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In big 5-star private hospitals there are a number of centres, having sleep apnoea laboratories, where they do poly-somnography, and the patient is kept overnight. I have seen many patients, who are made to spend more than Rs.10,000/- for the diagnosis, and are persuaded to buy a CPAP machine as a treatment (costing about Rs.60,000/-). I feel that this is being done just because it has become a super-speciality diagnosis.
In poor and middle class patients, first of all it is not necessary to send them to hospital for diagnosis. Taking a very good history will give you the diagnosis and at the most, the wife may be asked to keep a watch overnight on the patient and note the number of attacks of apnoea. You can also lend your pulse oximeter for one night especially, if he is your family patient. Oximeter can be used to see the SPO2 during the apnoea, to confirm your diagnosis.
Regarding CPAP treatment, in my experience 50-60% patients are not happy and after spending so much money, they do not use this mask, while sleeping.
Omission of smoking, drinking, sleeping pills, sedatives, etc. can help though the most important is to make the patient lose 10-20 kgs of weight. It is not necessary to bring the patient to normal weight. It is interesting to note that a number of patients are very happy even after they have lost only 8-10 kg weight.They no more experience daytime drowsiness and fatigue.
Recently, I had a patient, who claimed that when he went for coronary bypass surgery at a five star hospital, the chest physician also examined him and told him to buy CPAP machine for his sleep apnoea syndrome. But when the patient returned home from the hospital after his heart surgery, his wife confirmed that he was not snoring anymore and was feeling fresh throughout the day. Both were convinced that heart surgery had cured him of sleep apnoea syndrome. However, when I took a detailed history he had lost 8-10 kg weight, which explained his loss of symptoms of snoring and sleep apnoea syndrome.
INTRACORONARY BONE MARROW CELLS IN ACUTE MYOCARDIAL INFARCTION
To promote the regeneration of myocardial cells after myocardial infarction, intracoronary infusion of bone marrow cells, which contain stem cells and progenitor cells, has been investigated. In this study of patients with acute anterior myocardial infarction, infusion of bone marrow cells had no effect on left ventricular function or infarct size six months after the infarction.
N Engl J Med 2007; 355 : 1198.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
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