer is ‘yes’, if you’re suffering from an undiagnosed sleep condition just like the singer. Obstructive sleep is perhaps the most feared but untreated condition in society. It lacks awareness. A bad sleep at night is often sorted out by taking a pill. Thus, the cause often remains undiagnosed and untreated. OSA is definitely not the ‘didn’t get any sleep at night’ problem that you can put an end to with a sleeping pill,” Professor Bansal said.

The doctor explains how approximately one billion people globally have this condition, but only 20 per cent have been diagnosed with and treated.

Professor Bansal, incharge of sleep services of ENT department at PGI, and Professor Naresh Panda, head of ENT department, explain early signs of OSA which one must not ignore, the dignaosis, risks associated with it and its treatment.

What makes OSA different from other sleeping disorders?
When we say a person is having difficulty to sleep at night, it could be due to two reasons, either the person is unable to fall asleep or the person does fall asleep at night but wakes up several times due to breathlessness. The two conditions are very different from each other, the first one is a case of insomnia in which you’ll visit a psychiatrist while the second one is a case of Obstructive Sleep and that is the topic of discussion here. OSA is the mother of all major cardiac morbidities and other morbidities in adults as well as children.

How many cases of OSA are coming at PGI?
About 30 new patients of OSA are coming every month at PGI, says Professor Bansal. “We undertake about 15-20 sleep studies a month. Even during Covid times around 10 studies were being done in the department. Though there can be multiple reasons for sleep apnea, obesity/being overweight is one of the main causes of OSA which is treatable. Menopausal and postmenopausal women have an increased risk of OSA,” he says.

What are the signs one should look for to know if affected by OSA ?
Professor Bansal states that if you know someone who is a snorer or someone who finds it difficult to sleep at night due to sudden choking sensation in the neck, you must refer the person to a sleep surgeon for management of this condition. Snoring is not a regular event and should not be ignored.

“We have and are carrying out many research projects so as to improve the surgical treatment options for OSA. Excessive daytime sleepiness, loud snoring, episodes of stopped breathing during sleep, morning headache, night time sweating, experiencing mood changes, abrupt awakening at night with a dry mouth and sore throat are some of the signs one should not ignore,” he says, adding how OSA affects an individual’s productivity.

“Studies show that OSA can increase the chances of road accidents. This is because people with OSA do not get enough sleep and so can become drowsy while driving. Even the drop in oxygen level while sleeping can cause the body to release adrenaline to such a level that it can cause a sudden cardiac arrest. About 19 of people with severe sleep apnea have died as mentioned in recent studies,” he says.

What happens in a patient with OSA? What if the OSA is left untreated?
Professor Panda says that untreated sleep apnea can lead to potentially serious health complications, such as heart disease, blood pressure, diabetes and depression. It can also leave a person feeling drowsy, increasing the risk of accidents while driving or working and loss of concentration at work, subsequently poor productivity. So an early recognition of the problem and getting it treated is of utmost importance.

Professor Bansal adds that awareness of OSA became all the more important during this Covid pandemic.
“Obstructive Sleep Apnea usually happens because of repetitive narrowing of the airway during sleep despite breathing efforts. The person will unknowingly stop breathing repeatedly throughout sleep. Once the airway is opened or the breathing signal is received, the person may snore, take a deep breath, or awaken completely with a sensation of gasping, smothering, or choking.”

Are children also at risk of OSA?
“We are also receiving cases where children too have been diagnosed with OSA. Those children who are obese are at a higher risk. About 20 to 50 of obese children have OSA. Enlargement of the tonsils and adenoids is the most common cause of OSA in children and 85% of the children can be cured of their OSA by an adenotonsillectomy,” says Professor Bansal. During sleep, signs and symptoms of pediatric sleep apnea might include snoring, pauses in breathing, restless sleep, snorting,
coughing or choking, mouth breathing, bed wetting, sleep terrors. Infants and young children with obstructive sleep apnea don’t always snore. They just have disturbed sleep, he says, adding that during the day, children with sleep apnea might perform poorly in school, have difficulty paying attention etc.

How is OSA treated?
Doctors state that the diagnosis is done in a sleep lab. Around 15-20 sleep studies in a month in ENT Department of PGIMER and based on the severity of the condition that is Apnea Hypopnea Index AHI (AHI, a unit determines sleep apnea severity) , treatment is given. An AHI of less than 5 is normal. If the AHI of an individual falls between 5-15, it is considered mild, 16-30 is moderate and more than 30 is severe. Anything more than 15 AHI, it can be life-threatening and immediate treatment is advisable.

Talking about the treatment options for OSA, Professor Bansal says there can be medical as well as surgical treatment options in carefully selected patients but lifestyle modifications being the most useful adjunct in both treatment forms.

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