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Background: Chordomas are rare, malignant tumors typically centered in midline structures such as the clivus and sacrum, with peak prevalence in the fourth decade. Clival chordomas may secondarily extend to involve the nasopharynx and nasal cavity; however, primary extra-osseous chordomas are even more uncommon. We present an unusual case of a primary sinonasal chondroid chordoma arising from the maxillary sinus in a 5-year-old child. This is the second case of primary sinonasal chordoma reported in the literature so far, after Tao ZZ et al. and the first case of the chondroid variant. Case presentation: A 5-year-old male presented with right-sided nasal obstruction, nasal congestion, and snoring for 2 months. Physical examination showed a reddish polypoidal mass in the right nasal cavity obstructing the choana with nasal septal deviation toward left side. Radiological examination with CT confirmed the presence of a well-defined, heterogeneously hyperdense lobulated mass in right maxillary sinus extending into right nasal cavity with intralesional coarse calcifications. MRI revealed expansile solid altered signal intensity mass, which appears to be isointense on T1-weighted imaging (T1WI) and heterogeneously hyperintense on T2-weighted imaging (T2WI) with a heterogeneous honeycomb pattern of enhancement. Differentials considered were rhabdomyosarcoma, nasopharyngeal carcinoma, and neuroblastoma metastasis. However, the lesion was pathologically proven as a chondroid chordoma. No association with skull base or clival lesion was found on review. Conclusions: Primary sinonasal chordomas are rare in occurrence but should be considered a differential for sinonasal masses in the presence of characteristic MRI features, despite their uncommon location. [ABSTRACT FROM AUTHOR]

Background: Physiological and hormonal changes during pregnancy can alter the sleep patterns of the pregnant women and were said to be precursor for the development of obstructive sleep apnea (OSA) and complication of pre-existing OSA. Developing country like India has no health cost distribution for the treatment, as this condition's treatment trends absorbs 65-82% of all health cost. There is oblivious state among clinicians and patients, self-reporting of the symptoms are poor which, in turn, results to upshot underdiagnoses of OSA among southern Indian population. Aims and Objectives: The aim of the study is to screen the prevalence of OSA among the southern Indian pregnant women attending antenatal care and to evaluate its predisposing factors. Materials and Methods: We enrolled 305 pregnant women according to our study selection criteria, attended antenatal care at ACS medical college and hospitals from Chennai. On face-to-face basis, berlin questionnaire screening was done. With a brief interview, sociodemographic details, medical records and laboratory parameters were obtained. To cluster the risk of OSA prevalence, percentage was estimated using frequency distribution. Chi-square analysis was done to obtain significant relationship between contributing factors and OSA symptoms. Statistical testing was done with SPSS software version 21. Results: Among 305 pregnant women, 31.8% (97) were shown to have high-risk OSA and 68.2% (208) low-risk OSA. Across the trimester, highrisk OSA were noted among 8.2% (25), 11.1% (34), and 15.4% (48) at first, second, and third trimester, respectively. Age, body mass index, occupation, neck circumference, multiple pregnancy, and presence of conditions such as gestational hypertension, chronic hypertension, adenoids, mallampatti grade, nasal congestion, and family history of OSA can be the predisposing factors which could influence the OSA symptoms. Conclusion: The future investigations should rely on the analysis of the fetal outcomes after proper diagnosis of OSA. Furthermore, independent predictive values of physical signs, history, risk factors, and mechanisms behind the progression of OSA should be studied well. Region and area specific difference of risk of OSA to identify disparities and to promote decentralization of sleep care could be done. [ABSTRACT FROM AUTHOR]

Context: Excessive daytime sleepiness (EDS) due to obstructive sleep apnoea (OSA) is reported to be a major contributor to many road traffic accidents. Lack of awareness and diagnosis of OSA among public transport workers remains a threat to the society. Aims: The primary aim of this study was to assess the risk of OSA among transport drivers of south Kerala using modified Berlin questionnaire. The secondary objective included craniofacial assessment of the high-risk patients identified through the questionnaire using lateral cephalogram. Settings and Design: A cross-sectional study was conducted among 180 transport drivers of south Kerala. Methods and Material: Modified Berlin questionnaire and limited physical examination [body mass index (kg/m2), neck circumference (cm), waist circumference (cm), hip circumference and waist to hip ratio, blood pressure (mm Hg)] were recorded. The screened subjects were categorized as high-risk snorers and low-risk snorers based on modified Berlin questionnaire. Craniofacial morphological variations of high-risk group were assessed by lateral cephalograms. Statistical Analysis Used: The descriptive statistics were represented as mean and standard deviation and percentage. Inter-group comparison was performed with independent sample t test. Results: The study demonstrated 64.4% of subjects were non-snorers and 35.6% were snorers. Furthermore, among the snorers, 46.9% were identified as high-risk snorers, whereas the remaining 53.1% represented low-risk snorers. Conclusions: The study revealed the concealed risk of OSA among transport drivers could be screened through the questionnaires and demographics assessment. The application of the proposed screening protocol would triage and enhance safety of OSA affected transport drivers. [ABSTRACT FROM AUTHOR]

Introduction: Rising morbidty resulting from Obstructive Sleep Apnoea (OSA) is an emerging public health concern. The estimated prevalence of OSA in India has been investigated. STOP-Bang and Epworth Sleepiness Scale (ESS) have proven beneficial in identifying sleep breathing disorder. Validity of these questionnaire has been verified against polysomnography in many studies. Aim: To assess the predictive ability of STOP-Bang questionnaire and ESS in identifying OSA and comparing their efficacy with polysomnography. Materials and Methods: The cross-sectional study was conducted in the Department of Respiratory Medicine, Government Medical College, Kota, Rajasthan, India, from January 2020 to June 2021, among 100 patients with symptoms of OSA. The STOP-Bang questionnaires were administered to the patients, and scoring was done, followed by overnight attended polysomnography. The normality of data was tested by Shapiro Wilk's test. The values obtained were statistically analysed and to compare the parameters between groups and with in groups for normal data parametric test One-way Analysis of Variance (ANOVA) followed by Tukey's HSD test, for intragroup Paired t-test. Results: Mean age of the study population was 49.46±6.523 years, 79 were males and 21 females. Total, 79% of the subjects were males, and 21% of the study subjects were females. Among the 100, 65% had OSA as per polysomnography. STOP-Bang questionnaire had a higher sensitivity as compared to ESS in predicting OSA (75.38% for STOP-Bang and 72.31% for ESS). Conversely, the specificity of ESS (82.8%) was found to be greater than STOP-Bang (45.71%). Similar results were obtained for positive predictive value, in which ESS scored 88.6% while STOP-Bang scored 50%. For negative predictive values, ESS again scored higher (65%) than STOP-Bang (61.7%). Similarly, the Likelihood Ratio for a positive result (LR+) of ESS was greater than STOP-Bang (4.2 and 1.3 respectively). The STOP-Bang questionnaire, however, had higher Likelihood Ratio for a negative test (LR-) as compared to ESS (0.5 and 0.3 respectively). Conclusion: Polysomnography is the gold standard to diagnose OSA. For screening OSA, patients with symptoms of sleep disordered breathing, this study found that STOP-Bang questionnaire is better in identifying OSA as compared to ESS. [ABSTRACT FROM AUTHOR]

Context: Sparse published data are available from India regarding sleep disorders in elderly, sleep quality, and daytime sleepiness. Aims: To study sleep disturbances in the elderly (>60 years) subjects. Settings and Design: Hospital-based cross-sectional study. Methods and Material: All the subjects underwent a thorough clinical evaluation which included detailed history and a thorough physical examination. The daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). The sleep quality (SQ) was evaluated with the Pittsburgh Sleep Quality Index (PSQI). Statistical Analysis Used: Association between categorical variables was studied by Chi-square (χ2) test with continuity correction. All tests were two-tailed; a P value <0.05 was considered as significant. Results: During the period November 2019 to July 2020, 122 elderly subjects were studied; women (n = 70; 57.4%) outnumbered men. Only six (4.9%) patients presented with sleep-related complaints. Seven (5.7%) patients had an ESS score >10 suggestive of increased day time sleepiness. Sixty-four (52.5%) were labelled "bad sleepers" (PSQI >5). Compared with those with ≤3 comorbid conditions, a higher proportion of elderly with >3 comorbid conditions had significantly higher occurrence of poor sleep quality (PSQI >5) and daytime sleepiness (ESS >10). Increased daytime sleepiness (ESS >10) was significantly high in patients with osteoarthritis and cerebrovascular disease. Conclusions: Our observations suggest that a high proportion of elderly subjects who did not complain of sleep-related symptoms were found to have poor sleep quality. Therefore, incorporating SQ assessment as a part of routine geriatric assessment screening would be beneficial in early detection of this condition. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is reported in a high proportion of cardiac surgical patients, up to 73%. STOP-BANG is a validated questionnaire for screening of outpatients for OSA with high sensitivity. There is sparse literature from India regarding the prevalence of OSA in preoperative cardiovascular patients and the utility of screening tools.Aims: We sought to study the utility of the STOP-BANG questionnaire as a screening tool for OSA in cardiovascular patients validating it with ambulatory level 3 polysomnography.Materials and Methods: It was a prospective study where consecutive patients getting admitted for coronary artery bypass surgery (CABG) from August 2017-February 2019 were recruited. All the patients were screened with the STOP-BANG questionnaire. 53 patients underwent overnight level 3 polysomnography using Apnea-Link. Correlations were made between clinical symptoms, STOP-BANG score, and OSA severity, measured using Apnea hypopnea index (AHI).Results: We had 120 patients(103 males) with a mean age 60 years. Snoring was the most common sleep complaint. Our cohort had a high prevalence of vascular risk factors (DM 72.3%, hypertension 59.2%, dyslipidemia 60%) and 11.7% were obese (BMI >30). The median STOP-BANG score was 3 (IQR 2) with 83 having scores ≥3. Median AHI was 5.6 with AHI ≥5 in 28 patients and AHI 15 or above in 14 patients. Among the clinical parameters, arousals with respiratory difficulty at night, higher neck circumference, and tonsillar hypertrophy showed a significant association with PSG-proven OSA.STOP-BANG scores 3 or above had a sensitivity of 75% in predicting OSA.Conclusions: Our study shows that in cardiovascular patients less symptomatic for sleep complaints, the STOP-BANG questionnaire is a useful screening tool for OSA in outpatient settings. Among clinical parameters, airway narrowing and neck circumference can predict OSA. [ABSTRACT FROM AUTHOR]

Background: Globally, rates of obesity have trebled in the past four decades. India has more than 9.8 million men and 20 million women classified as obese. While poor diet and sedentary lifestyles are major causes, growing evidence suggests other factors like sleep disordered breathing may also be contributors. Methods: A cross sectional survey was carried out between October 2017 and May 2018 among a nonprobability sample of slum dwelling women, 40-64 years of age, in government designated slums in Mysore, India. After the informed consent process, data were collected on sociodemographics, tobacco and alcohol consumption, diet, physical activity, sleep, quality of life, and personal and family history of diagnosed cardiometabolic disorders. Body mass index (BMI) was calculated using anthropometry. The serum was tested for HbA1c and lipid profile. Results: In this sample of slum dwelling women, snoring was associated with obesity. Habitual snorers had more than double the odds (adjusted odds ratio [aOR] 2.05; 95% confidence interval [CI] 1.26-3.33; P < 0.004) of obesity I, and seven times the odds (aOR 7.71; CI: 3.58-16.62; P < 0.001) of being in the obesity II category compared to nonsnorers after adjustment for age, diabetes, hypertension, hypercholesterolemia, and daytime sleepiness. There was no difference in obesity status among participants reporting abnormal sleep duration, napping, daytime sleepiness, sleep apnea, insomnia, or the use of sleep medication. Conclusion: The relationship between snoring and obesity has not been well explored. This study among slum dwelling Indian women found a significant relationship between snoring and obesity. Future research should explore the underlying mechanisms connecting snoring to BMI. [ABSTRACT FROM AUTHOR]

Context: Obstructive sleep apnea (OSA) considered classically to be a male-dominant disease, may have significant gender-based differences in clinical presentation and diagnosis. Aims: To evaluate gender-based differences in the clinical profile and polysomnographic features of Indian patients with OSA. Settings and Design: A prospective observational study was conducted over a period of 12 months involving adult ambulatory patients, referred for evaluation of OSA. Methods and Materials: Enrolled patients underwent detailed clinical evaluation followed by supervised polysomnography. Sleep studies were manually validated and analyzed. Statistical Analysis Used: Continuous variables were compared using two-tailed independent- sample t-test. For the univariate analysis, the Chi-square test was used. Results: Out of 150 enrolled patients, 94 (62.7%) were males (male-to-female: 1.7:1; age: 51.85 ± 12.60 years; BMI: 32.09 ± 5.53 kg/m2). Most common presenting features were excessive daytime somnolence, snoring, and easy fatiguability. Women with OSA were older than men. Insomnia and anxiety were significantly higher among females. Parameters defining sleep architecture were similar in both groups. Although obstructive apneas and hypopneas were similar, mean apnea hypopnea index was significantly higher (P < 0.05) in males compared to females with higher titratable continuous positive airway pressure. Conclusions: There are gender-specific differences in the clinical presentation of OSA due to various anatomical, physiological, and psychosocial factors. Their potential influence on the clinical features, natural history, and implications on treatment need further evaluation on a larger scale. [ABSTRACT FROM AUTHOR]

Snoring is common disorder in India, which is caused due to obstructive sleep apnea. Nasal continuous positive airway pressure (CPAP) is an effective treatment for this condition. Prefabricated nasal masks lack intimate adaptation and cause air leakage producing discomfort for patient and decrease the compliance for treatment. This article describes a simple method for customizing nasal CPAP mask and fabrication using maxillofacial prosthodontic laboratory techniques currently available. [ABSTRACT FROM AUTHOR]

Objectives: To determine the risk of obstructive sleep apnea (OSA) for male permanent driving license (DL) applicants of Lucknow, India.Material and Methods: In this cross-sectional community based, study body mass index, waist-hip ratio, blood pressure of each subject were determined as an anthropometric parameter along with the history of habit of smoking, tobacco chewing, alcohol consumption. STOP-Bang (Snoring, Tired or sleepy, Observed apnea, high blood Pressure, Body mass index, Age, Neck, Gender) Questionnaire - a scoring risk assessment tool - was applied for assessment of OSA risk (high OSA risk defined by score ≥ 3) for 542 male DL recipients at 2 Regional Transport Office (RTO) centers in Lucknow, India. The statistical software SPSS 17.0 was applied to the testing.Results: In total 23% (N = 125) of participants were found with the risk of OSA. High blood pressure (≥ 140/90 mm Hg) was found for the maximum number of participants (40.5%) followed by neck circumference > 40 cm (17.1%), age (> 50 years old) (15.3%), snoring (12.3%) and tired/sleepy (10.5%). Mean values of age, anthropometric measurements and blood pressure were observed significantly higher (p < 0.001) for participants with the OSA risk. In this population the risk of OSA risk (STOP-Bang score ≥ 3) was observed for 6.7% of young (< 35 years old), 34% of middle (35-45 years old) and 73% of elder age adults (> 45 years old).Conclusions: In view of findings of this study a high number of male driving license applicants were observed with the risk of OSA. Therefore efforts should be made to develop a national screening guideline/protocol for the OSA risk assessment for driving license applicants in India. This may reduce the possibility of road traffic accidents due to the OSA-associated fatigue and drowsiness behind the wheels. Int J Occup Med Environ Health 2018;31(1):25-36. [ABSTRACT FROM AUTHOR]

Snoring can impair lifestyle and cause late cardiopulmonary complications. Early detection of snoring and timely intervention during adolescence can avoid complications. A single center prospective cross-sectional study was conducted in 548 undergraduate 17-25 years old undergraduate medical students of CSM Medical University, Lucknow, who were interviewed on the basis of the modified Berlin Questionnaire along with their room-partners describing their snoring habits. Ninety-seven (17.7%) subjects were found to be snorers. Risk factors viz. day time sleepiness (European Stroke Scale (ESS) scores), smoking habits, alcohol intake, neck size and BMI were observed. The proportion of males, smokers, BMI, neck size and ESS scores were significantly (p < 0.001) higher in snorers than non snorers. Logistic regression found sex (OR = 5.73, 95% CI = 2.11-15.61), smoking (OR = 2.20, 95% CI = 0.97-5.62), BMI (OR = 3.16, 95% CI = 1.09-7.36) and neck size (OR = 2.03, 95% CI = 0.79-6.35) as significant (p < 0.01) independent risk factors for snoring. A clinically significant form of Sleep Disordered Breathing (Habitual snoring, ESS score ≥ 11 and BMI ≥ 25 kg/m2) was suspected in 4 (0.7%) students. The findings of this study may also be validated in the general population. The study concluded that male undergraduate medical students are at a high risk for developing snoring habits. [ABSTRACT FROM AUTHOR]

The article offers information on the National Health Policy of India fails to address the critical issue of the requirement of adequate sleep for the population. It mentions that inadequate and restricted sleep affects mood, cognition, decision-making ability and is a cause of obesity and increased cardiovascular mortality; and also mentions that insufficient sleep in schoolchildren hampers their mood significantly,9 and causes daytime behavioural impairments.