Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Correlation between Degree of Desaturation and Severity of Obstructive Sleep Apnoea: A Cross-sectional Study
Correspondence Address :
Dr. Ivor D’sa,
Professor, Department of Internal Medicine, KS Hegde Medical Academy,
Mangaluru, Karnataka, India.
E-mail: ivordsa.69@gmail.com
Introduction: Obstructive Sleep Apnoea (OSA) is major Non Communicable Disease (NCD) which is becoming very common worldwide. The OSA results in day time hypersomnolence, nocturnal hypoxia and snoring. Repeated desaturation events during sleep results in aerobic metabolism at tissue level changing to anaerobic metabolism, which results in cellular inflammation and insulin resistance further complicating metabolic syndrome.
Aim: To study correlation between degree of desaturation and severity of obstructive sleep apnoea.
Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary medicine at KS Hegde Medical Academy (tertiary care hospital), Mangaluru, Karnataka, India, from March 2018 to February 2021. Total 54 patients who underwent overnight polysomnography and diagnosed to have OSA were included in the study. The minimum recorded oxygen saturation (SpO2) defined as maximum desaturation was noted. Relative desaturation was defined as drop in saturation by 3% or more from the pre-event baseline. Correlation between total number of relative desaturation and Apnoea Hypopnea Index (AHI) was analysed. The correlation between two variables were analysed by Pearson’s correlation and the coefficient was calculated. The p-value was calculated by regression analysis and Analysis of Variance (ANOVA).
Results: Total of 54 patients was included in the study. Out of which, 22 were mild, 14 moderate and 18 severe OSA, respectively. Number of relative desaturations recorded was from 0-636. The correlation between AHI and mean SpO2 in sleep was r-value=-0.4542 (p-value=0.001) and the correlation between AHI and minimum SpO2 was r-value=-0.45577 (p-value=0.001), respectively. Correlation between mean SpO2 and minimum SpO2 was r-value=0.747266 (p-value <0.001) and the correlation between AHI and relative desaturation was r-value=0.876698 (p-value=0.001).
Conclusion: As the severity of the obstructive sleep apnoea worsened, there was greater degree of desaturation in sleep and the lowest SpO2 was also observed during severe obstructive sleep apnoea.
Anaerobic metabolism, Hypoxia, Relative desaturation
Obstructive Sleep Apnoea (OSA) is the most common type of sleep related breathing disorder characterised by repetitive episodes of upper airway obstruction leading to desaturations, arousals, variations in heart rate, daytime sleepiness and impaired quality of life during daytime. OSA is diagnosed typically after overnight polysomnographic test showing events of apnoea (complete or more than 90% cessation of oronasal airflow for more than or equal to 10 seconds) and hypopnoea (more than 30% reduction in oronasal airflow lasting for more than or equal to 10 seconds with >3% fall in SpO2 from the pre-event baseline and/or arousal) of more than per hour of sleep with symptoms suggestive of OSA (1). There are various systems used to classify the severity of OSA. The worldwide accepted system being American Academy of Sleep Medicine (AASM) Apnoea Hypopnea Index (AHI), where AHI of 5-15 events per hour is mild, 15-30 events/hour is moderate and more than 30 events per hour is severe OSA (2).
The disruptions to breathing have lead to repeated blood gas disturbances (hypercapnia and hypoxaemia) and sympathetic nervous system activation (3). Repeated desaturation events might result in aerobic metabolism at tissue level changing to anaerobic metabolism, which results in cellular inflammation and insulin resistance further complicating metabolic syndrome (4). Previous study has been conducted on SpO2 less than 90% and respiratory arousal indices (5). However severity of OSA and its relation to degree of desaturation were not compared previously. Hence, to address this lacuna it was hypothesised that more severe the OSA, more severe the desaturation and this research was conducted to study degree of desaturation and severity of OSA to understand the metabolic implications of hypoxia.
A cross-sectional study was conducted in Department of Pulmonary Medicine at KS Hegde Medical Academy (tertiary care hospita), Mangaluru, Karnataka, India from March 2018 to February 2021. The ethical clearance was obtained from the Institutional Ethical Committee (NU/CEC/2018/0201).
Sample size calculation: The sample size was calculated using Cochran formula:
N=Z2pq/e2=53.16
Where, n=sample size,
Z=standard normal deviate {1.96 (taking a confidence interval of 95%)}
p=proportion in the target population having OSA {0.036 (taking 3.6% of population having OSA)}
(6)q=proportion in the target population not having OSA {1-p=0.964}
e=degree of accuracy required (0.05)
Inclusion and Exclusion criteria: All consenting 54 patients who underwent overnight polysomnography and diagnosed to have OSA by the pulmonologists were included in the study. Subjects diagnosed to have central sleep apnoea and not consenting for the study were excluded from the study.\
Study Procedure
• Demographic details like age, sex, height, weight and BMI were taken.
• Sleep study data included
-Apnoea Hypopnoea Index (AHI),
-Number of relative desaturations,
-Mean SpO2 recorded in sleep,
-Minimum SpO2 recorded in sleep
These parameters are part of the routine sleep study which were recorded in polysomnography laboratory {Alice-5 (Philips Respironics)} and retrieved from the software system. AHI is the current method for severity grading of OSA, which includes number of apnoea and hypopnea per hour of sleep. AHI severity grading OSA is divided (7):
• Mild OSA: AHI of 5-15
• Moderate OSA: AHI >15 upto 30
• Severe OSA: AHI>30
The AHI below 5 per hour was considered as normal and not included in the study. The minimum recorded SpO2 defined as maximum desaturation was noted. Relative desaturation was defined as drop in saturation by 3% or more from the pre-event baseline (1).
Statistical analysis
Statistical analysis was done using the software Statistical Package for Social Sciences (SPSS) version 2.0. Correlation between total number of relative desaturation and AHI was analysed. Nominal data were analysed as frequency and percentages. The correlation between two variables were analysed by Pearson’s correlation and the coefficient was calculated. The p-value was calculated by regression analysis and Analysis of Variance (ANOVA).
Out of total 54 patients, 70.37% were males. Majority of them were between the age group 45-57 years followed by 18-31 years. Total 18 patients had a BMI between 26-31.4 kg/m2 followed by 15 patients between 20.5-25.9 kg/m2. One patient was paraplegic and hence BMI could not be assessed. Out of the total, 22 had mild, 14 moderate and 18 severe OSA, respectively (Table/Fig 1). Number of relative desaturations recorded was from 0-640 (Table/Fig 2). Among desaturation details of all the patients, the minimum saturation (SpO2) recorded during sleep ranged from 27-97% (Table/Fig 3) and mean SpO2 ranged between 74-99% (Table/Fig 4).
The correlation between AHI and mean SpO2 in sleep was r-value=-0.4542, p-value=0.001 and the correlation between AHI and minimum SpO2 was r-value=-0.45577, p-value=0.001, respectively. Correlation between mean SpO2 and minimum SpO2 was r-value=0.747266, p-value <0.001 and the correlation between AHI and relative desaturation was r-value=0.876698, p-value=0.001 (Table/Fig 3),(Table/Fig 4),(Table/Fig 5),(Table/Fig 6).
This study showed that OSA is more prevalent in males than females and a male to female ratio was 2.3:1 which is similar to previous studies showing a ratio of 3:1 to 5:1 in the general population [8-10]. OSA is commonly seen in the age group between 44-57 years and is consistent with previous study which was common in 45-53 years (8).
Minimum SpO2 ranged from 27-94% in various subjects with OSA in our study. Minimum SpO2 and severity of OSA (as determined by AHI) had only moderate correlation (r of -0.45), mean SpO2 and AHI also had moderate correlation (r of -0.45), relative desaturation and AHI had a strong correlation (r-value=0.87) which is consistent with previous study, in which Wali SO et al., found that parameters such as Desaturation Index (DI), the sum of all desaturations, desaturation below 90%, the average duration of respiratory events, and indices of total arousals and respiratory arousals correlated directly with severity OSA (p-value <0.001). The correlation between mean SpO2 and minimum SpO2 in sleep was 0.75. This means that nocturnal hypoxia and the nadir saturation in sleep are linked (5).
The type of metabolism at cellular level is determined by the oxygen concentration in the mitochondria (11),(12),(13),(14). This is because the final step for aerobic metabolism takes place in the mitochondria. Cellular metabolic demands, the cell type and its adaptability to hypoxia are the factors which determine the response to various levels of hypoxia from substantial adaptation to cell death (14),(15),(16). If tissue hypoxia occurs, global compensatory respiratory and cardiac mechanisms like regional pulmonary vasoconstriction to improve ventilation perfusion (V?/Q?) matching, hyperventilation to improve alveolar oxygen tension, acidosis-related right shift of the oxyhaemoglobin dissociation curve and increase in cardiac output occur to improve oxygen delivery are activated (13),(14),(15),(16).
Hypoxia Inducible Factors (HIFs) are a group of heterodimeric proteins that interact with hundreds of genes in response to hypoxia (13),(14),(15),(16),(17),(18),(19). It plays a central role in adaptive tissue responses like up-regulation of erythropoietin, angiogenic factors, and vasoactive mediators; activation of glycolytic enzymes to produce anaerobic 39metabolism (with resulting lactate production); and even a mitochondrial hibernation-like phenomenon resulting in decreased oxygen demands (8),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28).
Mean SpO2<92% and minimum SpO2<80% in sleep were associated with carotid plaque formation regardless of their normotensive or hypertensive status [29,30]. Ventricular ectopic in OSA patients is more likely if SpO2 drops below 60% and unlikely if SpO2 stays above 60% (30). It was also observed symptoms of OSA were closely related to oxygen desaturations than AHI (31). Similarly resistance to ischaemic conduction failure is a sensitive but non specific marker of nocturnal hypoxemia in OSA patients (32). Repeated hypoxia and normoxia induces endothelial dysfunction (33). Oxygen desaturation plays a key role in the connection between obstructive sleep apnea and hypercoagulability state (34). Nocturnal hypoxia due to OSA is an independent predictor of atrial fibrillation in patients with subacute ischaemic stroke (35). In this study it has been observed as severity of the OSA worsens there is steeper fall of saturation which leads pronounced physiological impact of apnoea.
Limitation(s)
Study involved sample size of 54 which was smaller to conclude physiological impacts of apnoea and hypopnea. Study should have also incorporated heart rate variations as other physiological variant to assess severity of OSA.
Degree of desaturation worsened with increasing severity of OSA. Greater degree of desaturation and lowest recorded saturation was seen during severe obstructive sleep apnoea. Further studies are required to confirm that desaturation is a surrogate indicator of severity of obstructive sleep apnoea.
DOI: 10.7860/JCDR/2022/55114.16803
Date of Submission: Jan 21, 2022
Date of Peer Review: Feb 18, 2022
Date of Acceptance: Jul 09, 2022
Date of Publishing: Aug 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 22, 2022
• Manual Googling: Jul 08, 2022
• iThenticate Software: Jul 12, 2022 (10%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com