This article takes a theoretical look at the possible connections between the treatment for obsessive-compulsive disorder (OCD) and the treatment for another psychiatric disorder posttraumatic stress disorder (PTSD). It compares the dream patterns between OCD people and neurotypical people, explores how exposure and response prevention (ERP) impacts the dreams of OCD people, and hypothesizes a novel therapeutic approach involving imagery rehearsal therapy (IRT) that is approved to treat people with PTSD to treat people with OCD.
Objective: To evaluate the predictive ability of the Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaire (SBQ) in diagnosing obstructive sleep apnea (OSA) and compare their diagnostic performance against polysomnography (PSG). Materials and methods: This is a cross-sectional study conducted in the Department of Chest Medicine, Government Medical College, Baramulla, Jammu and Kashmir, India, among 83 patients with symptoms of snoring, choking during sleep, excessive daytime sleepiness, breathlessness, and witnessed apnea. The SBQ and ESS were used on the patients, and scoring was done, followed by an overnight attended PSG. Statistical analysis was done after obtaining all the values, and sensitivity and specificity were compared to PSG results. Results: Among the 83 patients (30 males, 53 females; mean age 49.9 years), 27.7% had a history of smoking, 20.5% were diabetic, and 14.5% were hypertensive. Snoring (50.6%) was the most common symptom, followed by excessive daytime sleepiness (38.5%) and cough (21.7%). Obstructive sleep apnea was diagnosed in 75 patients [apnea-hypopnea index (AHI) > 5], with 67 having severe OSA. Epworth Sleepiness Scale scores ≥11 were observed in 29 subjects, of whom 28 had OSA, yielding a sensitivity of 37.3% and specificity of 87.5%. The STOP-BANG scale identified OSA in 55 of 57 subjects with scores ≥3, achieving a sensitivity of 73.3% and specificity of 75%. The receiver operating characteristic (ROC) analysis showed moderate predictive value for STOP-BANG [area under the curve (AUC) = 0.703] and higher accuracy for ESS (AUC = 0.833). The majority of subjects maintained a mean SpO2 > 90%, with the lowest mean SpO2 recorded at 66%. Conclusion: In an outpatient setting, the ESS can serve as a useful screening tool for identifying individuals at risk of OSA, particularly in populations with similar characteristics to those in this study. However, its effectiveness may be influenced by age-related biases. Therefore, while ESS can aid in initial assessment, a definitive diagnosis of OSA should only be made following PSG.
Background: Obstructive sleep apnea (OSA) has emerged as a significant public health concern in South India, with mounting evidence linking it to cardiovascular complications, including elevated mean arterial pressure (MAP). The STOP-BANG questionnaire provides a validated, non-invasive screening approach for OSA risk assessment in resource-limited settings. However, the association between OSA risk and MAP in apparently healthy South Indian adults remains inadequately characterized. Materials and methods: We conducted a cross-sectional study among 144 apparently healthy adults (aged 18–65 years) accompanying patients to a tertiary care hospital in South India. Obstructive sleep apnea risk was assessed using the STOP-BANG questionnaire and categorized as low risk (score ≤ 2) or at risk (score > 2). Demographic and anthropometric data were collected, and MAP was calculated from standardized blood pressure (BP) measurements. Statistical analysis included independent t-tests and multiple linear regression to identify independent predictors of MAP, adjusting for alcohol use and smoking status. Results: The prevalence of OSA risk was 16.0% (n = 23). The MAP was significantly higher in the at-risk group than in the low-risk group (99.6 ± 10.2 vs 93.9 ± 10.8 mm Hg, p = 0.021, Cohen’s d = 0.531). After adjusting for alcohol use and smoking status, OSA risk remained independently associated with elevated MAP (β = 0.476, 95% CI: 0.551–9.830, p = 0.029). This association demonstrated a moderate effect size, suggesting clinical relevance. Conclusion: Obstructive sleep apnea risk is independently associated with elevated MAP in apparently healthy South Indian adults. These findings suggest that OSA risk screening may identify individuals with subclinical cardiovascular risk, providing opportunities for early intervention and prevention of hypertension.
Background: Obstructive sleep apnea (OSA) and diabetes mellitus (DM) are prevalent chronic conditions that often coexist. The bidirectional relationship between OSA and DM may influence glycemic control, particularly in obese individuals. Objective: To evaluate the correlation between the severity of OSA and glycemic control in diabetic patients and to assess the influence of body mass index (BMI) on HbA1c levels. Methodology: This cross-sectional observational study included 120 patients diagnosed with both OSA and DM. Data on age, gender, apnea–hypopnea index (AHI), BMI, and HbA1c levels were collected. Obstructive sleep apnea severity was classified based on AHI, and glycemic control based on the HbA1c levels (glycosylated hemoglobin). Statistical analysis included Chi-square tests to assess associations. Results: Among the 120 patients (65 males and 55 females), the majority were between 50 and 70 years. Severe OSA was present in 55 patients, moderate in 40, and mild in 25. Only three patients had normal HbA1c. A significant association was found between OSA severity and HbA1c (χ2 = 27.18, p = 0.0012). The Pearson correlation between AHI and HbA1c was r = 0.79 (p < 0.001), indicating a strong positive linear relationship. Similarly, BMI correlated significantly with HbA1c (χ2 = 45.26, p < 0.001, r = 0.88, p < 0.001) Conclusion: The study indicates a strong association between OSA severity and poor glycemic control in diabetic patients. Early screening for OSA in poorly controlled diabetics could help identify both metabolic and sleep-related outcomes.
Background: Sleep disorders are a growing public health concern that is linked to metabolic dysregulation. However, evidence of these effects in nondiabetic populations remains limited. This study aimed to assess the prevalence of poor sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and its association with random blood sugar (RBS) levels in healthy South Indian adults. Materials and methods: In this cross-sectional study, 130 apparently healthy individuals (aged 18–65 years) from a tertiary healthcare facility in South India were recruited. The quality of sleep was assessed using the PSQI, where poor sleep is indicated with a score of >5. Anthropometric measurements along with RBS were recorded. A two-stage sampling technique, stratified random sampling with proportional allocation, and simple random sampling were used. Multiple linear regression models explored the relationships, with adjustment for age, body mass index (BMI), gender, and lifestyle factors. Results: The present study had a 36.9% prevalence of poor sleep (PSQI >5). Median sleep duration was 7 hours [interquartile range (IQR) = 2.0], with poor sleepers reporting significantly shorter sleep durations (6 vs 8 hours, p < 0.001). Random blood sugar between poor and good sleepers showed no significant difference (median = 103.5 vs 108.5 mg/dL, p = 0.412). Regression analysis revealed no association between PSQI scores and RBS (p = 0.612), although the use of sleep medications was associated with elevated glucose levels (p < 0.001). Age also independently predicted higher RBS (p < 0.001). Conclusion: Over one-third of healthy adults experienced poor sleep quality, emphasizing the need for routine sleep screening. Despite no observed association between overall sleep quality and blood glucose levels, medication use emerged as a potential risk factor for glycemic control in nondiabetic adults. Clinical significance: Reduced sleep duration among poor sleepers may signal early health disturbances in otherwise healthy adult populations. Integrating sleep evaluation into routine care could support the early detection and prevention of metabolic issues.
Aims and background: The COVID-19 pandemic has introduced widespread disruptions, including significant psychological impacts such as insomnia in acute and chronic phases, particularly among undergraduate (UG) medical students. These students, already under considerable academic stress, faced unprecedented challenges during the pandemic. Materials and methods: A cross-sectional, descriptive study was conducted at a medical college in Gujarat, over 18 months. A total of 72 UG medical students out of a total 750 students were found to be eligible to participate, out of those who gave informed consent, completing semi-structured questionnaire, the Insomnia Severity Index (ISI), and the SF-36 Health Survey, and as per exclusion criteria. Results: A total of 72 students reported post-COVID-19 infection new onset of insomnia. Insomnia severity was categorized as follows in participants: subthreshold insomnia (73.6%), moderate insomnia (25%), and severe insomnia (1.4%). Severe insomnia was significantly linked to poorer outcomes in physical role functioning, energy/fatigue, social functioning, pain, and general health (p < 0.05). Specifically, participants with severe insomnia reported the lowest scores in these domains compared to those with subthreshold and moderate insomnia. Conclusion: Post-COVID-19 new onset insomnia significantly impacts quality of life among UG medical students, particularly affecting role functioning (physical), energy levels, social interactions, pain perception, and general health. Clinical significance: These findings underscore the need for targeted interventions to mitigate insomnia’s effects on students’ well-being and academic performance in the post-pandemic era.
Background: Cerebral palsy (CP) is a common neuromuscular condition that affects posture and muscle coordination, often leading to compromised airway stability during sleep. Children with CP are at a higher risk of developing obstructive sleep apnea (OSA), especially when accompanied by comorbid conditions like epilepsy. However, determining the exact prevalence of OSA in this group is challenging because of the inconsistencies in study designs and differences in the diagnostic criteria. Aims and objectives: To estimate the pooled prevalence of OSA in children with CP, with and without epilepsy, and assess the diagnostic approaches used across studies. Methods: A systematic search was conducted across PubMed, Web of Science, Cochrane Library, and Google Scholar. Observational studies involving children under 18 years with CP, with or without epilepsy, and reporting OSA prevalence were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist. Meta-analysis was performed using a random-effects model. Results: Twelve studies were included, having a total of 1,417 children with CP. A high variability in OSA prevalence was observed, which was influenced by CP subtype, presence of epilepsy, and the diagnostic tools. Questionnaire-based evaluations were more common than objective measures like polysomnography (PSG). The spastic subtype was consistently associated with higher OSA prevalence. Conclusion: Children with CP, especially those with the spastic subtype, are at a high risk for developing OSA. This risk may be further impacted by the presence of epilepsy. Standardized diagnostic protocols and further research are needed to improve early identification and management in this vulnerable population.
Restless legs syndrome (RLS) is a common neurological sleep disorder with a high global prevalence, yet it remains frequently underdiagnosed. As a result, a considerable proportion of patients fail to receive timely and adequate treatment. While pharmacological therapy represents a cornerstone of management, nonpharmacological interventions constitute an essential component for optimizing clinical outcomes. Behavioral approaches and other strategies beyond dopaminergic agonists or alpha-2-delta ligands have shown significant potential in improving sleep quality and, consequently, overall quality of life in affected individuals. This article provides a comprehensive review of these alternative approaches, focusing on their proposed mechanisms of action and outlining potential pathways for their clinical application.
Secondary polycythemia is a well-recognized consequence of chronic hypoxemia, commonly attributed to conditions such as chronic obstructive pulmonary disease, high-altitude exposure, and congenital heart disease. Sleep-disordered breathing associated with chronic respiratory failure, such as obesity hypoventilation syndrome, can also contribute to secondary polycythemia. However, obstructive sleep apnea (OSA) in the absence of daytime hypoxemia, presenting with secondary polycythemia and normal erythropoietin levels, is less frequently reported. We present a case of a 45-year-old male with severe OSA who developed secondary polycythemia, ultimately responding well to continuous positive airway pressure therapy. This case emphasizes the need for sleep disorder evaluation in unexplained polycythemia.
Introduction: Upper airway resistance syndrome (UARS) is an underrecognized form of sleep-disordered breathing that predominantly affects young, non-obese individuals, particularly women. Unlike obstructive sleep apnea (OSA), UARS occurs in the absence of significant hypoxemia, yet it produces substantial impairment in quality of life and is frequently misdiagnosed as a psychiatric or functional disorder. Pathophysiology: Upper airway resistance syndrome is characterized by increased upper airway resistance leading to progressive respiratory effort and repetitive microarousals (RERAs). A hallmark feature is a low arousal threshold, whereby patients awaken in response to minimal increases in intrathoracic pressure before oxygen desaturation occurs. This sensory-motor dysfunction results in severe sleep fragmentation, neuroendocrine dysregulation, and autonomic imbalance, despite preserved oxygenation. Diagnosis: Clinical suspicion is essential, as conventional apnea–hypopnea indices are typically normal. Definitive diagnosis requires polysomnography (PSG) with detection of airflow limitation and RERAs. Esophageal manometry remains the gold standard for quantifying respiratory effort, although nasal pressure transducers provide a reliable, non-invasive alternative in routine practice. Treatment: Continuous positive airway pressure (CPAP) is the most effective therapy, significantly reducing microarousals and improving daytime symptoms, though adherence may be challenging. Mandibular advancement devices (MADs) and targeted upper airway surgery represent effective alternatives in selected patients. Management of comorbid insomnia and allergic airway disease is crucial. Discussion: Upper airway resistance syndrome is a distinct clinical entity rather than a mild variant of OSA. Early recognition and personalized, multidisciplinary treatment are essential to prevent progression to OSA and to reduce cardiometabolic risk, particularly resistant hypertension. Greater awareness of UARS may profoundly improve patient outcomes and redefine current paradigms in sleep medicine.
Methylphenidate is a dopamine–norepinephrine reuptake inhibitor used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. We report the case of a child with Wolfram syndrome who had narcolepsy and obstructive sleep apnea. We used methylphenidate, which improved her narcolepsy as well as her obstructive sleep apnea.
Mandibular advancement devices are known to be effective in treating mild to moderate obstructive sleep apnea (OSA) and provide a viable treatment alternative for patients intolerant to continuous positive airway pressure therapy. This case report describes the treatment of severe OSA in a 42-year-old patient using a customized mandibular repositioning appliance. The patient underwent specific investigations for a sleep study, including subjective sleep study questionnaire evaluation, radiographic assessment, and polysomnography, following which a titrable precision fit mandibular repositioning appliance was fabricated with an advancement of 60% of maximum mandibular protrusion. The 2-year follow-up results confirmed significant improvement in pharyngeal airway width, substantiated through a marked decline in apnea/hypopnea index values, providing relief from daytime discomforts associated with sleep apnea and improving quality of sleep. The case report concluded that customized mandibular repositioning appliances can be used as an effective and efficient alternative therapeutic option for patients with severe obstructive sleep apnea.
Background: Sleep-related problems are increasingly recognized as a significant public-health issue in India, yet long-term population-level data remain limited. Online search behavior offers a useful proxy to understand emerging health information needs. This study assessed 15-year temporal patterns in public interest related to sleep deprivation (SD) and sleep hygiene (SH) using Google Trends (GT). Materials and methods: A retrospective infodemiology study was conducted using monthly GT data from January 2011 to October 2025. Composite indices for SD and SH were created using standardized and rescaled relative search volumes (RSVs) from selected terms/topics. Trends were analyzed using Kruskal–Wallis tests. Interrupted time-series (ITS) analysis assessed immediate and slope changes at the onset of COVID-19. Seasonal variation was examined using Seasonal Trend decomposition using LOESS (STL), and the cross-correlation function (CCF) assessed lead-lag relationships between SD and SH. Analyses were performed using R version 4.4.1. Results: Both SD and SH showed rising interest over 15 years, with a sharp increase during the COVID-19 period. Median SD RSV increased from 16.9 [interquartile range (IQR): 11.0–20.2] to 38.4 (IQR: 33.6–54.3), whereas SH rose from 29.7 (IQR): 21.9–34.0) to 68.0 (59.4–75.7). Interrupted time-series analysis showed significant immediate level increases at COVID onset for SD (β = 33.56; 95% CI: 28.07–40.07; p < 0.01) and SH (β = 22.43; 95% CI: 14.43–27.06; p < 0.01). Seasonal peaks were noted for SD in May and for SH in March. The CCF showed a strong simultaneous correlation (r = 0.774 at lag 0), with no lead-lag relationship. Conclusion: Public interest in sleep loss and sleep-health practices has increased substantially in India, with COVID-19 marking a major surge point. Persistent growth in SH-related searches suggests rising public interest in and awareness of preventive sleep-health practices, without implying behavioral adoption. The public-health impact of such interest depends on access to trustworthy, evidence-based digital information.
Aim: To evaluate the improvement in sleep-related quality of life among children with adenotonsillar hypertrophy following adenoidectomy or adenotonsillectomy using the OSA-18 questionnaire. Materials and methods: This prospective observational study was conducted in a tertiary care hospital and included 92 children aged 3–14 years with symptoms of sleep-disordered breathing (SDB) and an OSA-18 score >60. Caregivers completed the OSA-18 questionnaire pre-operatively and at 4 weeks post-operatively. Pre- and post- treatment scores, including individual domain scores, were compared using a paired t-test. Results: The mean pre-operative OSA-18 score for the study population was 78.30, which significantly decreased to 33.52 post-operatively (p < 0.001). The most frequent symptoms were loud snoring, mouth breathing because of nasal obstruction, and nasal discharge or a runny nose. Significant improvement was observed across all domains, with significant gains observed in the sleep disturbance and physical suffering domains. The overall mean OSA-18 scores indicate improved QOL, validating the efficacy of adenotonsillectomy for SDB. Conclusion: Sleep-disordered breathing significantly impairs quality of life. The findings of our study underscore the pivotal significance of adenotonsillectomy as a therapeutic intervention for pediatric SDB, yielding profound and far-reaching enhancements in quality of life, thereby reaffirming its crucial role in the management of this prevalent condition. Additionally, the OSA-18 questionnaire proves instrumental in guiding treatment decisions and counseling parents on the necessity of surgery. The concise design of the questionnaire enables rapid administration in an outpatient setting, ensuring efficient use of time while fostering active parental involvement.
Background: Sleep study services are experiencing exponential demand growth due to rising awareness of sleep-disordered breathing. Limited polysomnography (PSG) capacity in Indian hospitals results in prolonged waiting times, delaying diagnosis and treatment for obstructive sleep apnea (OSA) and related disorders. Objective: To apply predictive queueing-modeling techniques to determine the optimal bed capacity for a hospital-based sleep study center, minimizing patient waiting times while maximizing resource utilization efficiency. Methods: An M/M/c queueing model (Erlang C) was applied to 12-month operational data from a tertiary care teaching hospital sleep center in Pune, India. The facility operated 305 nights annually with one bed. Key parameters included an arrival rate of λ = 1.1475 patients/night (annual demand of 350 studies/year, including a 45-patient backlog) and a service rate of μ = 1 study/bed/night. System utilization (ρ), average waiting time (W q), queue length (L q), and backlog clearance time were calculated for configurations ranging from 1 to 4 beds using standard queueing formulas and validated through discrete-event simulation. Results: A single-bed configuration demonstrated critical instability (ρ = 114.7%), explaining the persistent 45-day wait and growing backlog. The two-bed system achieved stability (ρ = 57.4%) with a 12-hour average wait and a 2.1-month backlog clearance. The three-bed configuration provided optimal performance: 38.2% utilization, a 2-hour average wait, 1-month backlog clearance, and 62% reserve capacity. The four-bed system showed diminishing returns (28.7% utilization). Sensitivity analysis confirmed robustness across ±20% demand variations. Conclusions: Queueing theory provides a rigorous, evidence-based framework for sleep laboratory capacity planning. For an annual demand of 350 studies with 305 operational nights, three beds represent the optimal configuration, balancing minimal patient wait times, rapid backlog clearance, operational resilience, and efficiency. This reproducible methodology applies broadly to diagnostic services facing capacity constraints.
Aims and objectives: Since the medical curriculum is very wide and difficult, sleep duration in medical students is reduced significantly as they are under vast academic pressure. As a result, sleeping habits get disturbed. These reduced hours of sleep and nighttime awakening influence their stress adaptation capacity, i.e., the ability of the young individuals to adapt to changing stress in the environment. So, because of this disturbed sleep-wake cycle and a lot of stressors around, it is found that the medical students have an increased level of stress. With this background, this scoping review aims to collect the relevant literature on disturbed sleep patterns causing a high level of stress in students pursuing medicine. The hypothesis of this review is that disturbed sleep circadian timing may lead to increased stress levels because both the stress and sleep are closely related to the hypothalamic – pituitary – adrenal axis. Methods: Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines are used to perform this scoping review. We have selected the articles published until February 2025. First, we selected the articles, then added the authors’ names, populations studied, years of publication, methods applied and lastly the results. The analysis comprised 10 studies from different countries. All studies were conducted at a medical college, and the participants were medical students. Results: In all ten studies, significantly high stress levels were found, and they were strongly associated with disturbed sleep patterns. Also, no significant association between stress levels and gender was found. This review shows a significant association between poor sleep quality and stress in medical students. In almost all studies, the level of stress was more than 50%, and the sleep quality is also found to be very poor. The average sleep hours, which should be at least more than 6 hours, were found to be less than 5 hours in most of the studies. Conclusion: This review clearly indicates the need to relieve stress in medical students, and to explain the importance of good sleep. The majority of students pursuing medicine are under high academic pressure. They are mentally stressed, and that deteriorates their sleeping patterns. Clinical significance: This review shows a strong association between high levels of psychological stress and a dangerous level of poor sleep quality among students who are pursuing medicine as a future. In order to reduce stress and create a healthy environment, steps should be taken to ensure that clinical care and learning become enthralling for them.
