A study on accidental ammonia inhalation: Effects and after effects presenting at a tertiary care center in eastern India
Rupam Kumar Ta, Pronoy Sen, Preetam Goswami
E-mail: rupamkumarta@yahoo.com
Background: Acute exposure to ammonia is concerning as there is no antidote available for its toxicity, but ammonia’s effects can be treated. Inhalational ammonia exposure is rare. Hence, we performed this study.
Objectives: To estimate distribution pattern with respect to demographic variables, clinical presentations and treatment outcome
Methods: This was a prospective observational study where 9 workers who were exposed to ammonia gas leak from a cold storage facility for 6 hours were included. Detailed history, clinical examination, investigations were noted. Management, course of hospital stay and outcome were studied. The patients who survived following treatment 2 months post discharge were followed up. Data was analysed by descriptive statistical methods.
Results: All of the patients mostly belonging to age group 31-40 years experienced chest tightness, cough, hoarseness of voice and burning of eyes. All patients were treated with steroids and oxygen therapy, few had laryngeal oedema and facial burns while one patient suffered from ARDS and expired. Most of the patients had duration of stay between 13-33 days. On follow up most patients had hoarseness of voice and few had ‘tree-in-bud’ pattern on HRCT of thorax. Three patients showed obstructive pattern on spirometry with most having PEFR in yellow zone. Patients are on follow up to detect residual effects.
Conclusion: Early evacuation with immediate starting of oxygen therapy and steroids is essential for proper management of toxic ammonia inhalation.
STOP-BANG questionnaire as a screening tool for obstructive sleep apnea
Love Gupta, Indranil Halder
E-mail: lovegupta992@gmail.com
Introduction: The existing diagnostic tests for obstructive sleep apnea is both expensive and time consuming. A rapid, simple and effective screening test using questions is desirable to identify individuals with suspected (OSA) at early stage.
Aims and Objectives: The aim of the study was to see the sensitivity and specificity of the STOP-BANG Questionnaire compared to the current gold standard for diagnosing a case of obstructive sleep apnea. The research question was how sensitive and specific the STOP-BANG Questionnaire is in diagnosing a case of obstructive sleep apnea.
Methods: Study was conducted amongst the patients having clinical diagnosis of OSA visiting the Department of Pulmonary Medicine of a teaching hospital in the state of West Bengal of India. STOP-BANG Questionnaire was filled for 68 participants. Each patient then underwent Polygraphy test (ResMed’s Apnea LinkAir™ device).
Results: 63.3% of the participants had STOP-BANG risk of 5 or more. Around 59% had severe apnea on Apnea Hypopnea Index (AHI) based on polygraphy data. AHI and STOP-BANG scores were significantly correlated (Pearson Correlation coefficient of .366). STOP-BANG questionnaire had high sensitivity (78%) and high positive predictive value (72%) in predicting OSA when compared with the gold standard test polygraphy. The specificity was 57% and negative predictive value was 64%.
Conclusion: In resource limited countries where there is shortage of specialist and equipment, STOP-BANG Questionnaire is a good screening tool to diagnose obstructive sleep apnea.
Prevalence of obstructive sleep apnea in obese patients with endocrine comorbidities: A correlation study of clinical characteristics and screening questionnaire with Polysomnography
Katam Reddy Kowshik Reddy1, R. Pajanivel1, M. M. MuhamedKamaludeen1, Siva Ranganathan Green2
1Department of Respiratory Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India, 2Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India. E-mail: drkowshikreddy94@gmail.com
Background and Aim: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is associated with significant morbidity where the prevalence continues to rise in recent era. Polysomnography(PSG) is the gold standard investigation for the diagnosis of OSA, but it is expensive, time consuming and requires trained personnel. Screening questionnaires are simple and can be easily administer, which can be used to prioritize patients eligible for PSG. Hence, the present study aims to assess the correlation of clinical characteristics and screening questionnaire (STOP-BANG and Epworth Sleepiness Scale (ESS)) with Polysomnography in obese patients with Type II DiabetesMellitus and/or Hypothyroidism patients.
Methodology: Physical symptoms were assessed and data was collected from 80 patients (biodata, medical history, and social history). Sleep questionnaires (STOP-BANG, ESS) were given to eligible patients, who then underwent Polysomnography to determine their apnea/hypopnea index (AHI).
Results: Physical symptoms such as Snoring, excessive day time sleep, fatigue and early morning headache showed significantly positive relationship with AHI as well as ESS and STOP-BANG score which are positively correlated with AHI and found be significant.
Conclusion: Clinical Characteristics, Physical symptoms and Screening questionnaire were positively correlating with AHI in this study. As a result, in the future these can be used as, appropriate screening tools or as a surrogate test to determine OSA in patients with diabetes and/or hypothyroidism who cannot afford for PSG.
Elementary, my dear Watson! polysomnographic clues to systemic diseases. a tale of two cases and a discussion on the effect of drugs on sleep architecture
M. R. Gangakhedkar1, L. K. Saini1, R. Gupta2
1Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, 2Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. E-mail: mihirgangakhedkar@gmail.com
Background: Polysomnographic assessment of a patient complaining of a sleep disorder is generally with the pre-test probability of particular disorder. We present two not-so-straight-forward cases. Cases: 1. A middle-aged female under evaluation for a psychiatric disease complains of insomnia. With appropriate reported sleep schedules, the patient underwent a polysomnography and was found to have significant eye movements even during NREM sleep: “Prozac eyes”. She was then identified to be using SSRIs on detailed questioning. 2. A middle-aged male with complaints of nocturnal obstructive symptoms with a history of a permanent pacemaker implantation a year back underwent a sleep study. His last cardiology visit reported a normal echocardiogram. His sleep study revealed Cheyne-Stokes respiration and on further evaluation the patient had a pacemaker malfunction and non-compliance with a diuretic. Discussion: Both the cases highlight the importance of a detailed drug history in patients with sleep disorders. Even if they do not obviate a polysomnography, the results can be interpreted appropriately. Additionally sleep studies may allow a retrospective systemic diagnosis in patients when records suggest otherwise. Conclusion: One must be aware of uncommon polysomnographic findings which may provide unexpected insight into systemic illnesses.
Study of sleep architecture in patients with obstructive sleep apnea in a tertiary care hospital
Samarjit Das, Susmita Kundu
Department of Respiratory Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India. E-mail: drsamarjitdb@gmail.com
Background: Enhanced characterization of sleep architecture using routine polysomnography (PSG) is required to understand the wide spectrum of symptoms in patients of Obstructive Sleep Apnea Syndrome. But there is severe scarcity of data.
Objective: Finding key abnormalities in sleep architecture and its correlation with the severity of the disease, is the principal objective of this study.
Methods: Patients attending chest outdoor of R.G.K.M.C.H with symptoms suggestive of having Obstructive Sleep Apneas Syndrome (OSA) were taken consecutively using sleep questionnaire and thorough history and physical examination. After screening from 91 patients,46 patients attended PSG in designated sleep lab with consent and maintaining proper protocol. 36 patients having AHI>5 were diagnosed with OSA and detailed analysis of sleep architecture was done.
Results: 78.3% (36) patients met the criteria of OSA diagnosis with majority were male (69.4%). Mean age was 52.09(SD=7.23) and majority were of 41 to 50 (43.5%) years. Mean AHI in mild, moderate and severe OSA were 11.08(SD=2.39), 21.86(SD=4.31) and 35.56(SD=5.05) respectively (p<0.005). Sleep Architecture analysis showed significant correlation of maximum desaturation during sleep (r=-0.830;p<0.001), Sleep Efficiency(r= -0.286), increased N2(r=0.661;),decreased N3(r=0.744) and REM(r=0.585),increased Arousal Index(r=0.751)and Wake After Sleep Onset (r=0.694) as OSA severity increased but correlated poorly with ESS, REM latency(r=-0.28;p=0.38).
Conclusion: OSA is associated with significantly deranged sleep architecture. Severe OSA is associated with increased sleep fragmentation and both suppression of REM and NREM stages of sleep, later being more. So addressing correction of decreased N3 stage may be considered as an adjunct to conventional PAP treatment for OSA.
“ERASMUS SYNDROME”-deadly combination of systemic sclerosis and silicosis
Srishankar Bairy, Neeraj Gupta, Ramakant Dixit
JLN Medical College, Ajmer, Rajasthan, India. E-mail: srishankarabairy2012@gmail.com
Erasmus syndrome is association of systemic sclerosis following the exposure to the silica with or without silicosis. We report a case of Erasmus Syndrome in a 28 year old male who is a stone worker by occupation since 8 years who came with shortness of breath,cough, Raynaud’s phenomenon, skin tightening, microstomia. Further investigation showed Pulmonary hypertension, High resolution computed tomography showed multiple randomly distributed nodules in bilateral lung fields and bilateral progressive massive fibrosis with Multiple mediastinal and hilar calcified lymph nodes all suggested silicosis and serology showed raised Scl 70.Correlating occupational history, serology results, clinic radiological findings, a diagnosis of Erasmus syndrome was made.
Study of obstructive sleep apnea in patients with ischaemic heart disease using polysomnography
Prateek Bagarhatta
Department of Pulmonary Medicine, D. Y. Patil University School of Medicine, Nerul, Navi Mumbai, Maharashtra, India. E-mail: pbagarhatta1@gmail.com
Background: Obstructive sleep apnea (OSA) is a risk factor for IHD due to chronic nocturnal hypoxemia, so we aim to diagnose OSA in patient having IHD.
Methods: The present prospective study was of 2 years carried out at department of Pulmonary Medicine, DY Patil Medical College, Nerul Navi Mumbai. Total 50 cases of diagnosed Ischaemic heart disease on ECG/ Coronary Angiography were included. Detailed clinical history including the symptoms, occupation, associated risk factors history and co morbidities was taken. BMI and ESS score was calculated.
Results: Out of 50 patients with diagnosed IHD, 44 (88%) had OSA. 18 patients (36%) had severe OSA, 13 patients (26%) each had mild and moderate disease. 39 patients were obese as per BMI findings, of which 38 had OSA and 18 patients (46%) out of these had severe OSA (p<0.05). 28 patients (56%) had ESS score of 0 to 8 (p<0.05), of which 22 patients had OSA (79%) [p<0.05]. All the patients with COPD, 88% of diabetics and 93% of hypertensive had OSA.
Conclusion: High incidence of OSA (88%) in IHD, 46% of obese IHD patients had severe OSA and low ESS, so even asymtomatic IHD patients could be having OSA.
Knowledge and attitude regarding obstructive sleep apnea among doctors in mangalore city
Mohammed Naseeha, D. S. Harsha, Sharma Vishnu, N. Adrash
Department of Respiratory Medicine, A J Institute of Medical Sciences, Mangalore, Karnataka, India. E-mail: naseeha.nm@gmail.com
Background: Patients with Obstructive Sleep Apnea can present primarily to any specialities owing to the spectrum of symptoms at presentation.Lack of knowledge among the doctors may lead to patients with moderate or severe OSA remaining undiagnosed and untreated.
Aim: To assess the knowledge and attitude regarding Obstructive Sleep Apnea among doctors of the following specialities namely General Practitioners, Physicians, Cardiologists,Pulmonologists, Anaesthesiologists in Mangalore city.
Methods: This descriptive cross sectional study was conducted using a standard validated Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire consisting of 18 knowledge assessment and 5 attitude assessment questions.
Results: A total of 193 doctors participated in the survey.The mean score for knowledge assessment was 13.20 ± 2.66 while the mean score for attitude assessment was 19.11± 3.192.The mean OSA knowledge (15.91 ±1.63 ) and attitude (23.14±2.01 ) scores were highest among Pulmonologists when compared to other specialities.There was significant positive linear correlation between knowledge and attitude scores(p < 0.01).Cardiologists obtained a mean OSA knowledge (14.00±1.18) and attitude (18.55±2.54) score whereas physicians obtained a score of(13.87±1.82)& (18.99±2.83) respectively.The mean OSA knowledge score among anaesthesiologists were (12.58±2.77) and attitude score of (20.09±2.19) where as general practitioners obtained a score of (10.8±2.66)& (16.23±2.59) respectively.
Conclusion: The level of knowledge among Physicians,General practitioners, Anaesthesiologists was not optimal compared to Pulmonologists where as the level of knowledge among Cardiologists was adequate.The attitude regarding OSA was not optimal among all other specialities compared to Pulmonologists.Targeted educational interventions and CME programs are needed to provide an opportunity to improve the knowledge and attitude regarding OSA.
Obsessed with obesity – No more: A case study
M. Malathi1, Mahilmaran1, Palaniyappan1
1Institute of Thoracic Medicine, Madras Medical College, Chennai, Tamil Nadu, India, E-mail: malathimyth@gmail.com
Background: in the era of lifestyle diseases, burden of PCOS is mounting high accounting to 3.7-22.5%in India . recent reports indicate an unexpectedly high prevalence of obstructive sleep apnea (OSA) among pcos.hence we conducted a crossectional study on PCOS patients to find the burden of OSA.
Objective: To study the prevalence of OSA among pcos women. To study the distribution of BMI among PCOS women diagnosed with OSA.
Materials and Methods: 90 PCOS patients after meeting with inclusion and exclusion criteria with informed written consent were included into the study . these patients were subjected to elicitation of clinical history followed by physical examination and system examination and stop bang score was estimated. level 1 sleep study was planned but in consideration of covid pandemic level 4 was performed.
Results: Among 90 PCOS patients, 48.9 % patients were diagnosed with OSA. mild osa[5-15 ahi] were found among 18.9% patients and 26.7%had moderate OSA[15-30 ahi],severe OSA was around 3.3%. among mild and moderate OSA cases, 29.4% cases and26.7% had normal bmi[18.5-24.9] respectively.
Conclusion: The prevalence of OSA was high(48..9%) among PCOS patients and there is necessity for screening people with normal BMI too since there is significant proportion of lean pcos patients diagnosed with OSA.
Clinico-radiological profile of patients with silicosis admitted in South Tamil Nadu tertiary care hospital
K. Venkateswaran, R. Prabhakaran, R. Hariprasad, Saravanavasan
Department of Respiratory Medicine, Madurai Medical College, Madurai, Tamil Nadu, India. E-mail: venkat19922014@gmail.com
Introduction: Silicosis is an occupational lung disease attributable to the inhalation of silicon dioxide, commonly known as silica, in crystalline forms, usually as quartz, but also as other important crystalline forms of silica (i.e., cristobalite and tridymite). In India, prevalence varies from 3.5% in ordinance factory to 54.6% in slate factory
Objective: This is to study clinico-radiological profile of patients with silicosis admitted in our south Tamilnadu tertiary care hospital.
Methods: 15 patients admitted in our hospital in last 1 year with occupational history of exposure to silica. Clinical examination, radiology, spirometry and bronchoscopy done and statistically analysed.
Results: Clinical spectrum includes dyspnoea, cough, wheeze, chest pain, were seen. complications seen were hydropneumothorax and respiratory failure. Radiological spectrum includes small nodules to large mass like fibrosis with calcifications and calcified nodes were observed. Bilateral presentation and upper lobe predominance were commonly seen. Spirometry showed obstruction, restriction or both. There is a higher incidence of tuberculosis in silicosis patients.
Conclusion: Proper precautionary methods to be provided to the people who working in the quarry like working places to prevent silicosis. Tuberculosis is more common among silicosis patients and patient should be evaluated regularly by both radiologically and microbiologically for early diagnosis of the disease and its complications.
“Prevalence of obstructive sleep apnoea among asthmatics
A. P. Aishwarya, Amit Sharma, Anil Saxena
Department of Respiratory Medicine, Government Medical College, Kota, Rajasthan, India. E-mail: aishwaryaadukkath93@gmail.com
Background: Bronchial asthma is one of the most common diseases in the world affecting about 300 million individuals worldwide and therefore a substantial burden of disease. It is a heterogenous disease, usually characterized by chronic airway inflammation. Various pathophysiological mechanisms are related to the worsening of asthma symptoms and control, of them OSA is reported to be one of the important factor.
Objectives: To know the prevalence of obstructive sleep apnoea among controlled and uncontrolled asthmatics and To know the relationship between severity of OSA and asthma control.
Methods: Patients was divided into two groups based on their asthma control. Asthma. Group A had patients with stable uncontrolled asthma and group B had patients with controlled asthma. 60 patients were taken in each group.Each patient in the study was subjected to polysomnography overnight.Patients having apnea/hypopnea index of more than 5/hour of sleep were diagnosed as OSA.Parameters were analyzed and compared
Results: The number of patients with OSA in the controlled group was 6 (10%) and in uncontrolled group was26s(43.3%)with a total number of 32patients(26.7%).(p=0.001). The mean Duration of symptoms with no OSA was 6.21 years, mild OSA was 17.90 years, moderate OSA was 13.50 years and for severe OSA was 18.71 years (p<0.001).
Conclusion: OSA is significantly more prevalent in uncontrolled asthmatics compared to well controlled asthmatics. We found that severity of OSA was directly proportional to poor asthma control, severity of airflow obstruction and duration of asthma symptoms.
A rare case of Asbestosis without occupational exposure
K. S. Sravani
E-mail: sravani11.kanchi@gmail.com
Background: Asbestos fibres, from occupational sources like miners, tile setters, aircraft manufacturers and ship builders; on inhalation, accumulate in the lung, phagacytosed incompletely by macrophages, forming asbestos bodies. An array of fibrogenic mediators are triggered by them. Owing to the occupational sources, more prevalence is seen in men.
Case Study: We report an interesting case of Asbestosis in a 35 year old female, homemaker, with no history of occupational exposure. She presented to us with gradual onset, progressive dyspnea from 4 years, dry cough and a dull aching chest pain in the right hypochondrium. On bronchoscopy, bronchoalveolar lavage fluid showed asbestos bodies.
Discussion: Asbestosis is a type of pneumoconiosis, caused by inhalation and deposition of asbestos fibres in lungs, and tissue reaction in its response. Once fibres are inhaled, due to their fibrous and flexible nature, are not successfully expelled by mucociliary escalator. They are phagocytosed by both alveolar and interstitial macrophages, that sets in release of fibrogenic mediators. Long term deposition of fibres and impaired clearance leads to continous release of fibrogenic mediators, reactive oxygen species and parenchymal fibrosis.
Conclusion: We report this case to raise concerns over the unnoticed exposure to carcinogenic and fibrogenic mineral dusts. Although, asbestos use has been banned and restricted in most parts of the world, it is still a major threat from older buildings and machine parts.
Prevalence of obstructive sleep apnea amongst type 2 diabetes patients in a tertiary care centre
Govind Narayan Srivastav, Devendra Pratap Yadav, Mohit Bhatia, Aiyush Jain
Department of TB and Respiratory Diseases, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India. E-mail: devendraims027@gmail.com
Background: Obstructive Sleep Apnea (OSA) is chronic treatable sleep disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. Cardinal features of OSA, including intermittent hypoxemia and sleep fragmentation, have been linked to abnormal glucose metabolism. Aim of this study was to assess prevalence of OSA in Type 2 diabetes patients.
Materials and Methods: With informed consent, 105 patient (Mean age 52±5 years, 58 male and 47 female with Mean Hba1c level ≥ 7 ) attending the tertiary care centre were recruited for this study. After detailed clinical history, examination and lab investigations, complete diabetic and cardiovascular work up was done. They were undergone polysomnography (PSG). As par AASM guidelines apnea hypopnea index (AHI ) was taken as measure of diagnosis and severity of OSA.
Observation and Results: Out of 105 patients, OSA was found in 18 patients (AHI more than 5) with male predominance. In these patients HbA1c level was 10.3 ± 1.2, whereas in non OSA patients it was 8.2 ± 0.6. Out of 18 patients, 10 have mild OSA, 4 have moderate and 4 having severe OSA. Patient with high BMI have more prevalence of OSA (p value 0.01). Severity of OSA was positively correleated with HbA1C level.
Conclusion: High prevalence of OSA amongst type 2 diabetes patients suggests that all patients should be screened for OSA and treated as early as possible. It will decrease the diabetes related cardiovascular complications.
A study on the comorbidities and quality of life in patients with obstructive sleep apnea attending a tertiary care hospital in West Bengal
Sourav Ray, Jaydip Deb
Department of Respiratory Medicine, NRSMCH, Kolkata, West Bengal, India. E-mail: souravdgr8@gmail.com
Background: Obstructive Sleep Apnea (OSA) is an important unrecognized health problem & associated with various comorbid conditions. Due to paucity of data there is great need for reliable Quality of life (QOL) measures for OSA patients.
Objectives: To evaluate the prevalence of various comorbidity &to evaluate the impact of OSA on the QOL and its association with the disease severity among OSA patients with & without comorbidity respectively.
Methods: Comorbidities & QOLof 51 Polysomnography confirmed OSA patients were assessed using a sets of investigations, comorbidity history &the translated version of Functionaloutcome of sleep questionnaires-10 (FOSQ10) & Calgary sleep apnea quality of life index (SAQLI) questionnaires during a evaluation session. The QOL was assessed by the ultimate score obtained by the patient.
Results: Participants were 38(74.5%) male, 13(25.5%) females & 26(51%) obese with a mean age of 50.43 ±10.19 years. Comorbidity found on 42(82.4%) patients (Group A) & no comorbidity on 9(17.6%) patients (Group B). Themost prevalent comobidity was Hypertension (54.9%). 5(9.8%) patients had mild OSA, 11(21.6%) had moderate OSA & 35(68.6%) had severe OSA. Severe OSA patients were significantly younger (mean age = 48.54 years,p=0.0413), had higher BMI (mean =31.285 kg/m2, p =0.0342) and had lower total SAQLIScore (mean=3.7688, p<0.0001) than patientswith mild OSA (5.0442)& moderate OSA (4.2671).When QOL analyzed according to comorbidity, GROUP A patients had significantly lower mean scores for the totalSAQLI score(3.8828, p= 0.0024), FOSQ-10 score (13.0238, p=0.0039) compared GROUP B patients (4.5543, 17.111 respectively).The Apnea hypopnea index (AHI) was correlated with SAQLI&FOSQ-10 shows significantly negative correlation among GROUP A(r=-.538**,p=.000 &r=-.722**, p=.000)& GROUP B (r=-.864**,p=.003 &r=-.965**,p=.000 respectively).
Conclution: OSA can present in a variety of ways. There is significant impairment of QOL in OSA with comorbidities than OSA without comorbidities. Quality of life impairment of OSA patients directly proportional with the severity of OSA as determined by AHI.
A case of rare co-occurrence of silicosis and systemic sclerosis
Batoee Ram, Mohammed Javed Qureshi, Chand Bhandari, Jaankhi
E-mail: drbram92@gmail.com
A 39-year-old male patient who was a chronic smoker presented to our department with complaints of progressive worsening of shortness of breath, dry cough and bilateral diffuse chest pain from two months. He also complained of bluish discolouration of hands-on exposure to cold, tightening of the skin on his hands for the last 4 years, arthralgia for 2 years and high-grade fever for 10 days. He worked as stone crusher for 10 years and quit from that occupation for last nine years. On examination, pallor and clubbing were present. Thickening and pigmentation of skin on the hands was also noted. HRCT chest revealed early conglomerated fibrotic masses with multiple small 1-3 mm rounded airspace nodules in upper zone of both lungs. Multiple enlarged lymph nodes were also present. PFT revealed restrictive ventilatory defect. 2D-ECHO revealed pulmonary hypertension. The laboratory tests were as follows: haemoglobin 9.8 g/dL; total leukocyte count: 18800/ mm3; positive anti-Scl 70 antibody. Skin punch biopsy taken from right hand showed collagenisation of subcutaneous tissue with presence of eccrine glands between collagen bundles suggestive of scleroderma. Correlating the history of prolonged exposure to silica dust, positive serological markers, consistent radiological and histopathological features a final diagnosis of Erasmus syndrome was made. Patient was treated with higher antibiotics, bronchodilators and referred to Rheumatologist for further management.
Evaluation of nocturnal desaturation and sleep pattern in patients with posttuberculosis pleuropulmonary fibrosis with no active infection
Akhil Tiwari, Sudhir Chaudhri, Anand Kumar, Avdhesh Kumar
Department of Respiratory Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India. e-mail: akhil.aug12@gmail.com
Background: INDIA is currently on its way to eliminate tuberculosis by NTEP, however the respiratory impairment in treated patients remains a major problem. Post-tubercular involvement of lungs can be observed in terms to pulmonary functions, ventilatory defect, nocturnal oxygen desaturation.
Methods: 33 post tubercular fibrosis patients had level 1 polysomnography. Manual scoring was done using AASM manual scoring.
Results: Most of the post-tubercular patients had no symptoms of sleep disordered breathing. Breathlessness and cough were the most common symptoms. Maximum percentage of sleep duration was spent in N1 sleep followed by N2. Twenty-one (63.63%) patients recorded minimum saturation <90%, sixteen (48.48%) patients recorded minimum saturation below 85%. Ten (30.30%) patients had minimum saturation <90 with more than 30% of total recording time. 60%, 30%, 6.06 % & 3% patients had <5, mild, moderate & severe AHI respectively. During sleep patients with AHI <5, 5-15, 15-30, and >30 had mean minimum saturation of 86.5%, 84.8%, 80.5%, & 78% respectively. Seven (21.21%) patients had x-ray opacities up to 25% with mean minimum spo2 of 88.42% & AHI 4.92. Twenty-five (75%) patients had x-ray opacities 26-50% with mean minimum spo2 84.84% & AHI of 6.86. One (3.03%) patient had x-ray opacities >50% with mean minimum spo2 of 78% & AHI 0.3%. As the percentage x-ray opacities increases mean minimum spo2 decreases.
Conclusion: Most of the patients did not reach REM stage in their sleep. Most patients show desaturation during sleep & the level of nocturnal desaturation worsens with increasing radiological involvement of parenchyma.