Indians among the most sleep-deprived.

Payal Gwalani | Mar 2, 2015, 03.40 AM IST

Nagpur: Several studies put India high up in the list of the world’s most sleep deprived countries. Until recently, there was no government study of policy on the issue. The first step towards framing regulations about treatment of sleep disorders was taken in the last quarter of 2014 by the ministry of health and family welfare.

The guidelines of Indian initiative on Obstructive Sleep Apnoea (INOSA) were laid down under the aegis of department of health research, ministry of health and family welfare of Government of India. A series of meetings and discussions were held before laying down these regulations with participation of department of medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, and Indian Council of Medical Research (ICMR). Based on the available evidence, consensus statements were developed and finalized by the experts in the field of sleep medicine including internists, pulmonologists, neurologists, otorhinolaryngologists, endocrinologists, bariatric surgeons and dental surgeons.

Saying there was little awareness among common man as well as doctors about sleep disorders, president of Indian Association of Surgeons for Sleep Apnoea (IASSA) and life member of Indian Sleep Disorder Association (ISDA) Dr Seemab Shaikh welcomed this initiative. “The pathology of the disease remains the same globally. However, the genetic and structural differences between different ethnic groups necessitate indigenous guidelines. Making the government acknowledge that sleep deprivation and disorders are not just lifestyle issues but diseases that need to be treated is a big step for sleep medicine specialists in the country,” he said.

Explaining more about these differences, city-based sleep physician Dr Sushant Meshram said that while in the West, sleep disorders were largely caused by obesity, it was not so in India. “Indians are genetically predisposed to several structural deformities in the craniofacial cavity. Some of these abnormalities include a retracted lower jaw, deviated septum, smaller jaw, big teeth and enlarged tongue. These often obstruct breathing, especially when a person goes into deep sleep,” he said.

Other problems among Indians that could lead to sleep disorders include diseases like tonsillitis or allergic rhinitis at an early age. “Children with these problems have several episodes of apnoea during the night. Such repeated episodes when the child’s bones are still soft, result in maldevelopment or craniofacial deformities that cause OSA in them as adults,” said Dr Meshram.

One of the reasons for increasing sleep deprivation in India could be the ever-increasing cases of diabetes. “As diabetes is a metabolic disorder, it is both a cause and result of obesity that increases the chance of a person getting sleep disorders. It also makes a person more vulnerable to problems like hypertension and heart diseases. It’s a vicious cycle as each of these conditions is tied to the others,” said endocrinologist Dr Sunil Gupta.

ABOUT SLEEP DISORDERS

* Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. OSA is the occurrence of five or more episodes of breathing obstructions per hour of sleep. OSAS is defined as OSA associated with symptoms like excessive sleepiness during the day

* It is common among obese individuals, children and post-menopausal women

* It is usually associated with several co-morbidities such as insulin resistance, metabolic syndrome, diabetes mellitus, hypertension, stroke, coronary artery disease, increased risk of vehicular accidents and various psychiatric disorders.

SLEEP DISORDERS AMONG INDIANS

* In urban India, 8% males between 35 and 65 years of age are reported to have OSA

* Community-based epidemiological studies from several parts of India have estimated that the prevalence of OSAS is 2.4 to 4.96% in men and 1 to 2% in women

* Studies on children and adolescents have shown that the occurrence of sleep-disordered breathing is about 2%

* A recent study by Deloitte states that 115 million Indians have OSA and OSAS, which constitutes 9% of the total population

* Prevalence in diabetics is estimated at almost 50%, 77% for obese individuals and 87% among obese individuals with type 2 diabetes

SUGGESTIONS UNDER INOSA

* Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation

* Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for it

* Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study

* Supervised overnight polysomnography (PSG) is the gold standard for evaluation of OSA. In specific situations, portable monitoring of sleep can be done as an alternative to lab-based PSG. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA* Oral appliances are indicated for use in patients with mild to moderate OSA. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy