Page 18 - Highlights of Napcon 2021

Screening for Sleep Disordered Breathing

Dr. Anand Kumar

Associate Professor, Department of Respiratory Medicine
GSVM Medical College
Kanpur

In this outstanding talk, Dr. Anand Kumar reviewed sleeping disorders and focused on maximizing the screening yield
for sleep disorders. He mentioned that sleep disorders affect the ability to sleep well regularly and are increasingly
becoming more common in practice. Respiratory physicians must remain alert enough to diagnose sleep disorders.
He suggested that several symptoms can indicate sleep disorders, including snoring, excessive daytime sleepiness,
witnessed apneas, restless sleep, heavy sweating during sleep, nocturnal choking or coughing, impaired concentration,
morning headaches, unrefreshing sleep, and mood swings. He also described several high-risk groups for sleep
disorders (Figure 1). In addition, he recommended specifically ruling out obstructive sleep apnea in individuals with
one or more of the following comorbidities: Obesity, systemic hypertension, myocardial infarction, cerebrovascular
accidents, type 2 diabetes mellitus (T2DM), pulmonary hypertension, polycystic ovarian syndrome, atrial fibrillation,
abnormal findings in pre-anesthetic evaluation, and driver having sleep-related accidents.

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Figure 1: High-risk groups for sleep disorders Figure 2: Screening of sleep disorders
with overnight pulse oximetry

Dr. Kumar pointed out that several subjective questionnaires can be used in the clinical setting, including the Stanford
sleepiness test, Karolinska sleepiness scale, and Epworth sleepiness scale. In addition, objective measures can also be
used, including the Multiple Sleep Latency Test, Maintenance of Wakefulness Test, and Oxford Sleep Resistance Test.
Moreover, several types of sleep studies can aid in the diagnosis, including Type 1: Fully attended polysomnography
(≥7 channels) in a laboratory setting; Type 2: Unattended polysomnography (≥7 channels); Type 3: Limited channel
study (using 4–7 channels); and Type 4: One or two channels usually, using oximetry as one of the parameters. Of
these, Type 4 can be particularly helpful in screening sleep disorders due to its convenience (Figure 2). He concluded
that sleep-related complications should be thoroughly evaluated by all respiratory physicians; a complete clinical
evaluation is mandatory before going for polysomnography (PSG). However, the selection of the level of PSG should
be individualized.

16 Highlights of NAPCON 2021