Sleep DisordersPub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0043
A. May, T. Gildea, R. Mehra
{"title":"Is the Jury Out or In?","authors":"A. May, T. Gildea, R. Mehra","doi":"10.1093/MED/9780190671099.003.0043","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0043","url":null,"abstract":"This case illustrates potential perioperative complications associated with obstructive sleep apnea (OSA): respiratory decompensation sometimes leading to morbidity, mortality, increase in the level of care, and increased health care expenditures. OSA is common and affects more than 40% of the surgical population. However, an estimated 85% of those with OSA are undiagnosed preoperatively. This chapter describes an individual with severe OSA complicated by perioperative respiratory failure who required intensive care unit admission and emergent reintubation. This case is used to highlight perioperative considerations for OSA screening, testing, and treatment with a focus on respiratory management based on guideline recommendations. This case underscores the most common types and timing of such postoperative complications and ways to prevent and treat them.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72954788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0042
J. Rundo, H. Mehta, R. Mehra
{"title":"Dying to Fall Asleep","authors":"J. Rundo, H. Mehta, R. Mehra","doi":"10.1093/MED/9780190671099.003.0042","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0042","url":null,"abstract":"Fatal familial insomnia (FFI) is a rare autosomal dominant genetic disease characterized by progressive insomnia, autonomic hyperactivity, memory deficits, hallucinations, and myoclonus. Unlike its name, insomnia is not the most common initial presentation in patients with FFI. More common features like autonomic hyperactivity (hypertension and tachycardia) are often missed, delaying the diagnosis of FFI. Genetic analysis of FFI shows a D178N-129M mutation that results in generation of insoluble proteins (prion proteins) that aggregate to form amyloid plaques, leading to deterioration of the central nervous system, particularly in the hypothalamus. This case illustrates the difficulty in determining a definitive diagnosis in patients with FFI. Unfortunately, no treatment or cure is available for FFI. The disease is fatal in all the patients.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72782198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0041
E. P. Knight, M. Grigg-Damberger
{"title":"Spikes, Spikes Go Away!","authors":"E. P. Knight, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0041","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0041","url":null,"abstract":"The child described in this chapter presented with seizures and developmental regression and had continuous spike-wave discharges activated by non–rapid-eye-movement (NREM) sleep consistent with epileptic encephalopathy with continuous spikes and waves during slow-wave sleep (E-CSWS), which is a rare age-dependent pediatric epilepsy syndrome. The CSWS electroencephalographic pattern in children with E-CSWS usually develops 1 to 2 years after seizure onset. While the CSWS EEG pattern in NREM sleep is diagnostic of E-CSWS, the cardinal clinical symptoms are a progressive decline in cognitive, behavioral, and/or psychiatric functioning. The pattern of CSWS is more often associated with neurodevelopmental problems, and the almost continuous discharges are thought to contribute or cause them. Encountering a CSWS EEG on an EEG or PSG requires clinical correlation to determine whether it is (or will become) symptomatic, and whether it should (or can) be treated. CSWS affects all cognitive domains, including language and communication, temporo-spatial orientation, attention, and social interaction. Antecedent and birth history are usually normal, although structural brain abnormalities are seen in 20% to 50%, most often prenatal or perinatal lesions, involving thalamus in some.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88874915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0003
M. Grigg-Damberger, Kathy M Wolfe
{"title":"Introduction to Pediatric Sleep Clinic and Sleep Testing","authors":"M. Grigg-Damberger, Kathy M Wolfe","doi":"10.1093/MED/9780190671099.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0003","url":null,"abstract":"This chapter covers the diagnostic evaluation of children and adolescents referred to sleep centers. Diagnosis of sleep disorders in children begins with a structured history. Pediatric sleep questionnaires can be useful. Polysomnography can be frightening for children, and child-friendly polysomnography techniques are discussed. The authors outline how sleep studies are scored in children. The use of actigraphy, nocturnal home oximetry, and multiple sleep latency testing is reviewed. Smartphone apps for monitoring sleep/wake are summarized. The authors believe that more evidence of the validity of smartphone apps is needed before we accept data from them and integrate this information into decision making and the electronic medical records.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90871841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0023
J. Krishna, M. Grigg-Damberger
{"title":"Oh My, Wet Bed and Dry Mouth Lead to Wet Eyes","authors":"J. Krishna, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0023","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0023","url":null,"abstract":"The association between childhood obstructive sleep apnea (OSA) and sleep enuresis has been known for some time. This case discusses current understanding of the pathophysiologic relationship between the two. The authors also discuss the current diagnostic criteria and standardized terminology of enuresis as developed by the International Children’s Continence Society and the American Academy of Sleep Medicine. Components of a sleep history and physical examination that are key to establishing the complex relationships between enuresis and OSA are reviewed. Hypotheses for the higher prevalence of sleep enuresis in patients with OSA are summarized. Although the treatment of OSA often results in reversal of enuresis, and the mechanistic pathways appear plausible, the strength of evidence in the literature that OSA causes enuresis in children is not very strong, and further research is warranted.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79453059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0039
R. Downey, R. Mehra, S. Davin
{"title":"A Painful Trifecta","authors":"R. Downey, R. Mehra, S. Davin","doi":"10.1093/MED/9780190671099.003.0039","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0039","url":null,"abstract":"In clinical practice, the treatment of sleep disturbance in the setting of chronic pain can be challenging. In the case presented, a patient with a longstanding history of insomnia, chronic pain, and psychiatric comorbidity was recently assessed and treated for mild obstructive sleep apnea. With treatment, there was substantial clinical improvement in several areas of functioning. This helps to illustrate that addressing coexisting sleep problems can help more refractory symptoms, such as chronic pain. While severe impairment persisted, this complex patient had a rapid change in symptoms. The dynamic interplay between sleep, pain, and psychiatric disorders is discussed, as well as the finding of alpha intrusions and alpha-delta sleep on the patient’s polysomnogram. Treatment implications are addressed.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90622701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0001
R. Mehra, N. Foldvary-Schaefer, M. Grigg-Damberger
{"title":"Introduction to the Sleep Clinic Evaluation","authors":"R. Mehra, N. Foldvary-Schaefer, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0001","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0001","url":null,"abstract":"This chapter provides an overview of the clinical evaluation of sleep disorders, including the sleep history (sleep habits, nighttime and daytime symptoms), medical/surgical history, medication use, family history, and social/environmental factors that may impact sleep. Patient assessment tools are reviewed in terms of their composition and utility. Emerging literature elucidating the benefits and efficiencies of innovative models of care is reviewed. An overview of the classification and nosology of sleep disorders is provided based on the International Classification of Sleep Disorders. The use of consumer sleep technologies and wearable devices is discussed, including the American Academy of Sleep Medicine’s issued position statement on how sleep clinicians can best incorporate these new technologies in their clinical practice.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83783863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0044
M. Lavery, E. White
{"title":"Midnight Mystery","authors":"M. Lavery, E. White","doi":"10.1093/MED/9780190671099.003.0044","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0044","url":null,"abstract":"This chapter discusses the treatment of night eating syndrome (NES) in an obese man seeking bariatric surgery. There is some evidence to suggest that the prevalence of NES increases with higher body mass and is relatively common in the bariatric surgery population. NES is considered to be a contraindication for surgery by many bariatric surgery programs. Therefore, targeted treatment is often necessary prior to approval for surgery. Although research is still emerging in regards to treatment of NES, current approaches include pharmacologic, biologic, and behavioral or cognitive-behavioral interventions. The authors describe the application of key treatment approaches in the current case and differentiate NES, sleep-related eating disorder, and binge eating disorder.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89293926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-07-01DOI: 10.1155/2019/3184382
P. J. Edmonds, K. Gunasekaran, L. Edmonds
{"title":"Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus","authors":"P. J. Edmonds, K. Gunasekaran, L. Edmonds","doi":"10.1155/2019/3184382","DOIUrl":"https://doi.org/10.1155/2019/3184382","url":null,"abstract":"Aims Obstructive sleep apnea (OSA) is a common disorder with high morbidity, mortality, and an increasing prevalence in the general population. It has an even higher prevalence among individuals with type 2 diabetes mellitus (DM). The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-BANG) questionnaire and Berlin Questionnaire can be cumbersome in clinical practice and require subjective data on sleepiness. We proposed prospectively studying a primary care population with type 2 DM comparing neck grasp, neck circumference, and common screening questionnaires to identify OSA. Methods Persons with a diagnosis of type 2 DM were recruited from a primary care clinic. Participants were screened using Easy Sleep Apnea Predictor (ESAP), STOP-Bang questionnaire, and Berlin questionnaire. A positive ESAP was defined as a 1cm gap when a patient encircled their hands around the neck. All subjects underwent in-laboratory PSG testing. Results Forty-three participants were enrolled and the prevalence of OSA was 90.7% (AHI ≥ 5). The median BMI was 38.0. The prevalence of mild OSA by PSG (AHI 5-14) was 27.9%, moderate OSA (AHI 15-29) was 25.6%, and severe OSA (AHI >30) was 37.2%. For mild OSA both ESAP and neck circumference showed 100% specificity. Conclusions This study reinforces the need for screening diabetic persons for obstructive sleep apnea. ESAP and neck circumference are useful for identifying persons with type 2 DM who are at risk for OSA. Together these findings could improve recognition of OSA in persons at risk for cardiovascular disease. Trial Registration of “Neck grasp as a predictor of Sleep Apnea,” https://clinicaltrials.gov/ct2/show/NCT02474823, Clinical Trials.gov Identifier, is NCT02474823.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79983620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep DisordersPub Date : 2019-06-11DOI: 10.1155/2019/1278579
H. Lawson, J. T. Wellens-Mensah, Salamatu Attah Nantogma
{"title":"Evaluation of Sleep Patterns and Self-Reported Academic Performance among Medical Students at the University of Ghana School of Medicine and Dentistry","authors":"H. Lawson, J. T. Wellens-Mensah, Salamatu Attah Nantogma","doi":"10.1155/2019/1278579","DOIUrl":"https://doi.org/10.1155/2019/1278579","url":null,"abstract":"Background Sleep habits and problems play a vital role in determining sleep quality. We describe sleep habits and problems among medical students and assess their possible effect on self-reported academic performance. Methods We conducted a cross-sectional study among medical students at the University of Ghana during the 2014/2015 academic year. Data was collected using the Pittsburgh Sleep Quality Index (PSQI), a self-report questionnaire that assesses sleep quality over a 1-month time interval. Results 153 medical students were recruited comprising 83 (54.2%) females and 70 (45.8%) males with a mean age of 23.1 ± 2.4 years. The mean duration of night sleep was 5.7 ± 1.2 hours; 88 (57.5%) students had sleep latency of 10-30 minutes while 18 (11.8%) woke up nightly. 23 (15%) students experienced nightmares, 13 (8.5%) snored at night, and only one student reported coffee intake of 2-3 times daily. Sleep quality was poor in 86 (56.2%) and was significantly associated with sleep latency, morning tiredness, daytime sleepiness during lectures, academic performance, living conditions, leisure time, frequency of nocturnal awakenings, waking up due to noise, sleep walking, and nocturnal awakening to use washroom. There was also a significant positive relation between sleep quality and academic performance (X2 = 10.004 p = 0.019). Conclusion Poor sleep quality and daytime dysfunction are widespread among medical students in Ghana. There was a significant positive relation between sleep quality and self-reported academic performance.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85144243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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