श्री चित्रा तिरुनाल आयुर्विज्ञान और प्रौद्योगिकी संस्थान, त्रिवेंद्रम
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
Sleep is a natural periodic state of rest for the mind and body, in which the eyes usually close and consciousness is completely or partially lost from which a person can be aroused. Historically, sleep was thought to be a passive state. However, sleep is now known to be a dynamic process, and our brains are active during sleep. Sleep affects our physical and mental health, and is essential for the normal functioning of all the systems of our body.
The International Classification of Sleep Disorders lists more than 80 different sleep disorders. Prevalence of insomnia is around 6% to 15% in the population. Sleep apnea syndrome, often associated with insomnia or daytime sleepiness, is found in approximately 2% to 4% of the general population. Restless legs syndrome is present for approximately 6% of the general population with a higher prevalence in the elderly subject. Narcolepsy is rare with a prevalence of 0.04%. Parasomnias are less studied in the general population; prevalence of several parasomnias remains unknown. Among those more extensively studied, sleep paralysis is found in approximately 6% of the general population. Nocturnal terrors, confusional arousals and nightmares have been observed with prevalence ranging from 2.2% to 5%. Despite their high frequency, sleep disorders remain poorly identified; less than 20% of individuals with sleep disorders are correctly diagnosed and treated.
Ever since its inception in May 2009,CCSD through its multidisciplinary treatment approach to every patient with sleep disorder from diagnosis to the evaluation with polysomnography(PSG), CPAP titration, multiple sleep latency test(MSLT) psychiatric and psychological evaluation and dental assessment has proved to be the only comprehensive sleep disorder care program of its kind in the country.
Facilities for PSG, CPAP titration, MSLT, MWT and SIT
Also known as a sleep study, is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. Polysomnography is a comprehensive recording of the biophysiological changes that occur during sleep. It is usually performed at night. The PSG monitors many body functions including brain (EEG), eye movements (EOG), muscle activity or skeletal muscle activation (EMG) ,heart rhythm (ECG), respiratory airflow and respiratory effort indicators and peripheral pulse oximetry during sleep.
CPAP stands for continuous positive airway pressure, and a CPAP titration study is the process that a health facility goes through to fit someone with sleep apnea with a CPAP machine. The CPAP machine is a small pump that pumps room air through a mask and into the nasal passages of a person with sleep apnea, and this opens up the breathing pathways to allow for a deeper sleep.
The Multiple Sleep Latency Test (MSLT) is a sleep disorder diagnostic tool. It is used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep, called sleep latency. The test is based on the idea that the sleepier people are, the faster they will fall asleep.
The MSLT can be used to test for narcolepsy, to distinguish between physical tiredness and true excessive daytime sleepiness
In contrast to the MSLT, which measures a subject's ability to fall asleep, the maintenance of wakefulness test (MWT) measures a subject's ability to stay awake in a quiet, non-stimulating situation for a given period of time
Suggested Immobilization Test (SIT) is conducted in the evening prior to diagnostic polysomnography (sleep study). The SIT uses rest duration to provoke symptoms of restless legs.
Patients are seen in sleep clinic every Thursday between 2-5 pm. These patients in addition to medical consultation undergo neuropsychological evaluation, psychiatric counseling and dental sleep evaluation.
All patients on CPAP are re-evaluated on Thursdays once every three months.
Group sessions moderated by social worker are conducted for patients for over thirty minutes prior to sleep clinic. Patients discuss their problems, experiences and get to know each other.
1) Prevalence of sleep disorders in the general population.
2) Epworth sleepiness score standardization in Indian population
3) Formulation of new sleep apnea clinical score and its correlation with OSA severity
4) Contribution of SDB in the manifestations of ADHD in children
5) Neuropsychiatric manifestations of patients with OSA and its improvement after CPAP treatment
6) Contribution of sleep apnea in the progression of CHF, systemic hypertension, isolated pulmonary hypertension, COPD and Type 2 DM
7) Prevalence of SDB in patients with drug resistant epilepsy and seizure control after CPAP treatment- a double blind, placebo controlled prospective trial.
Journal club/Seminars/Patient management conference is conducted every Thursday from 4-5 pm