Cerebral Anoxic Attacks in Sleep Apnea Syndrome
|
|
- Juniper Dalton
- 5 years ago
- Views:
Transcription
1 Sleep 12(5): , Raven Press, Ltd., New York 1989 Association of Professional Sleep Societies Cerebral Anoxic Attacks in Sleep Apnea Syndrome Fabio Cirignotta, Marco Zucconi, Susanna Mondini, Roberto Gerardi, and Elio Lugaresi Institute of Neurology, University of Bologna, Italy Summary: In a 52-year-old man who presented with an obstructive sleep apnea (OSAS) syndrome, we observed cerebral anoxic attacks during rapid eye movement (REM) sleep. Polysomnography showed that the attacks were due to severe hypoxia provoked by apneas lasting up to 220 s. Electroencephalogram (EEG) and clinical features clearly differentiate cerebral anoxic attacks from epileptic seizures. The length of apneas in our patient is very unusual, indicating an impairment of the mechanism terminating apneas. The cause of this impairment is unknown. However, this case report documents a possible pathogenetic mechanism other than heart arrhythmias responsible for sudden death or coma arising during sleep. Key Words: Sleep apnea-cerebral anoxic attack. In 1960, Houdart et al. (1) reported epileptic seizures during sleep in a patient with Pickwickian syndrome, and ascribed the fits to apnea-induced anoxia. Few other reports of seizures in sleep apnea syndrome are available in the literature (2,3). On the other hand, without electroencephalogram (EEG) monitoring it is not easy to discriminate epileptic seizures from cerebral anoxic attacks. This is the first polygraphically documented report of cerebral anoxic attacks provoked by obstructive sleep apneas. CASE REPORT A 52-year-old man working in a factory for orthopedic fittings since age 14 was referred to us for daytime sleepiness and heavy snoring. He had been snoring since age 20, and at age 51, had experienced a hypercapnic coma during sleep which lasted several hours. His wife reported that during the last few months he had presented sporadic "jerks" during sleep. Neurological examination and electromyogram (EMG) showed a mild polyneuropathy in the lower limbs, attributed to solvents, (including n-hexane), which he had been exposed to for over 30 years. Autonomic studies included tilt table test, Valsalva maneuver, and deep breathing Accepted for publication May Address correspondence and reprint request to Dr. F. Cirignotta, Institute of Neurology, via U. Foscolo 7,40123, Bologna, Italy. 400
2 CEREBRAL ANOXIA IN SLEEP APNEA 401 test, which were normal. On testing the diving reflex, however, the patient had a cardiac arrest lasting 5 s as soon as his face was immersed. Pulmonary function evaluation during wakefulness demonstrated a mild restrictive syndrome (forced expiratory volume in 1 s/forced vital capacity = 85.5%) with slight hypoxemia (arterial P mm Hg) and mild hypercapnia (arterial PC mm Hg), normalized by hyperventilation. The ventilatory response to inhaled CO 2 was normal (1.6 Llmin/mm Hg). Ventilatory response to hypoxia was not investigated. Electrocardiogram (ECG) was normal. The patient underwent all-night TV -monitored polysomnographic recording, including EEG, electrooculogram, submental and intercostal EMG, ECG, oral-nasal, thoracic, and abdominal respirogram, ear oximetry (Biox III, BTl, Boulder, CO), and snoring noise. During non-rapid-eye-movement (NREM) sleep the breathing pattern was characterized by heavy snoring and obstructive apneas. The apneas were 40.9/h, lasting 49 ± 23 s, with a mean low arterial oxygen saturation (Sa0 2 ) of 70.6 ± 17% and a lowest Sa0 2 of 40%. During continuous snoring, a progressive hypoxia occurred (lowest Sa0 2 54%) (Fig. O. At the onset of each rapid-eye-movement (REM) period, the apneas immediately became more prolonged, lasting 166 ± 51 s. Seven of 10 apneas in REM led to an attack characterized by slowing and then flattening of EEG activity, followed by a generalized spasm lasting 5-10 s. Before, during, and after the attacks, no epileptic activity was recorded in the EEG: heart rate did not change significantly during the apneas (Figs. 2 and 3). After the attacks, the patient did not wake up; the EEG showed generalized theta activity for 1-2 min and then a stage 2 or REM sleep reappeared. The patient was not aware of the attacks on awakening in the morning. Sleep structure was disrupted by 311 arousals; total sleep time = 427 min; sleep latency == 9 min; Stl = 137 min (32.1%); St2 = 266 min (62.4%); St 3 == 3 min (0.7%); St 4 = 0 min; REM sleep 21 min (4.6%); first REM latency = 30 min. Given the risks, the patient underwent tracheostomy combined with uvulopalato-pharyngo-plasty surgery. Three months later, he was again hospitalized and slept for 7 consecutive nights with his tracheal stoma closed. Polysomnographic recordings were made on the 7th night and showed regular breathing, even in REM sleep, N:~E ~ U --...,UU ,UU ,U 85 Sa II It Microph. 20 mv 24 FIG. 1. Top to bottom: schematic hypnogram (arousals are not marked), SaOz, snoring noise, time. Arrows indicate the anoxic attacks appearing after the first or second apnea of each REM sleep period. Snoring, associated with progressive hypoxia, is evident from the continuous noise picked up by the microphone (h ; h ). Sleep, Vol. 12, No.5, 1989
3 402 F. CIRIGNOTTA ET AL. 1 ~ 2 + C 3 - A. """'Mf...w.""""..."..""""""""... """'-..,---"""f'v'{'-"~...,--.. O~-A, ~~~~~~~~~-v~~~~---v~~ C.A, ~~~~~~~~~~~~~~~~~~~~ ROC loc ~ ~r-~~~-f~~~~~-v~~~~ My'o EMG '11'" EKG Intercostal EMG ~'" I, ~! I!, I! I I! 'd I (., 1. rasp. Duration of apnea Sa O 2 < ,'...,"',' """4~... d,..., 200.~.. 'FIG. 2. Polysomnographic recording of a anoxic attack in REM sleep. At first the EEG tracing slows (arrow 1), then after 200 s of apnea and 90 s of severe hypoxia (Sa02 < 40%), a flattening of EEG appears (arrow 2), followed 15 s later by muscular artifacts due to a generalized spasm (arrow 3). Opening of the upper airways occurs during the spasm. when the patient was lying on his side. When in a supine position, obstructive apneas were present but lasted under 40 s (lowest Sa02 = 60%). No attacks occurred. DISCUSSION REM sleep in our patient was disrupted by apneas of such duration (over 3 min) as to provoke anoxic cerebral attacks. As we did not monitor systemic arterial pressure, cerebral ischemia could not be ruled out as a cofactor of the attacks. Duration of the apnea-related anoxic state alone, however, could account for the attacks, irrespective of a reduction in cerebral blood flow. The anoxic origin of the attacks was confirmed by the flattening of the EEG tracings and the following generalized tonic spasm. These clinical and EEG patterns clearly differentiate the attacks from epileptic seizures (4). Pure anoxic cerebral attacks have been reported in children during wakefulness as "sobbing spasms" or "breath-holding spells." As far as we know, these attacks have never been described in adults or in patients with obstructive sleep apnea (OSAS). In the literature on OSAS, epileptic seizures have been reported previously (1-3), however, the clinical EEG features of these seizures arising during sleep were not reported in detail. Even in'those cases, the seizures could have been cerebral anoxic attacks. In our patient, apneas lengthened, provoking attacks immediately after the beginning of each REM sleep period. This can be explained considering the mechanism responsible for arousal which terminates the apneas. The hypoxia and reflexes triggered by the occluded airways seem to playa major role, probably mediated by the carotid bodies and oropharyngeal mechanoreceptors (5-6). Arousal response during REM sleep is reduced with respect to NREM sleep, and this explains why in OSAS the longest apneas occur during REM sleep (7-8). In our patient, the arousal response seems sufficiently impaired to lead to an anoxic attack. Such unusual duration of the apneas I 5 s, I Sleep, Vol, 12, No.5, 1989
4 CEREBRAL ANOXIA IN SLEEP APNEA 403 (a) (b) (c) FIG. 3. Video pictures of an attack occurring during REM sleep. The sequence lasts 75. At the end of a prolonged apnea (a) the patient suddenly pulls his legs up and throws his head back (b) then relaxes (c). was probably related to a reduced reactivity to the chemoreceptor stimuli. A chemoreceptorial impairment was also suggested by the tendency to hypoventilate during wakefulness, the hypoxia being induced by the only slight respiratory overload provoked by snoring and the scant variations in heart rate during the apneas. The causes of this autonomic impairment are unknown. However, we can speculate that, according to recent findings (9), more than 30 years' chronic exposure to solvents could have been responsible for the dysfunction observed in our patients. We could not perform serial polygraphic recordings to determine whether the patient presented such a high number of attacks every night. The anamnesis and the short latency of first REM sleep, however, suggest that REM disruption provoked by the attacks was not a chance finding. Tilkian et al. (10) have emphasized the importance of cardiac arrhythmias as major risk factors for death in patients with OSAS. Our case documents another pathogenetic mechanism responsible for sudden death or coma arising during sleep. REFERENCES 1. Houdart R, Mamo H, Tomkiewicz H. La forme epileptogene du syndrome de Pickwick. Rev Neural 1960; 103: Sleep, Vol. 12. No.5, 1989
5 404 F. CIRIGNOTTA ET AL. 2. Kryger M, Quesney LF, Holder D, Gloor P, MacLeod P. The sleep deprivation syndrome of the obese patient. Ani J Afed 1974;56: Guilleminault C. Natural history, cardiac impact and long-term follow-up of sleep apnea syndrome. In: Guilleminault C, Lugaresi E, eds. Sleep/wake disorders: natural history, epidemiology, and long-term evolution. New York: Raven Press, 1983: Gastaut H. Syncopes: generalized anoxic cerebral seizures. In: Vinken P, Bruin GW, eds. Handbook of clinical neurology, vol. 15. Amsterdam: Elsevier, 1974: Bowes G, Phillipson EA. Arousal responses to respiratory stimuli during sleep. In: Saunders NA, Sullivan CE, eds. Sleep and breathing. New York: Marcel Dekker, 1984: Sullivan CE, Saunders NA, Issa FG, Berthon-Jones M. Pathophysiology of sleep apnea. In: Saunders NA, Sullivan CE, eds. Sleep and breathing. New York: Marcel Dekker, 1984: Phillipson EA. Control of breathing during sleep. Am Rev Respir Dis 1978;118: Lugaresi E, Coccagna G, Mantovani M, Cirignotta F, Ambrosetto G, Baturic P. Hypersomnia with periodic breathing: periodic apneas and alveolar hypo ventilation during sleep. Bull Physiopath Resp 1972;8: Matikainen E, Juntunen 1. Autonomic nervous system dysfunction in workers exposed to organic solvents. J Neurol Neurosurg Psychiatry 1985;48: Tilkian AG, Motta J, Guilleminault C. Cardiac arrhythmias in sleep apnea. In: Guilleminault C, Dement WC, eds. Sleep apnea syndromes. New York: Alan R. Liss, 1978: Sleep, Vol. 12, No.5, 1989
In 1994, the American Sleep Disorders Association
Unreliability of Automatic Scoring of MESAM 4 in Assessing Patients With Complicated Obstructive Sleep Apnea Syndrome* Fabio Cirignotta, MD; Susanna Mondini, MD; Roberto Gerardi, MD Barbara Mostacci, MD;
More informationA 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation
1 A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation The following 3 minute polysomnogram (PSG) tracing was recorded in a 74-year-old man with severe ischemic cardiomyopathy
More informationPatterns of Sleepiness in Various Disorders of Excessive Daytime Somnolence
Sleep, 5:S165S174 1982 Raven Press, New York Patterns of Sleepiness in Various Disorders of Excessive Daytime Somnolence F. Zorick, T. Roehrs, G. Koshorek, J. Sicklesteel, *K. Hartse, R. Wittig, and T.
More information(To be filled by the treating physician)
CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type
More informationAssessment of Sleep Disorders DR HUGH SELSICK
Assessment of Sleep Disorders DR HUGH SELSICK Goals Understand the importance of history taking Be able to take a basic sleep history Be aware the technology used to assess sleep disorders. Understand
More informationBi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients
Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Objectives Describe nocturnal ventilation characteristics that may indicate underlying conditions and benefits of bilevel therapy for specific
More informationUsing the Pathophysiology of Obstructive Sleep Apnea (OSA) to Teach Cardiopulmonary Integration
Using the Pathophysiology of Obstructive Sleep Apnea (OSA) to Teach Cardiopulmonary Integration Michael G. Levitzky, Ph.D. Department of Physiology Louisiana State University Health Sciences Center 1901
More informationPEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA)
PEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA) DEFINITION OSA Inspiratory airflow is either partly (hypopnea) or completely (apnea) occluded during sleep. The combination of sleep-disordered breathing with daytime
More informationCauses and Consequences of Respiratory Centre Depression and Hypoventilation
Causes and Consequences of Respiratory Centre Depression and Hypoventilation Lou Irving Director Respiratory and Sleep Medicine, RMH louis.irving@mh.org.au Capacity of the Respiratory System At rest During
More informationSleep Medicine. Maintenance of Certification Examination Blueprint. Purpose of the exam
Sleep Medicine Maintenance of Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the
More informationSleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease
1 Sleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease Rami Khayat, MD Professor of Internal Medicine Director, OSU Sleep Heart Program Medical Director, Department of
More informationIndex SLEEP MEDICINE CLINICS. Note: Page numbers of article titles are in boldface type. Cerebrospinal fluid analysis, for Kleine-Levin syndrome,
165 SLEEP MEDICINE CLINICS Index Sleep Med Clin 1 (2006) 165 170 Note: Page numbers of article titles are in boldface type. A Academic performance, effects of sleepiness in children on, 112 Accidents,
More informationKENNEDY DISEASE PULMONARY CONSIDERATIONS: SCIENCE & MANAGEMENT STRATEGIES
KENNEDY DISEASE PULMONARY CONSIDERATIONS: SCIENCE & MANAGEMENT STRATEGIES When you can t breathe nothing else matters American Lung Association Noah Lechtzin, MD; MHS Associate Professor of Medicine Johns
More informationCoding for Sleep Disorders Jennifer Rose V. Molano, MD
Practice Coding for Sleep Disorders Jennifer Rose V. Molano, MD Accurate coding is an important function of neurologic practice. This section of is part of an ongoing series that presents helpful coding
More informationSleep and the Heart. Sleep Stages. Sleep and the Heart: non REM 8/31/2016
Sleep and the Heart Overview of sleep Hypertension Arrhythmias Ischemic events CHF Pulmonary Hypertension Cardiac Meds and Sleep Sleep Stages Non-REM sleep(75-80%) Stage 1(5%) Stage 2(50%) Stage 3-4*(15-20%)
More informationIndex SLEEP MEDICINE CLINICS. Note: Page numbers of article titles are in boldface type.
549 SLEEP MEDICINE CLINICS Sleep Med Clin 1 (2007) 549 553 Note: Page numbers of article titles are in boldface type. A Abdominal motion, in assessment of sleep-related breathing disorders, 452 454 Adherence,
More informationBasics of Polysomnography. Chitra Lal, MD, FCCP, FAASM Assistant professor of Medicine, Pulmonary, Critical Care and Sleep, MUSC, Charleston, SC
Basics of Polysomnography Chitra Lal, MD, FCCP, FAASM Assistant professor of Medicine, Pulmonary, Critical Care and Sleep, MUSC, Charleston, SC Basics of Polysomnography Continuous and simultaneous recording
More informationSleep Diordered Breathing (Part 1)
Sleep Diordered Breathing (Part 1) History (for more topics & presentations, visit ) Obstructive sleep apnea - first described by Charles Dickens in 1836 in Papers of the Pickwick Club, Dickens depicted
More informationmore than 50% of adults weigh more than 20% above optimum
In the US: more than 50% of adults weigh more than 20% above optimum >30 kg m -2 obesity >40 kg m -2 morbid obesity BMI = weight(kg) / height(m 2 ) Pounds X 2.2 Inches divided by 39, squared From 2000
More informationSleep Complaints and Disorders in Epileptic Patients 순천향의대천안병원순천향의대천안병원신경과양광익
Sleep Complaints and Disorders in Epileptic Patients 순천향의대천안병원순천향의대천안병원신경과양광익 Introduction The global physical, social and economic consequence of epilepsy are high. WHO 2000 study Improving QoL is increasingly
More informationCircadian Variations Influential in Circulatory & Vascular Phenomena
SLEEP & STROKE 1 Circadian Variations Influential in Circulatory & Vascular Phenomena Endocrine secretions Thermo regulations Renal Functions Respiratory control Heart Rhythm Hematologic parameters Immune
More informationPediatric Sleep-Disordered Breathing
Pediatric Sleep-Disordered Breathing OSA in infants and young children is generally characterized by partial, persistent obstruction of the upper airway Continuum Benign primary snoring Upper-airway resistance
More informationEffect of Metabolic Acidosis Upon Sleep Apnea*
Effect of Metabolic Upon Sleep Apnea* john T. Sharp, M.D., F.C.C.P.; WalterS. Druz, Ph.D.; Vivian D'Souza, M.D.; and Edward Diamond, M.D. The effects of metabolic acidosis upon the pattern of apnea during
More informationH-Reflex Suppression and Autonomic Activation During Lucid REM Sleep: A Case Study
Sleep 12(4):374-378, Raven Press, Ltd., New York 1989 Association of Professional Sleep Societies Short Communication H-Reflex Suppression and Autonomic Activation During Lucid REM Sleep: A Case Study
More informationArousal detection in sleep
Arousal detection in sleep FW BES, H KUYKENS AND A KUMAR MEDCARE AUTOMATION, OTTHO HELDRINGSTRAAT 27 1066XT AMSTERDAM, THE NETHERLANDS Introduction Arousals are part of normal sleep. They become pathological
More informationExcessive Daytime Sleepiness Associated with Insufficient Sleep
Sleep, 6(4):319-325 1983 Raven Press, New York Excessive Daytime Sleepiness Associated with Insufficient Sleep T. Roehrs, F. Zorick, J. Sicklesteel, R. Wittig, and T. Roth Sleep Disorders and Research
More informationIncreasing the Functional Residual Capacity May Reverse Obstructive Sleep Apnea
Sleep 11(4):349-353, Raven Press, Ltd., New York 1988 Association of Professional Sleep Societies ncreasing the Functional Residual Capacity May Reverse Obstructive Sleep Apnea F. Series, Y. Cormier, N.
More informationImprovement of epileptic seizure control with treatment of obstructive sleep apnoea
Seizure 1996; 5:73-78 Improvement of epileptic seizure control with treatment of obstructive sleep apnoea BRADLY V. VAUGHN, O'NILL F. D'CRUZ, ROBRT BACH & JOHN A. MSSNHIMR Department of Neurology, School
More informationSNORING AND OBSTRUCTIVE SLEEP APNOEA WAYS TO DEAL WITH THESE PROBLEMS
SNORING AND OBSTRUCTIVE SLEEP APNOEA WAYS TO DEAL WITH THESE PROBLEMS Laugh and the world laughs with you; snore and you sleep alone. These words by novelist Anthony Vergess ring true with all too many
More informationSleep Apnea Syndromes: Impact of Sleep and Sleep States
Sleep. 3(3/4):227-234 1980 Raven Press. New York Sleep Apnea Syndromes: Impact of Sleep and Sleep States Christian Guilleminault Sleep Disorders Center. Stanford University School of Medicine. Stanford,
More informationWhat is SDB? Obstructive sleep apnea-hypopnea syndrome (OSAHS)
Have a Good Sleep? Estimated 70 million Americans have clinically significant sleep problems Chronic insomnias report decreased quality of life, memory and attention problems, decreased physical health
More informationSleep Apnea: Diagnosis & Treatment
Disclosure Sleep Apnea: Diagnosis & Treatment Lawrence J. Epstein, MD Sleep HealthCenters Harvard Medical School Chief Medical Officer for Sleep HealthCenters Sleep medicine specialty practice group Consultant
More informationPeriodic Leg Movement, L-Dopa, 5-Hydroxytryptophan, and L-Tryptophan
Sleep 10(4):393-397, Raven Press, New York 1987, Association of Professional Sleep Societies Short Report Periodic Leg Movement, L-Dopa, 5-Hydroxytryptophan, and L-Tryptophan C. Guilleminault, S. Mondini,
More informationA Scream in the Night. ARTP Conference 2010 Dr Christopher Kosky
A Scream in the Night ARTP Conference 2010 Dr Christopher Kosky Parasomnia Slow Wave Sleep Arousal Disorder REM Sleep Behaviour Disorder Nocturnal Epilepsy Catathrenia Slow Wave Sleep Arousal Disorders
More informationSleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK
Sleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK Sleep Disordered Breathing in CHF Erratic breathing during sleep known for years e.g.
More informationChallenging Cases in Pediatric Polysomnography. Fauziya Hassan, MBBS, MS Assistant Professor Pediatric Pulmonary and Sleep
Challenging Cases in Pediatric Polysomnography Fauziya Hassan, MBBS, MS Assistant Professor Pediatric Pulmonary and Sleep Conflict of Interest None pertaining to this topic Will be using some slides from
More informationAlexandria Workshop on
Alexandria Workshop on 1 Snoring & OSA Surgery Course Director: Yassin Bahgat MD Claudio Vicini MD Course Board: Filippo Montevecchi MD Pietro Canzi MD Snoring & Obstructive ti Sleep Apnea The basic information
More informationSleep and the Heart. Physiologic Changes in Cardiovascular Parameters during Sleep
Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University
More informationSleep and the Heart. Rami N. Khayat, MD
Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University
More informationSLEEP APNOEA DR TAN KAH LEONG ALVIN CO-DIRECTOR SLEEP LABORATORY SITE CHIEF SDDC (SLEEP) DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD & NECK SURGERY
SLEEP APNOEA DR TAN KAH LEONG ALVIN CO-DIRECTOR SLEEP LABORATORY SITE CHIEF SDDC (SLEEP) DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD & NECK SURGERY
More informationMario Kinsella MD FAASM 10/5/2016
Mario Kinsella MD FAASM 10/5/2016 Repetitive episodes of apnea or reduced airflow Due to upper airway obstruction during sleep Patients often obese Often have hypertension or DM 1 Obstructive apneas, hypopneas,
More informationNATIONAL COMPETENCY SKILL STANDARDS FOR PERFORMING POLYSOMNOGRAPHY/SLEEP TECHNOLOGY
NATIONAL COMPETENCY SKILL STANDARDS FOR PERFORMING POLYSOMNOGRAPHY/SLEEP TECHNOLOGY Polysomnography/Sleep Technology providers practice in accordance with the facility policy and procedure manual which
More informationKey words: adenotonsillectomy; arousal; rapid eye movement sleep; sleep apnea
Sleep Characteristics Following Adenotonsillectomy in Children With Obstructive Sleep Apnea Syndrome* Asher Tal, MD; Amir Bar, MD; Alberto Leiberman, MD; and Ariel Tarasiuk, PhD Objective: To compare the
More informationHigh Flow Nasal Cannula in Children During Sleep. Brian McGinley M.D. Associate Professor of Pediatrics University of Utah
High Flow Nasal Cannula in Children During Sleep Brian McGinley M.D. Associate Professor of Pediatrics University of Utah Disclosures Conflicts of Interest: None Will discuss a product that is commercially
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Effective Date: October 15, 2018 Related Policies: 2.01.18 Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome Polysomnography for Non-Respiratory Sleep Disorders
More informationPolysomnography (PSG) (Sleep Studies), Sleep Center
Policy Number: 1036 Policy History Approve Date: 07/09/2015 Effective Date: 07/09/2015 Preauthorization All Plans Benefit plans vary in coverage and some plans may not provide coverage for certain service(s)
More informationTitle: Polysomnography and Sleep Studies Division: Medical Management Department: Utilization Management
Retired Date: Page 1 of 14 1. POLICY DESCRIPTION: Polysomnography and Sleep Studies 2. RESPONSIBLE PARTIES: Medical Management Administration, Utilization Management, Integrated Care Management, Pharmacy,
More informationBeyond Sleep Apnoea. Dr Justin Pepperell DA SODIT 2017
Beyond Sleep Apnoea Dr Justin Pepperell DA SODIT 2017 disclosures Introduction Sleep and its disorders Obstructive sleep apnea Other common sleep disorders Critical illness sleep disorders Bonus BIS monitoring
More informationA TECH S TOOLKIT FOR THE PEDIATRIC SLEEP LAB
A TECH S TOOLKIT FOR THE PEDIATRIC SLEEP LAB Craig Canapari, MD craig.canapari@gmail.com drcraigcanapari.com: Updated syllabus will be here along with link to visual presentation. Twitter: DrCanapari INTRODUCTION
More informationIndex. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Actigraphy, 475, 485, 496 Adolescents, sleep disorders in, 576 578 Adults, sleep disorders in, 578 580 Advanced sleep phase disorder, 482 Age,
More informationAppendix 1. Practice Guidelines for Standards of Adult Sleep Medicine Services
Appendix 1 Practice Guidelines for Standards of Adult Sleep Medicine Services 1 Premises and Procedures Out-patient/Clinic Rooms Sleep bedroom for PSG/PG Monitoring/Analysis/ Scoring room PSG equipment
More informationSleep is that golden chain that ties health and our bodies together. Thomas Dekker, English dramatist ( ).
Sleep Sleep is that golden chain that ties health and our bodies together. Thomas Dekker, English dramatist (1572-1632). Without adequate sleep people become irritable, have lowered resistance to illness,
More informationOxygen treatment of sleep hypoxaemia in Duchenne
Thorax 1989;44:997-1001 Oxygen treatment of sleep hypoxaemia in Duchenne muscular dystrophy P E M SMITH, R H T EDWARDS, P M A CALVERLEY From the Muscle Research Centre, University Department ofmedicine
More informationRespiratory/Sleep Disorder Breathing (SDB) SDB is highly prevalent, under recognized, under reported and under treated
Respiratory/Sleep Disorder Breathing (SDB) Definitions SDB is highly prevalent, under recognized, under reported and under treated Central 1. Central sleep apnea (CSA) is defined by the cessation of air
More informationMilena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical
Milena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical Director, Faulkner EEG and Sleep Testing Center Course
More informationCONTROL OF BREATHING DURING WAKEFULNESS AND SLEEP. Renata Pecotić, M.D., PhD.
CONTROL OF BREATHING DURING WAKEFULNESS AND SLEEP Renata Pecotić, M.D., PhD. Shev Gul, BSc, NLP & Hypnosis Master Pract, Life and Sports Coach, WSCA, ASCA, ASA GB FIOS(cc) Why do we have to breathe?? Breathing
More informationSleep Apnea and Body Position during Sleep
Sleep 11(1):9-99, Raven Press, Ltd" New York 1988 Association of Professional Sleep Societies Sleep Apnea and Body Position during Sleep C. F. George, T. W. Millar, and M. H. Kryger Department / Respiratory
More informationMedical Policy Original Effective Date:01/23/2019
Page 1 of 17 Disclaimer Description Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans or the plan may have broader or more
More informationAutomobile Accidents in Patients with Sleep Disorders
Sleep 12(6):487-494, Raven Press, Ltd., New York 1989 Association of Professional Sleep Societies Automobile Accidents in Patients with Sleep Disorders Michael S. Aldrich Department of Neurology, University
More informationOSA and COPD: What happens when the two OVERLAP?
2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine
More informationSleep and Neuromuscular Disease. Sharon De Cruz, MD Tisha Wang, MD
Sleep and Neuromuscular Disease Sharon De Cruz, MD Tisha Wang, MD Case Presentation Part I GR is a 21-year old male with Becker muscular dystrophy who comes to your office complaining of progressively
More informationDisclosures. Acknowledgements. Sleep in Autism Spectrum Disorders: Window to Treatment and Etiology NONE. Ruth O Hara, Ph.D.
Sleep in Autism Spectrum Disorders: Window to Treatment and Etiology Ruth O Hara, Ph.D. Associate Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine Disclosures
More informationEFFICACY OF MODAFINIL IN 10 TAIWANESE PATIENTS WITH NARCOLEPSY: FINDINGS USING THE MULTIPLE SLEEP LATENCY TEST AND EPWORTH SLEEPINESS SCALE
EFFICACY OF MODAFINIL IN 10 TAIWANESE PATIENTS WITH NARCOLEPSY: FINDINGS USING THE MULTIPLE SLEEP LATENCY TEST AND EPWORTH SLEEPINESS SCALE Shih-Bin Yeh 1 and Carlos Hugh Schenck 2,3 1 Department of Neurology
More informationPeriodic Leg Movements in Narcolepsy
In: Nacrolepsy: Symptoms, Causes... ISBN: 978-1-60876-645-1 Editor: Guillermo Santos, et al. 2009 Nova Science Publishers, Inc. Chapter 7 Periodic Leg Movements in Narcolepsy Ahmed Bahammam * Sleep Disorders
More informationF. Barbé*, M.A. Quera-Salva**, C. McCann**, Ph. Gajdos**, J.C. Raphael**, J. de Lattre**, A.G.N. Agustí*
Eur Respir J, 1994, 7, 143 148 DOI: 1.1183/931936.94.78143 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1994 European Respiratory Journal ISSN 93-1936 Sleep-related respiratory disturbances
More informationSimplest method: Questionnaires. Retrospective: past week, month, year, lifetime Daily: Sleep diary What kinds of questions would you ask?
Spencer Dawson Simplest method: Questionnaires Retrospective: past week, month, year, lifetime Daily: Sleep diary What kinds of questions would you ask? Did you nap during the day? Bed time and rise time
More informationThe AASM Manual for the Scoring of Sleep and Associated Events
The AASM Manual for the Scoring of Sleep and Associated Events The 2007 AASM Scoring Manual vs. the AASM Scoring Manual v2.0 October 2012 The American Academy of Sleep Medicine (AASM) is committed to ensuring
More informationNational Sleep Disorders Research Plan
Research Plan Home Foreword Preface Introduction Executive Summary Contents Contact Us National Sleep Disorders Research Plan Return to Table of Contents SECTION 5 - SLEEP DISORDERS SLEEP-DISORDERED BREATHING
More informationAHA Sleep Apnea and Cardiovascular Disease. Slide Set
AHA 2008 Sleep Apnea and Cardiovascular Disease Slide Set Based on the AHA 2008 Scientific Statement Sleep Apnea and Cardiovascular Disease Virend K. Somers, MD, DPhil, FAHA, FACC Mayo Clinic and Mayo
More informationThe AASM Manual for the Scoring of Sleep and Associated Events
The AASM Manual for the Scoring of Sleep and Associated Events Summary of Updates in Version 2.1 July 1, 2014 The American Academy of Sleep Medicine (AASM) is committed to ensuring that The AASM Manual
More informationQuestions: What tests are available to diagnose sleep disordered breathing? How do you calculate overall AHI vs obstructive AHI?
Pediatric Obstructive Sleep Apnea Case Study : Margaret-Ann Carno PhD, CPNP, D,ABSM for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee April 2014. Facilitator s guide Part
More informationRelationship of Periodic Movements in Sleep (Nocturnal Myoclonus) and the Babinski Sign
Sleep. 8(3):239-243 1985 Raven Press. New York Relationship of Periodic Movements in Sleep (Nocturnal Myoclonus) and the Babinski Sign Robert C. Smith Sleep Disorders Center. St. Louis University. St.
More informationIntroducing the WatchPAT 200 # 1 Home Sleep Study Device
Introducing the WatchPAT 200 # 1 Home Sleep Study Device Top 10 Medical Innovation for 2010 Cleveland Clinic Fidelis Diagnostics & Itamar Medical Fidelis Diagnostics founded in 2004, is a privately-held
More informationHypoventilation? Obstructive Sleep Apnea? Different Tests, Different Treatment
Hypoventilation? Obstructive Sleep Apnea? Different Tests, Different Treatment Judith R. Fischer, MSLS, Editor, Ventilator-Assisted Living (fischer.judith@sbcglobal.net) Thanks to Josh Benditt, MD, University
More informationOpioids Cause Central and Complex Sleep Apnea in Humans and Reversal With Discontinuation: A Plea for Detoxification
pii: jc-16-00020 http://dx.doi.org/10.5664/jcsm.6628 CASE REPORTS Opioids Cause Central and Complex Sleep Apnea in Humans and Reversal With Discontinuation: A Plea for Detoxification Shahrokh Javaheri,
More informationPEDIATRIC SLEEP GUIDELINES Version 1.0; Effective
MedSolutions, Inc. Clinical Decision Support Tool Diagnostic Strategies This tool addresses common symptoms and symptom complexes. Requests for patients with atypical symptoms or clinical presentations
More informationInterdisciplinary Care of the Patient with Amyotrophic Lateral Sclerosis Respiratory Therapy Care
Peggy Cox, RRT, RN Frazier Rehab Institute Pulmonary Rehab Interdisciplinary Care of the Patient with Amyotrophic Lateral Sclerosis Respiratory Therapy Care Disclosure I have the following relevant financial
More informationJosé Haba-Rubio, MD; Jean-Paul Janssens, MD; Thierry Rochat, MD, PhD; and Emilia Sforza, MD, PhD
Rapid Eye Movement-Related Disordered Breathing* Clinical and Polysomnographic Features José Haba-Rubio, MD; Jean-Paul Janssens, MD; Thierry Rochat, MD, PhD; and Emilia Sforza, MD, PhD Objective: The existence
More information3/10/2014. Pearls to Remember. 1) Consequences of OSA related to both arousals and hypoxia. 2) Arousals provoke increased
Cardiovascular disease and Sleep Disorders Timothy L. Grant, M.D.,F.A.A.S.M. Medical Director Baptist Sleep Center at Sunset Medical Director Baptist Sleep Education Series Medical Director Sleep Division
More informationROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA
ROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA A Person is physically qualified to drive a motor vehicle if that person; -(5) has no established medical history or clinical diagnosis
More informationDr. Karan Madan Senior Resident
SLEEP DISORDERED BREATHING DIAGNOSIS & MANAGEMENT Dr. Karan Madan Senior Resident Department of Pulmonary medicine Sleep disordered breathing (SDB) Definition- Sleep-disordered breathing (SDB) is present
More informationJulie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist
Julie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist Objectives Define capnography vs. end tidal CO2 (EtCO 2 ) Identify what normal vs. abnormal EtCO2 values mean and what to do Understand when to
More informationChildhood Obstructive Sleep Apnea
Childhood Obstructive Sleep Apnea 1 PROF. RAJESHWAR DAYAL MD, FAMS,FIAP,DNB, DCH (LONDON) NATIONAL CONVENOR,IAP SLEEP PROGRAM NATIONAL VICE PRESIDENT IAP 2011 HEAD DEPARTMENT OF PAEDIATRICS S. N. MEDICAL
More informationThe Effect of a Mandibular Advancement Device on Apneas and Sleep in Patients With Obstructive Sleep Apnea*
The Effect of a Mandibular Advancement Device on Apneas and Sleep in Patients With Obstructive Sleep Apnea* Marie Marklund, DDS; Karl A. Franklin, MD, PhD, FCCP; Carin Sahlin, RTA; and Rune Lundgren, MD,
More informationBrian Palmer, D.D.S, Kansas City, Missouri, USA. April, 2001
Brian Palmer, D.D.S, Kansas City, Missouri, USA A1 April, 2001 Disclaimer The information in this presentation is for basic information only and is not to be construed as a diagnosis or treatment for any
More informationIn-Patient Sleep Testing/Management Boaz Markewitz, MD
In-Patient Sleep Testing/Management Boaz Markewitz, MD Objectives: Discuss inpatient sleep programs and if they provide a benefit to patients and sleep centers Identify things needed to be considered when
More informationTriennial Pulmonary Workshop 2012
Triennial Pulmonary Workshop 2012 Rod Richie, M.D., DBIM Medical Director Texas Life Insurance Company, Waco, TX EMSI, Waco, TX Lisa Papazian, M.D., DBIM Assistant Vice President and Medical Director Sun
More informationMultiple Naps and the Evaluation of Daytime Sleepiness in Patients with Upper Airway Sleep Apnea
Sleep. 3(3/4):425-439 1980 Raven Press. New York, Multiple Naps and the Evaluation of Daytime Sleepiness in Patients with Upper Airway Sleep Apnea T. Roth, K. M. Hartse, F. Zorick, and W. Conway Sleep
More informationReceived November 19, 2012; revised December 20, 2012; accepted December 27, 2012
Journal of Behavioral and Brain Science, 2013, 3, 26-48 doi:10.4236/jbbs.2013.31004 Published Online February 2013 (http://www.scirp.org/journal/jbbs) Heart Rate Variability, Standard of Measurement, Physiological
More informationA.J. Finnimore, M. Roebuck, D. Sajkov, R.D. McEvoy
Eur Respir J, 1995, 8: 230 234 DOI: 10.1183/09031936.95.08020230 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1995 European Respiratory Journal ISSN 0903-1936 The effects of the GABA
More informationCPAP titration by an auto-cpap device based on snoring detection: a clinical trial and economic considerations
Eur Respir J 199; : 759 7 DOI:.113/09031936.9.0759 Printed in UK - all rights reserved Copyright ERS Journals Ltd 199 European Respiratory Journal ISSN 0903-1936 CPAP titration by an auto-cpap device based
More informationDiagnosis and treatment of sleep disorders
Diagnosis and treatment of sleep disorders Normal human sleep Sleep cycle occurs about every 90 minutes, approximately 4-6 cycles occur per major sleep episode NREM (70-80%) slow wave sleep heart rate,
More informationThe Effects of Lamotrigine on Sleep in Patients with Epilepsy
Epilepsia, 42(12):1569 1573, 2001 Blackwell Science, Inc. International League Against Epilepsy The Effects of Lamotrigine on Sleep in Patients with Epilepsy *Nancy Foldvary, *Michael Perry, Julia Lee,
More informationPolicy Specific Section: October 1, 2010 January 21, 2013
Medical Policy Bi-level Positive Airway Pressure (BPAP/NPPV) Type: Medical Necessity/Not Medical Necessity Policy Specific Section: Durable Medical Equipment Original Policy Date: Effective Date: October
More informationObstructive Sleep Apnea
Obstructive Sleep Apnea Introduction Obstructive sleep apnea is an interruption in breathing during sleep. It is caused by throat and tongue muscles collapsing and relaxing. This blocks, or obstructs,
More informationSLEEP DISORDERED BREATHING The Clinical Conditions
SLEEP DISORDERED BREATHING The Clinical Conditions Robert G. Hooper, M.D. In the previous portion of this paper, the definitions of the respiratory events that are the hallmarks of problems with breathing
More informationIndex. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Accidents. See Motor vehicle accidents. Acetazolamide, in OSA therapy, 531 Acetylcholinesterase inhibitors, in OSA therapy, 532 533 Acromegaly,
More informationNight-to-night variability of apnea indices
Night-to-night variability of apnea indices M.M.R. VERHELST, R.J. SCHIMSHEIMER, C. KLUFT, A.W. DE WEERD CENTRE FOR SLEEP AND WAKE DISORDERS, MCH, WESTEINDE HOSPITAL, THE HAGUE In our centre, the diagnosis
More informationPolysomnography Course Session: Sept 2017
Polysomnography Course Session: Sept 2017 General Information Polysomnography course will be held at SLEEP AND ALERTNESS CLINIC Med-West Medical centre 750 Dundas St. W., Suite 2-259 (Conference Room)
More information