Sleep Apnea No More
Summary (provided by applicant) Epilepsy affects approximately 2.5 million Americans, resulting in substantial disability. Because up to 30 of patients with epilepsy continue to have seizures despite appropriate treatment with antiepileptic medications, additional interventions to improve seizure control are needed. One approach to improving seizure control is to treat coexisting sleep disorders, such as obstructive sleep apnea. Obstructive sleep apnea (OSA) may exacerbate seizures via sleep fragmentation, sleep deprivation, or other pathophysiological processes that have not yet been determined. The investigators recently documented that OSA is common in epilepsy patients with seizures refractory to medical treatment. In addition, preliminary data in the form of retrospective case series by the investigators and others have suggested that treatment of OSA may improve seizure control. However, no prospective studies have been done to verify these findings. Proof that treating OSA is...
A 42-year-old right-handed male was evaluated for episodes of twitching movements of the right hand that began 2 weeks earlier. He had a 3-year history of bipolar disorder, which was well controlled on valproate 1500 mg day. He was moderately overweight and had a history of sleep apnea treated with continuous positive air pressure (CPAP).
A number of reports of sleep-disordered breathing and sleep apnoea with VNS have appeared. These problems have been seen in adults as well as children. Excessive daytime sleepiness after VNS implantation should be explored with polysomnography, if possible. Continuous positive airway pressure or turning the device off at night may solve the problems 54-56 .
In the largest retrospective study, 63 adults with epilepsy were referred for PSG for EDS and suspected OSAS (27), suspected OSAS without EDS (22), spells and EDS or suspected OSAS (10), nocturnal spells (2), or EDS alone (2) (Malow et al., 1997). Multiple sleep latency tests (MSLTs) were performed in 33 cases. Sleep disorders were suspected in 79 of patients. Obstructive sleep apnea syndrome was diagnosed in 71 . The disorder was considered mild in 14, moderate in 21, and severe in 10 patients, including 7 females. Other diagnoses included nocturnal seizures (4), mild OSAS and narcolepsy (1), and insufficient sleep syndrome with probable idiopathic hypersomnia (1). In 13 cases, the diagnosis was uncertain. These included six subjects with PLMS with 20 or greater leg movements per hour generally not causing arousal. Of the subjects who had MSLTs, the average mean sleep latency was 6.8 min, suggesting a moderate degree of daytime sleepiness. Treatment of OSAS with continuous positive...
Treatment with nocturnal continuous positive airway pressure (CPAP) was initiated, with good compliance. Owing to the history of absence seizures in childhood, the antiepileptic drug treatment phenytoin was replaced with valproate, which, however, had to be discontinued because of severe generalized exanthema. Carbamazepine was not tolerated either (again because of generalized exanthema). Finally, phenylbarbital was tried and found to be well tolerated. A control polysomnography performed 1 year after the initiation of CPAP treatment showed normal findings with an apnoea hypopnoea index of less than 1, and 0.3 oxygen desaturations an hour (Fig. 79.2). Sleep latency was 6 minutes, Figure 79.2 Tests performed 1 year after the initiation of CPAP treatment. The hypnogram (top) is much less fragmented than the earlier test and there is more REM sleep. There are no episodes of oxygen desaturation (middle). There are no episodes of apnoea or hypopnoea. Two years after the status...
We have reported on a group of six infants and children who presented for evaluation of apnea and in whom a combined video EEG-PSG study was performed (Kotagal and Dinner, 1991). In three of the six patients, the apnea represented a manifestation of an epileptic seizure. Zucconi and colleagues (1997) reported on two adults who presented with a history of awakening from sleep with a sensation of choking and abnormal motor activity as well as daytime sleepiness, and who had been previously diagnosed with obstructive sleep apnea. These patients underwent video EEG-PSG and were found to have
Usually disorders leading to periods of apnea during sleep are classified as central, obstructive, or mixed (28). Most premature infants and some older infants have apneic events that can be central, secondary to delayed maturation of the centers that control breathing (29), or obstructive, resulting from partial constriction of the upper airway. Polysomnography uses airflow monitors and strain gauges to relate movement of the chest and abdominal musculature to effective rhythmic inspiration and expiration. In obstructive apnea, movements of chest or abdominal musculature continue while the flow of air is markedly decreased or stopped. This is followed by a significant drop in the oxygen saturation of the blood. In central apnea, muscle movements decrease coincident with the
This CAP is then superimposed on a relatively homogeneous background of EEG activity, lasting for more than 60 s in duration, referred to as non-CAP. The CAP consisted of two phases, CPAP-A, which is characterized by a paroxysm of phasic activity, representing a state of greater arousal, and alternates with a second phase, CAP-B, which consists of a return to the background EEG activity and represents a state of lesser arousal. These two phases alternate during CAP, which then alternates with the NCAP state. The amount of sleep time in CAP was expressed as a percentage of the total sleep time, defined as the CAP rate. This represented the amount of relative arousal defined by the microarchitecture. Studies in relation to both primary generalized epilepsy and focal epilepsy report an increase in the CAP rate compared with normal controls. In addition, epileptiform discharges appear to be activated in the CAP-A phase (Gigli et al., 1992). Focal motor seizures occurring in NREM sleep...
Excessive daytime sleepiness as measured by the ESS was found in 28 of 158 subjects with epilepsy and 18 of 68 control subjects with other neurologic disorders (Malow et al., 1997). Symptoms of sleep apnea and RLS reliably predicted daytime sleepiness. Having epilepsy conferred only a nonsignificant trend for EDS. Patients with epilepsy between the ages of 30 and 45 years were most likely to report daytime sleepiness. In patients with epilepsy, the number and type of AEDs, seizure frequency, epilepsy syndrome, and presence of sleep-related seizures were not significant predictors of daytime sleepiness.
Children are predisposed to arousal disorders because they have abundant slow-wave sleep from which arousal is difficult. In one study, auditory stimuli of as much as 120 dB did not consistently elicit arousal in young children (Busby and Pivik, 1983). In most children and young adults, confusional arousals and sleepwalking can be induced by stimulation during deep slow-wave sleep. Sleep apnea and other sleep disorders associated with arousal sometimes provide the precipitating factor.
The measurement of airflow and respiratory movement has become standard practice for the recording of all PSG. It is, of course, essential in the diagnosis of apnea as well as hypopnea or respiratory pauses. There is also a known association between these as well as other breathing disturbances and a variety of other sleep-related conditions, such as parasomnias and seizures. Air exchange is commonly monitored using a thermistor or thermocouple, simultaneously recording both nasal and oral airflow. Nasal pressure transducers are an alternative method. Respiratory movement or effort can be recorded in a variety of ways. The use of intercostal electrodes, abdominal and thoracic strain gauges, and abdominal and thoracic belts all have proven to be dependable. The use of pulse oximetry to monitor blood oxygen levels collects vital information concerning the severity of any recorded desaturations.
His past medical history was significant for a left occipital skull fracture without loss of consciousness at the age of 4 years. He had no other risk factors for epilepsy. Prior testing had included CT, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and single photon emission computed tomography (SPECT) scan, all thought to be essentially normal, as well as both EEG and PSG. The sleep study had shown moderate obstructive sleep apnea. Routine EEG had been read as normal. The patient had undergone a prior epilepsy workup, and while nine of these typical events had been recorded on video EEG, no EEG changes were observed. The patient had been treated unsuccessfully with a number of anticonvulsant medications to no avail, and was currently taking phenytoin and carbamezepine. The patient underwent combined video EEG and PSG in hopes of further defining these spells. The 10-20 system of electrodes was placed, as well as additional physiological parameters of the...
Sleep disorders commonly accompany epilepsy obstructive sleep apnea appears twice as commonly in people with epilepsy compared to the background population. There are three main categories of sleep disorders. Obstructive sleep apnea is common, especially in overweight men with large neck sizes who develop upper airway collapse during sleep leading to loud snoring, frequent apneic spells in sleep, morning headache, and marked sleep fragmentation causing daytime somnolence. The sleep attacks and the daytime somnolence both can be confused with epilepsy. Furthermore, the resulting sleep deprivation may exacerbate pre-existing epilepsy.
|Didgeridoo for Sleep Apnea|
Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?