Ten years ago, sleep medicine was at its infancy in India. The first sleep disorders center was started by Dr J C Suri at Safdarjung hospital, and sleep medicine remained a pulmonologists domain as in the west. Over the years, the ISDA and the ISRS have held many national conferences and symposia as well as practical workshops fuelling the interest, knowledge, and practice of sleep medicine, particularly among neurologists and allied specialties such as psychiatry, ENT as well as physicians. As a result, there are many centers in India, which cater to diagnosis and treatment of sleep-related disorders at various levels of expertise.
The article published in this issue typically projects the changing scenario over 8 years, the use of proper questionnaire, better equipment as well as the increase in public awareness of sleep-related disorders, particularly obstructive sleep apnea (OSA), and specialized training in sleep medicine evaluation and its diagnostic accuracy. With the boom of increasing incidence of obesity, metabolic syndrome, there is rising public awareness of disorders such as snoring, UARS, and OSA. This increase in diagnostic accuracy by use of relevant questionnaire and better diagnostic tools and similar pattern of changing scenario are now seen in most of the advanced sleep centers in India but have not been reported. There are very few epidemiological studies to depict the exact prevalence and incidence of OSA, RLS in India.
The prevalence of OSA is about 9.3% to 13.7%.[1,2] This would- probably be much higher if data was pooled across India. The prevalence of RLS ranges from 2.1% to 8.2%.[3,4] Higher in specific population such as PD (14%), alcoholics (16.7%), anemic patients (34.75 %).[3,5,6] Narcolepsy has been underdiagnosed in the Indian population.
A pilot, hospital-based study has shown that the awareness of medical professional as well as the public attending the hospital for various reasons was poor with regard to the existence of sleep disorders, implications, and its treatment.[7] A recent questionnaire-based study involving the prevalence of sleep disorders and sleep wake pattern in an outpatient pediatric population showed RLS in 63/497 children (12.6%), OSA in 8%, 6-15% of children with sleep problems had nightmares, sleep talking, sleep walking. Nocturnal enuresis was found in 12% of children, bruxism noted in 8%.[8] It is essential to note that systematic approach, using proper questionnaire, having dedicated staff, and equipment, are key factors in developing a sleep disorders center.
Educational programs, standard equipment’s for PSG and sleep analysis software, as well as CPAP/BiPAP machines need to be produced in India in order to reduce the cost of both recording-analyzing and therapeutic equipment’s. This in addition to introduction of sleep medicine programs into the medical curriculum as well as national awareness programs would help to enrich awareness and propel forward the field of sleep medicine in India.
A collaboration with IIT-madras is underway with Chennai Sleep disorders Centre providing the professional know-how and IIT providing teaching support for research and development of the same. It is hoped that cheaper instruments for both analysis and treatment will be available in the near future and will pave way for general public to access and use the equipment’s at a relatively lower cost. ISDA needs to be congratulated for the pioneering effort to educate the medical professionals as well as in understanding sleep disorders and their impact on health.
The formation of sleep medicine subcommittee in the IAN is a welcome note and will help in spearheading this field among neurologists.
References
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