Nithra Institute of Sleep Sciences, Chennai: A quality journey

Evolution of Sleep Medicine in India in the past decade

Sleep medicine in India is a growing medical subspecialty in India. A decade back, dedicated sleep medicine specialists and centres were far and few. The practice of sleep medicine at that time was predominantly an extended domain of neurologists, pulmonologists and ENT specialists who focused on specific aspects of sleep pertaining to their speciality. Over the years, national societies in sleep medicine (Indian Sleep Disorders Association and Indian Sleep Research Society) and returning sleep specialists with international training and certification have created awareness amongst medical fraternity and the general public.

The number of hospital based and independent sleep centres has certainly been on the rise but more in urban areas and still inadequate in Tier 2 cities and rural areas.

Nithra Institute of Sleep Sciences, Chennai, is India’s first freestanding comprehensive center for Education, Training, Diagnosis and Treatment for sleep related problems. The center was started in July 2004 by Dr. N. Ramakrishnan who is American Board Certified in Internal Medicine, Critical Care Medicine & Sleep Medicine. The team comprises of Dr. N. Ramakrishnan (Medical Director), Dr. Ashwin Mani (Pulmonologist), Dr. Dedeepiya Devaprasad (Internal Medicine), Ms. Mary Isabel (Administrator), Ms. Hema Deenadayalan (Clinical Dietician), Sleep technicians (Mr. Vijay, Ms. Aruna & Ms. Sathiya and other part time tehcnicians), Lab technician (Ms. Devi). We share our experience of challenges and success over the past decade.

Clinical Experience: Patient Profile

Patient volume

The graph in Figure below depicts the growth pattern in patient volume. From a small number in 2004 (64 patients from July to Dec), there has been a steady increase in the number of new patients who have registered in the clinic with the total number close to 4000. This reflects a combination of increasing awareness and willingness to seek attention for medical problems.

Age and Gender of patients

There was a predominance of male patients (76.3%). Patients in the age group of 41-50 yrs represented the highest proportion (24%) and pediatric age group representing the least (1.4%).

Sleep disorders

The most common presenting sleep disorder was Obstructive Sleep Apnea (OSA) (50.5%), followed by Insomnia (41%). Circadian Rhythm disorders constituted 1.8%, and other sleep related disorders such as Narcolepsy, Restless Leg Syndrome (RLS) / Periodic Limb Movements Disorder (PLMD), Nocturnal Seizures, Bruxism and Fragmented sleep together constituted 5.35%.

Referral pattern

Patients presented to the Sleep clinic either referred by other physicians or on their own based on information available on print media and internet. Interestingly a majority of patients (55.6%) presented on their own and others were referred by physicians including Neurologists, Endocrinologists, Cardiologists Psychiatrists, ENT specialists and General physicians.

Patients’ Follow up visits

Patients who follow up are usually less, although the percentage has increased over the years from 10% in 2005 to 25% in 2014.

Academic Journey

Nithra Institute of Sleep Sciences has been accredited for one year fellowship training by Indian Sleep Disorders Association (ISDA). The institution also offers one year post doctoral fellowship accredited by Tamilnadu Dr MGR Medical University which is the first University affiliated training program in sleep medicine in India.

Short term training programs (two weeks) are offered for doctors that have gained popularity and sought by physicians from various parts of India and also a few International Physicians. Certified Polsymnography Technician (CPT) training programs have been offered and successful candidates have had immediate job placements.

Nithra Institute of Sleep Sciences hosted International Sleep Conference in association with Indian Sleep Disorders Association (ISDA) in 2009 and 2014. The center has also been publishing original research in peer reviewed journals and collaborated with other academic centers in research projects.

Public Education:

Creating awareness amongst general public has been a core mission and commitment of Nithra. Awareness camps, print and visual media campaigns are periodically organized. Our website (www.nithra.com) provides information on sleep disorders and books (print & audio books) have been published. Support group meetings are organized where patient families exchange information and the staff of Nithra provide supplemental information and advice.

Quality Journey:

Nithra Institute of Sleep Sciences has always been committed to quality and received ISO accreditation since early years. The institution also became the first allopathic clinic in south India to receive accreditation from National Board of Hospitals and Healthcare Organizations (NABH) in 2004 and currently is the only sleep center to have this recognition.

Way Forward:

Awareness about sleep problems and treatment options is steadily increasing in India although still far from desirable. OSA and Insomnia are leading problems, although circadian rhythm problems are also on the rise because of the Business Process Outsourcing (BPO) industry providing services to varied time zone. The predominance of self-referrals in comparison to physician referrals highlights the impact of media and internet on knowledge dissemination to the public and also the need to include Sleep Medicine in medical curriculum.

Training opportunities at Nithra Institute of Sleep Sciences, Chennai

Nithra Institute of Sleep Sciences has the unique distinction of offering the first University affiliated postdoctoral fellowship in Sleep Medicine. Our training program is accredited by The Tamilnadu Dr. MGR Medical University. In addition we are accredited by Indian Sleep Disorders Association to train post graduate doctors for one year diploma in sleep medicine. We also offer short term training programs for doctors and sleep technicians

1. Post doctoral Fellowship in Sleep Medicine (The Tamilnadu MGR Medical University)
   Course Duration: One Year
   Eligibility: Doctors with Post graduate degree in Medicine, Chest Medicine, Psychiatry, and Neurology are eligible to apply
2. Diploma in Sleep Medicine (Indian Sleep Disorders Association)
   Course Duration: One Year
   Eligibility: Doctors with postgraduate qualification in Internal Medicine, Chest Medicine/Pulmonary Medicine, Psychiatry, and Neurology & ENT are eligible to apply.
3. Short Term Courses in Sleep Medicine Only for Doctors
   • Basics of Sleep Medicine – One Week Course
   • Essentials of Sleep Medicine – Two weeks Course
4. Certified Polysomnography Technician (CPT) – 6 months

Interested Candidates can send their CV to info@nithra.com
For more details please log on to http://www.nithra.com/education-training/