Shahid Akhter, editor of ETHealthworld talked about the impact of Covid-19 on sleep distorted diseases and how co-morbidity aggravates the problem with Dr. Sandeep Bansal, Additional Professor, Department of Otolaryngology & Head Neck Surgery, PGIMER Changigarh.
Your views on sleep being impacted by Covid-19?
Because of the change in the schedules of the people because being off work, being at home, you know, the sleep patterns of course have changed and they are because of, apart from being that they are not going to work so they are sleeping late and they are getting up late, they are not setting alarms because they don’t have to rush to the office.
Apart from that, I think the stress of the financial burden which they might have to face, the stress of the wellbeing of their family, the stress of that fear of not contracting Covid-19, all those things have changed the quality and quantity of sleep in people. Another factor would be because of staying at home, those who take alcohol maybe they have increased the quantity of taking alcohol because there is nothing much to do. The stress of again the financial burdens have made them take more alcohol. The alcohol might be putting them to sleep, but the quality of sleep is not good, so the sleep always remains fragmented and ultimately leads to its, you know, sequelae of, anxiety, fear, not being fresh the next morning, not being physically fit, headaches and so on and so forth.
Impact on sleep medicine?
The sleep medicine of course has taken a big hit because of this pandemic, as such the emergency services and the Covid services were going on in most of the hospitals. The normal routine work had been stopped and sleep medicine is one sub-specialty, which has been affected the most primarily because I think these patients have been snoring and snoring produces a lot of aerosol, so the aerosol can transmit the coronavirus.
All the tests, all the sleep studies which were being happening in the hospitals have been stopped because it’s a closed room, sound proof rooms, the labs, so all that had taken a bit hit because of the covid pandemic, so we had to stop work for some time for the peak of that covid-19 pandemic.
Co-morbidities and risk factor from ENT point of view ?
See, the co-morbidities would be per se, first and foremost I would say is the obesity. Obesity is the mother of all other co-morbidities, be it diabetes, be it hypertension, be it cardiovascular disease, everything. I would say the core of the basic problem is the obesity, which leads to all these problems again and again. Apart from these co-morbidities, I think the decrease in the immunity level of the patients, again I would say may be because of the stress, may be because of lack of sleep or inadequate sleep again have led to decrease in immunity levels, which were, and the covid virus being so virulent that the patients who had associated uncontrolled diabetes, the patients who had taken steroids, especially strong doses of steroids, later on in the second phase, second wave of Covid have been coming up with an entity called mucormycosis that is an invasive fungal disease proved to be quite morbid and fatal also. From the ENT point of view, I think this is a most significant co-morbidity which we have seen during this Covid pandemic.
How do you see the surge in Mucormycosis during the second wave?
Mucormycosis is not an entity that, which has been new to us as an ENT surgeons. Being a tertiary care referral centre I am working in, so we used to see about 40 to 45 patients per year of mucor mycosis previously also, but during this second wave of Covid, the numbers have been just humongous. You know, there has been so much of mucormycosis all around and from my clinical experience, I would say the most important two factors have been hyperglycaemia that is uncontrolled diabetes and steroids being given for treatment of Covid, indicated, not indicated we will not go into that, but, you know, high doses of steroids being given. So, those two factors are the most important thing and the most, I would say scientifically proven things at present that which have led to such an increase in mucormycosis in India.
From an ENT surgeon point of view, of course, it has to be, you know, we have to detect it as early as possible and we have to start the treatment again as early as possible and as early as possible, I would say immediate we need to take, earlier we start treatment the better prognosis it would be because as such it’s a very debilitating disease. It is a very morbid condition. So, the diagnosis and starting of the medical therapy and the most urgently the surgical therapy for that in conjunction with medical therapy would help us to increase the prognosis or make the prognosis better for this disease
With Covid on the wane, how do you see the reopening of sleep lab
So now with the covid waning as the covid patients are decreasing day by day, so we have opened our sleep lab again, we started doing our sleep studies and you know, we have even started doing our drug induced sleep endoscopies in our operation theatres to know the level of obstruction in the patients who have been referred for, like who have had a failure of CPAP therapy, medical management or who had not been tolerating medical management, who have not been, who have not improved even after lifestyle modifications and losing weight and all, so for all those patients we have started doing our drug induced sleep endoscopy and we have operated one or two patients also, so I am seeing my sleep practice back on track slowly and slowly.