Time Sleepiness Research Articles

Absence of dysregulation in amplitude and phase of circadian rhythm of core body temperature in idiopathic hypersomnia: A case-control study.

To investigate amplitude and phase of the circadian rhythm of core body temperature (CBT) via the continuous measure of the gastrointestinal temperature in participants with idiopathic hypersomnia (IH), non-specified hypersomnia (NSH) compared to healthy controls (HC) in a constant routine standardized bedrest (BR) protocol. Consecutive participants evaluated in a National Reference Center for Rare Hypersomnias benefited from an extensive evaluation with one night polysomnography, followed by modified Multiple Sleep Latency Test (mMSLT), and a continuous 32-hour BR recording in standardized conditions. CBT was recorded via a telemetry pill (e-Celsius®) during the BR, modeled by a Cosinor, with extraction of MESOR, amplitude and phase. Participants with IH, diagnosed according to ICSD-3, were compared with participants with NSH (complaint of hypersomnolence but normal mMSLT and BR), and HC. Participants were divided in 4 groups based on their mMSLT mean sleep latency (mMSLT+,≤8min) and their BR total sleep time (BR+,≥19h). 108 participants (80% women, 28.3±7.8 y.o) were included in the analyses, 81 IH (83% women), 16 NSH (75% women), 11 HC (64% women). Cosinor amplitude and phase of CBT did not differ between IH, NSH and HC, nor in the subgroup analysis (37 BR+/mMSLT+, 35 BR+/mMSLT-, 9 BR-/mMSLT+, 27 BR-/mMSLT-). No difference in chronotypes was observed between groups. Women had a greater MESOR and reduced CBT amplitude compared to men. The circadian rhythm of CBT showed no difference in amplitude or phase between IH, NSH and HC, and was not related to prolonged sleep time or objective daytime sleepiness.

A comparative study to assess the effect of sleep deprivation on cognitive function among adolescent’s male and female in selected rural and urban areas of district Mohali, Punjab

Adolescence may be a critical period which marks puberty and physical maturation, where there’s a gradual transition between childhood and adulthood. Sleep affects the physical, mental, and emotional development of the adolescents, and it’s a possible impact on their academic performance. Adolescents should sleep 8-10 hours/day on a regular basis to promote optimal health. Poor sleep has multiple effects on adolescent health which includes depression, excessive day time sleepiness and metabolic dysfunctions. Unlike adults, children don’t usually complain of sleep problems or seek treatment.

Assessment of Quality of Sleep and Daytime Sleepiness in Medical Professionals and Students in a Medical College: A Descriptive Cross-Sectional Study

Introduction: Poor sleep quality is a global public health issue particularly more prevalent in medical professionals and students. Despite various health and occupational risks, research is still lacking regarding the quality of sleep and its irelated factors among medical professionals and students in our region. Therefore, our study aimed to estimate the prevalence of poor sleep quality in this population.Methods: This observational, cross-sectional study was conducted among medical professionals and students of Devdaha Medical College from December 2023 to June 2024 after ethical approval from the Institutional Review Board. Data regarding sleep quality and excessive daytime sleepiness were collected using the Pittsburg Sleep Quality Index (PQSI) and Epworth Sleepiness Scale with pre-made questionnaires in Google Forms.Results: Among 395 participants, 260 (65.83%) were in the age group 20-25 years and 200 (50.63%) were nursing students. The prevalence of poor sleep quality was 146 (36.96%; 95% CI: 32.19%-42.93%) and the global mean score of PSQI was calculated to be 5.12. Out of the total participants, 255 (64.55%) had excessive daytime sleepiness, 84 (21.26%) participants had one or more sleep problems out of which, snoring was in 40 (10.12%) participants.Conclusions: About one-third of the study population poor sleep quality and day time sleepiness was reported in more than half of the respondents.

Non-invasive hemodynamic monitoring during initiation of positive airway pressure treatment in patients with obstructive sleep apnea: a feasibility study

BackgroundThe association of obstructive sleep apnea (OSA) with cardiovascular morbidity has been repeatedly reported in numerous studies and argues for treatment initiation even in the absence of significant day time sleepiness. While the long-term consequences of positive airway pressure (PAP) treatment on OSA related comorbidities like secondary hypertension are based on substantial clinical evidence, less is known about the immediate hemodynamic effects.MethodsThis study tried to investigate the impact of PAP treatment on different hemodynamic parameters in 48 patients with OSA by extending the standard polysomnographic assessment with non-invasive hemodynamic monitoring using impedance cardiography (ICG). On two consecutive nights under diagnostic and therapeutic conditions, polysomnographic and hemodynamic data were acquired. In addition, we subdivided the participants according to their treatment related change in stroke volume (SV) and assigned the hemodynamic measurements to the corresponding sleep stage.ResultsComparing both conditions, a non-statistically significant decrease in SV and cardiac output (CO) was observed for all participants. Treatment initiation was associated with a statistically significant prolongation of the pre-ejection period (PEP) for the entire study population (p = 0.001) and the subgroup with decreasing SV (p = 0.008). In addition, systolic blood pressure (SBP) (p = 0.026) and pulse pressure (PP) (p = 0.041) were lowered significantly for patients with a therapeutically reduced SV under treatment conditions. A higher BMI (p = 0.020) and a more pronounced reduction of the respiratory distress index (RDI) (p = 0.030) and the arousal-index (p = 0.021) were observed for patients with decreasing SV. Correlational analysis revealed a negative relationship between the diagnostic values for both SBP (r=-0.324, p = 0.025) and PP (r=-0.407, p = 0.004) with the change in SV and a positive correlation with the change of the SBP (r = 0.317, p = 0.028) for all participants.ConclusionsTo conclude, our results indicate that treatment with a PAP device in patients with OSA can lead to a decrease in SV which is associated with a lowering of the SBP. This may be caused by a reduced sympathetic tone due to less respiratory events and an improved sleep profile.

Abstract RF01-08: A randomized, open-label phase III trial Evaluating Low-Dose Vs standard-dose Olanzapine with triple Antiemetic therapy for Prevention of highly emetogenic chemotherapy- induced Nausea and vomiting in solid tumors (OLAnzaPiNE)

Abstract Background Chemotherapy induced nausea and vomiting (CINV) is a major adverse event for cancer patients. Olanzapine (OLZ) in standard 10 mg dose along with triple antiemetics (TAE), has shown effectiveness in treating CINV with highly emetogenic chemotherapy (HEC), however, significant day time somnolence (DTS) precludes its widespread use. Steroids related side effects are another major concern. Hence, a lower dose of OLZ, with single dose (SD) steroid use is worth exploring in a randomized fashion. Methods Solid tumors planned for anthracycline-cyclophosphamide & high-dose cisplatin chemotherapy was randomized (1:1) to receive either 10mg OLZ (standard arm) or 2.5mg (experimental arm) till day 4 with TAE regimen [5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, dexamethasone (SD, without delayed doses), and neurokinin-1 (NK1) receptor antagonists] in both arms. Primary objective was to evaluate Complete control rate (CCR) defined as proportion of subjects with no emetic episodes (EE), no use of rescue medications (RM), no or mild nausea assessed in overall phase (OP) =0-120 hours(h) in both groups. Secondary objectives were to compare two groups for the CCR in acute(AP) and delayed phase(DP);Complete response rate (CRR)=no EE and no use of RM in AP(0- 24h), DP(25-120h) and OP; Total control rate(TCR)= no EE, no use of RM, and no nausea) in AP, DP, OP; Time to treatment failure(TTF), defined as mean duration from chemotherapy initiation to first episode of nausea, EE, use of RM; Incidence of significant daytime somnolence(DTS).Tertiary objectives were effect on appetite loss. Subjects maintained a daily record of nausea, EE, RM use with the severity graded on a four-category scale. Statistical analysis CCR, CRR, TCR are given in counts and proportions. Occurrence of nausea, EE, DTS and their grades were compared using Chi-square test. Results A total of 275 subjects were enrolled, among them 267 were analyzable, inclusive of 132 subjects in 2.5mg and135 in 10mg arms with well-balanced baseline characteristics (Table 1) Proportion of patients with CCR in OP (Primary end point) in 2.5mg vs. 10mg arms were, 44.7 % vs. 43.7 % (P = 0.87) respectively. CCR in 2.5mg vs. 10mg arms in AP, DP were 50% vs. 48.9%(p=0.856) and 50.8% vs. 58.5% (P=0.203) respectively. CRR in 2.5mg vs. 10mg in AP, DP and OP were 56.1% vs. 57 % (P=0.872), 55.3% vs. 63% (P = 0.203), and 50.8 % vs. 51.1% (P=0.954), respectively. TCR in2.5mg vs. 10mg in AP, DP, and OP were25% vs. 23 % (P=0.697), 20.5% vs. 22% (P = 0.725), and 13.6 % vs. 15.6% (P=0.657), respectively. Subjects receiving 2.5 mg as compared with those receiving 10 mg, had statistically significant decreased DTS on overall grades 65.2%vs 89.6% vs. (p < 0.001); severe grade DTS was more on day1 i.e., 4.5%vs. 40% (p < 0.001) and although successively reduced from day 2-5 in both the arms, however, 2.5 mg fared better on all the days (table 1). No statistically significant effect of reduced appetite noted in 2.5mg vs. 10mg i.e., 17.4% vs. 24.4 %(p=0.208) Conclusion Low dose olanzapine (2.5mg) is non inferior to 10mg olanzapine in controlling CINV without requirement of delayed steroids, and is superior with respect to DTS (all days, all grades, severe grades) in subjects receiving HEC. This merits wide recognition as a new steroid sparing antiemetic regimen of choice with HEC. Demographic data, Clinical characteristics and Outcomes Citation Format: Jyoti Bajpai, Venkatesh Kapu, Sushmita Rath, Sravan Kumar, Anbarasan Sekar, Srikanth Anne, Akash Pawar, Sujay Srinivas, Prabhat Bhargava, Seema Gulia, Rajiv Sarin, Rajendra Badwe, Sudeep Gupta. A randomized, open-label phase III trial Evaluating Low-Dose Vs standard-dose Olanzapine with triple Antiemetic therapy for Prevention of highly emetogenic chemotherapy- induced Nausea and vomiting in solid tumors (OLAnzaPiNE) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr RF01-08.

Association between physical activity over a 10-year period and current insomnia symptoms, sleep duration and daytime sleepiness: a European population-based study

ObjectivesTo explore the relationship between physical activity over a 10-year period and current symptoms of insomnia, daytime sleepiness and estimated sleep duration in adults aged 39–67.DesignPopulation-based, multicentre cohort study.Setting21 centres...

Subjective sleep onset latency is influenced by sleep structure and body heat loss in human subjects.

The present study examined the relationship between subjective sleep onset latency (SOL), sleep structure, changes in skin and body temperature, and subjective evaluation of sleep in healthy young adults to elucidate the pathophysiological mechanisms of insomnia. A total of 28 participants (age 21.54 [0.50] years) with no sleep problems participated in a 1-h polysomnographic recording that obtained objective sleep parameters during the daytime while skin and body temperatures were recorded. The distal-proximal skin temperature gradient (DPG) was calculated. Subjective parameters, such as subjective SOL, sleep time, and restorative sleepiness, were evaluated before and after sleep. Most participants estimated their sleep latency as being longer than their actual SOL (13.7 versus 7.6 min). Objective SOL was significantly correlated with each sleep stage parameter whereas subjective SOL was negatively correlated with Stage N2 sleep duration (Rho = -0.454, p = 0.020), slow-wave activity and delta power (Rho = -0.500, p = 0.011 and Rho = -0.432, p = 0.031, respectively), and ΔDPG (the degree of reduction of heat loss before and after lights-off). Stepwise regression analysis showed that ΔDPG was the strongest predictive factor in explaining the length of subjective SOL. The degree of heat dissipation before and after lights-off contributed most to the sensation of falling asleep in healthy young adults. This finding may be helpful for elucidating the physiological mechanisms of insomnia and its treatment.

Excessive day time sleepiness and its associated factors among adult population in an urban area of southern Rajasthan

Background: Sleep problems have been considered as an unmet public health problem. Sleep problems are mostly under reported and neglected by the Indian population. Very limited studies have been conducted in India on this aspect. Aims and Objectives: The aim of the study was to estimate the prevalence of excessive day time sleepiness (EDS) and its associated factors among urban adult population. Materials and Methods: A community based cross-sectional study was conducted among 409 adults of 20–60 years age group in urban Udaipur. Socio-demographic and other details were obtained using a semi structured questionnaire. Using Epworth Sleepiness Scale, assessment of EDS was assessed. Results: In the present study, mean age of the participants was 40.8 ± 11.3 years. Considering the ESS score of 10 or more, EDS was observed in 60.2% subjects. EDS was associated with age, gender, milk consumption, and mobile use. No significant association was found between EDS with central obesity, body mass index, marital status, literacy, occupation, exercise, smoking, and consumption of alcohol. Conclusion: In the present study, the prevalence of EDS was high. Therefore, early identification of excessive sleep problems and appropriate intervention that address the various determinants of the sleep problems is of prime importance.

The Influence of Digital Literacy in Online Learning on Student Learning Outcomes


 
 
 
 
 The purpose of the study was to describe the effect of digital literacy in online learning on student learning outcomes and identify the constraints of digital literacy in online learning on student learning outcomes at SDN Klurak Kec.Candi Kab.Sidoarjo. The research is an ex post facto research with a quantitative approach. Data were collected through questionnaires and learning outcomes test documents on 37 students at SDN Klurak Kec.Candi Kab.Sidoarjo. Data were analyzed using descriptive analysis and simple linear regression analysis.
 The results of the first study showed that the calculated t value was 0.625 < t table 2.030, so there was no effect of digital literacy in online learning on student learning outcomes at SDN Klurak Kec.Candi Kab.Sidoarjo. This is because students' understanding of digital media and the internet in online learning is very limited and does not lead to the use of digital media and the internet to find information.
 The second research result on digital literacy constraints in online learning on learning outcomes, including motivation/attitude and physical access. Motivation/attitude, including 4 students not having friends, 6 students not understanding the material, and 3 students having time problems, boredom, and sleepiness. Physical access, 5 students did not have a digital device, 5 students did not have a quota, and 3 students had problems with the signal..
 
 
 

1029 Inspire Confidence In CPAP

Abstract Introduction Obstructive sleep apnea (OSA) is defined as the repetitive episodes of complete or partial occlusion of the airway occurring during sleep. OSA is thought to play a role in many different diseases including anxiety, depression, excessive day time sleepiness, and GERD. Treatment of OSA can often be difficult as many patients cannot tolerate CPAP. Report of case(s) The patient is a 76-year-old male who was diagnosed with OSA in 1991. He had undergone Uvulopalatopharyngoplasty in 1997 and maxillomandibular advancement in 1999 but continued to have snoring and witnessed apneas and excessive daytime sleepiness (EDS). A repeat PSG in 2019 showed severe sleep apnea with an AHI of 37.3. The patient had been unable to tolerate his CPAP at home due to discomfort from the pressure. He was then referred for evaluation and subsequent placement of a hypoglossal nerve stimulator known as inspire by ENT. On follow-up at the sleep clinic, the patient complained that he was still having daytime sleepiness and snoring despite compliance with INSPIRE. A home study was done to evaluate the effectiveness of INSPIRE and his AHI was found to be 46. INSPIRE was reconfigured and a repeat sleep study was done which showed similar results. A decision was made to try combination therapy with INSPIRE and CPAP at a lower pressure than previously. His original CPAP settings were 12cmH20 and with combo therapy we were able to change this to autoPAP 7-10, which the patient tolerated well and showed good control of his sleep apnea with an AHI of 4.6. Conclusion For those with moderate to severe OSA, the gold standard therapy is CPAP, but not every patient can tolerate CPAP therapy. One of the reasons is the CPAP pressure being too high. In 2014 the FDA approved a new treatment option for those with moderate to severe sleep apnea with the hypoglossal nerve stimulator. In our patient, multiple different INSPIRE configurations were attempted but he still had uncontrolled OSA and EDS. We were able to use combination therapy with INSPIRE and CPAP to adequately control his OSA without needing the high pressure that he could not tolerate previously. Support (if any)

0516 Biopsychosocial intervention using virtual multidisciplinary group with improved PAP adherence after 1 year post intervention

Abstract Introduction Prevalence of untreated sleep apnea among veterans is 22.2 %. Untreated patients are at risk for multiple adverse outcomes including chronic sleep deprivation, excessive day time sleepiness, chronic fatigue, depression, and cardiovascular complications including hypertension, coronary artery disease, cerebrovascular accidents, pulmonary hypertension as result of increased sympathetic activity during apnea episodes. Nonadherence to PAP therapy within the first week of treatment are up to 50 % of patients who use PAP device during the first week between 12-25 % discontinue by PAP use by year 3. Barriers to PAP use include physical problems with PAP hardware, knowledge gaps, and psychological issues. Methods Veterans from sleep medicine and sleep apnea clinics as well as multiple primary care clinics participated in the PAP adherence group following 6 weeks biopsychosocial model. The intervention included weekly synchronized video encounters of behavior sleep specialist, respiratory therapist and sleep clinic nurse with the targeted group of veterans with sleep apnea and poor PAP adherence. This approach has multiple benefits, including being patient centered, cost effective and efficient with ability to help veterans at various motivational levels, assist 6-10 veterans virtually in 6 one-hour group sessions and easy care coordination. Results A total of 21 veterans with sleep apnea participated in virtual multidisciplinary group to improve PAP adherence between September 2020 and January 2021. Patients PAP adherence before intervention, post intervention and 1year after intervention was evaluated. Percent of patients using PAP >2 hours before intervention was 5 %, immediately after intervention it increased to 20 %, and there was further increase up to 33% after 1 year post. Conclusion A structured multidisciplinary biopsychosocial intervention demonstrated statistically significant improvement in PAP adherence which persisted up till 1 year post intervention. In fact additional improvement of >2 hours of PAP usage was noted in this patient group suggesting possible long term benefit of psychosocial multidisciplinary intervention on PAP adherence. This study also demonstrated efficiency of utilization of virtual/telemedicine platform for psychosocial intervention and brief behavioral therapy. Support (if any)

Prevalence of Sleep Disturbance Among DPT Students

Sleeping is essential for student physical as well as mental health. Sleep disturbance is distressing state that affect quality of work. Objective: To determine the sleep disturbance in DPT students. Methods: This observational study recruited 884 participants out of which 800 filled the questionnaire with mean age 21.54 ±1.76 from different medical universities and medical colleges of Punjab. Non probability convenient sampling technique was used. Both male and female students of all the years of DPT were included. Students with psychiatric illness, chronic medical illness, smoking and taking drugs excluded from the study. The effects of insomnia were checked by Athens Insomnia Scale (AIS) questionnaire. For data analysis SPSS version 26 was used. Results: Mean age of the physical therapy students was 21.54 ±1.76. Out of 800, 61.75% students were insomniac. Most of the students had unsatisfactory sleep quality (55.87%), awakening at the night time (62%), and day time sleepiness (76.25%). Conclusion: According to present study prevalence of sleep disturbance was very high among physical therapy students

An interesting case of seronegative neuro myelitis optica spectrum disorder

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that causes severe demyelination, especially in the optic nerve and spinal cord with typical clinical manifestations of acute optic neuritis and transverse myelitis. Seventy to ninety percent of the cases of NMOSD test positive for aquaporin 4 IgG Antibodies (AQP4 IgG Ab). Here we report a case of 22-year-old female who presented with history of diffuse headache since 1 week, history of double vision since1 week and excessive day time sleepiness since2 months. Patient had a past history of bilateral and simultaneous optic neuritis 9 months back. On further evaluation patient was diagnosed as seronegative NMOSD (AQP4 IgG Ab–negative).

Syncope masquerading narcolepsy- An unusual presentation

Narcolepsy is a rare disorder of sleep wake cycle which can result in persistent excessive day time sleepiness. It is due to the deficiency of the Orexin/Hypocretin in the body. Most of these cases are reported in young adults and are difficult to diagnose early. This can lead to serious impairments in social and occupational settings if not promptly treated. Thus we are reporting an interesting case of a teenager who presented with falls. He was diagnosed with nocturnal Polysomnography followed by Multiple Sleep Latency Test (MSLT), and he significantly benefitted from treatment with Modafinil.

Comparing the Timbre of Different Musical Sounds used in Music Therapy and its Effect on the Quality of Sleep in Medical Students with Insomnia- A Prospective Interventional Study

Introduction: Stress and the pressure to perform in a competitive world has led to a rise in insomnia cases, especially in medical students. Music serves as a great alternative or additional therapy and hence, specifying the details of the type of music and creating a standard set of musical parameters, e.g., a specific value for tempo that sleep music should have. This will make it a more viable and clear option. One of these important but minimally explored aspects is timbre of music. Aim: To assess and compare the effect of timbre of different musical sounds on an individual’s quality of sleep, duration and day time sleepiness. Materials and Methods: This prospective interventional (community trial) study was done in the Department of Physiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India for three weeks. Hundred medical students having insomnia were chosen and split into five groups: Group A-Sitar, B-violin, C-vocal, D-flute and E-control. Groups A-D had to listen to tracks with an assigned timbre for 20 minutes before going to sleep daily for three weeks. Pittsburg Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were used to assess sleep quality, duration and day time sleepiness. Kruskal-Wallis test was used to analyse the results. Results: Sleep quality improved with sitar being the one that improved the quality the most, followed by violin, then flute and finally, vocal (p-value=0.001). Sleep duration improved with sitar being the one that showed the most improvement, followed by flute, then violin and finally, vocal (p-value=0.001). Daytime sleepiness decreased with sitar being the one that decreased it the most, followed by violin, then flute and lastly, vocal (p-value=0.021). Conclusion: The most effective timbre in improving sleep quality, duration and reducing day time sleepiness was Sitar and the least effective was vocal.

Mental Health and Sleep Disorders in Obese Patients, Their Relationship with Clinical and Pathogenetic Changes in the Organism and Impact on Quality of Life

In the world the problem of obesity is an important aspect in the non-infectious diseases progression. It is known, that 95% of the pathogenic factor for the obesity development depends on the changes caused by neurochemical, hormonal and metabolic mechanisms that occur by depression, anxiety, eating disorders, circadian rhythms and sleepiness. The objective: to determine the psychosocial features and their relationship with clinical and pathogenetic changes in obese patients of working age. Materials and methods. 75 patients with obesity of the 1st and 2d degrees (39.03±0.93 years old) and 75 practically healthy persons of the corresponding age (36.84±0.96 years old) were examined. Waist circumference (WC), hip circumference (HC), body surface area (BSA), waist/hip ratio (WHR), conicity index (ConI), a body shape index (ABSI), abdominal volume index (AVI), blood pressure, blood levels of glucose, insulin, index HOMA, cholesterol, lipidogram indicators, serotonin, and leptin were determined in the patients. The psychological status was assessed by Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Scale (HAM-A), the Dutch Eating Behavior Questionnaire (DEBQ), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), the patient’s quality of life – by 36-Item Short Form Survey (SF-36). The statistical analysis was conducted by IBM SPSS Statistics, Statistica 12, descriptive statistics Excel 2010. Results. The patients of the studied group, unlike the control group, had significantly higher indices of WC, HC, BMI, WHR, ConI, ABSI, AVI, HOMA index, blood pressure, glucose, insulin, total cholesterol, lipidogram, leptin and the lower level of serotonin. This was accompanied with clinically expressed anxiety of depression which led to eating disorders (a tendency “to eat emotions”, to overeat when food is available, a habit to eat without restrictions), sleep disorders (excessive day time sleepiness, low quality of sleep) and reduced quality of life. The results of correlation analysis indicate a strong or moderate positive correlation between obesity indices, glucose level, lipidogram, atherogenicity index, HOMA index, scores of depression and anxiety scales, as well as strong negative correlation with ABSI index, high density lipoproteins, serotonin. In addition, a positive correlation was found between leptin level and scores of depression and anxiety scales, scores of eating behavior, sleepiness, and a negative correlation was determined between these indices and serotonin level. Conclusions. The patients of the studied group (100.0 %) had abdominal obesity. Among the anthropometric indices ABSI and AVI ones were the most significant and informative for determination of abdominal obesity in gender aspect, this can be an alternative for MRI diagnosis of visceral obesity at the level of primary medical care. A close relationship between abdominal obesity with psycho-emotional disorders, disorders of sleep and eat behavior, metabolic disorders, leptin and serotonin levels was determined. Taking into account these interrelationships in a patient-centered management in persons with obesity will improve the quality of medical care.

A STUDY ON IMPACT OF SOCIAL MEDIA USAGE ON SLEEP DISTURBANCES AMONG MEDICAL COLLEGE STUDENTS

Background: Sleep and circadian functioning are vital to promoting good health. Sleep disturbance and insufficient sleep duration are associated with day time sleepiness and a range of poor health outcomes.The rapidly growing rate of SM use in recent years raises concern that SM use may adversely affect sleep quality.The objective of the study is to find the correlation between social media usage and sleep disturbance among medical college students. Methodology: The study was conducted among 350 medical college students using a questionnaire and Pittsburgh sleep quality index scale with the help of google forms. The data was downloaded as Excel and analysed using SPSS software. Results: About 56% were using social media for 3 to 5 years,followed by 6-10 years usage (22.3%) and less than 2 years (20.6%). About 81.4% were using social media for more than 60 minutes in a day and 18.6% were using social media for less than 60 minutes.About 71.1% had poor sleep quality index as per PSQI scale.It is found that those using social media longer duration in a day had poor sleep quality, which is statistically significant. Conclusion: This study indicated that the usage of social media at a greater extent will have an impact on one's sleep. One has to understand the impact of social media on young adult's life and the proper and needy usage of social media has to be made in practice.

Practical approach to sleep disordered breathing

It is not uncommon to have occasional difficulty in falling asleep or have fatigue and day time sleepiness. However, when sleep disturbances persist for over a month and are associated with significant daytime dysfunction for at least two weeks, it may be a warning of an underlying sleep disorder requiring further evaluation and treatment. The combination of snoring, nonrefreshing sleep and daytime sleepiness is usually a hallmark of Obstructive Sleep Apnea (OSA) which is the most common sleep related breathing disorder. This review article aims to provide a practical and comprehensive approach to the diagnosis and management of sleep related breathing disorders with a focus on OSA.

Nocturnal hypoventilation-a case report

Nocturnal hypoventilation is commonly seen in disorders affecting the function of the diaphragm or central respiratory drive mechanisms. The consequences of nocturnal hypoventilation such as sleep disturbances, poor gas exchange, day time sleepiness and effect on daily activities are similar irrespective of the precipitating underlying disorder. Here we report a rare case of nocturnal hypoventilation which posed a diagnostic and therapeutic challenge.

Effects of inspiratory muscle training in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis.

Obstructive sleep apnoea (OSA) is a common disorder marked by repetitive occurrence of breathing cessation during sleep due to partial or complete upper airway obstruction. An obstructive airway and the successive asphyxia chronically overload the inspiratory muscles resulting in an increased inspiratory effort. The present systematic review aimed to examine the effects of inspiratory muscle training (IMT) on inspiratory muscle strength [maximal inspiratory pressure (PImax)], severity of disease [apnea hypopnoea index (AHI)], sleep quality [Pittsburgh sleep quality index (PSQI)], day time sleepiness [Epworth sleepiness scale (ESS)], lung function [forced expiratory volume in 1 second (FEV1)] and exercise capacity [cardiopulmonary exercise testing, (CPET), 6 minute walk test, (6MWT)] in mild to severe OSA. Among 953 articles retrieved from various databases (PubMed, SCOPUS, Web of Science and Cochrane), 7 articles were found to be eligible for the present review. Randomized controlled trials reporting the effect of IMT in OSA were selected. The quality assessment was conducted using Cochrane risk-of-bias tool for randomized trials. All seven studies were meta-analyzed. The result depicted significant change in PImax, ES 1.73 (95%CI 0.54 to 2.92, p=0.004), PSQI -1.29 (95%CI -1.94 to -0.65, p<0.0001), ESS -1.08 (95% CI -1.79 to - 0.37, p=0.003) and FEV1 0.74 (95%CI 0.20 to 1.28, p=0.007). IMT may be considered as an effective treatment strategy in mild to severe OSA resulting in improved inspiratory muscle strength, sleep quality, daytime sleepiness, and lung function. However, there is still dearth evidence on repercussion of IMT on lung function and exercise capacity and warrants high quality evidence to reach definitive conclusions.