Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome

The CSF pressure was measured continuously at the lumbar level during nocturnal sleep in 3 patients with sleep apnea hypersomnia syndrome. Nocturnal sleep was very unstable with frequent episodes of obstructive sleep apnea. When the patients were awake and relaxed in the supine position, their CSF pressure was stable and within the normal range. Episodic marked elevations of CSF pressure occurred frequently during sleep, and each elevation was preceded and accompanied by an episode of sleep apnea or hypopnea. Significant correlations were found between the duration of apneic episodes and increase of CSF pressure, and between decrease of SaO2 or TcPO2 and increase of CSF pressure. The duration of sleep apnea was longer, increase of CSF pressure was greater, and decreases of SaO2 and TcPO2 were more marked during REM sleep than during NREM sleep. It is suggested that the frequent marked episodic elevations of CSF pressure are caused by an increase in the intracranial vascular volume occurring mainly in response to transient hypercapnia and hypoxia, which are induced by pulmonary hypoventilation during the episodes of sleep apnea.     

Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study

Background and purposeContinuous positive airway pressure (CPAP) is an effective treatment for sleep apnea (SA), although the evidence for improving chronic heart failure (CHF) is inconclusive. Our aim was to evaluate the effect of CPAP treatment on the left ventricle ejection fraction (LVEF) among other cardiological variables in a randomized, multicenter, placebo (sham-CPAP)-controlled study.MethodsAfter the selection procedure, 60 patients with CHF with LVEF < 45% and SA with an apnea–hypopnea index (AHI) > 10/h were evaluated at baseline, and after 3 months of treatment with optimal CPAP or sham-CPAP. The assessment was based on the LVEF, hypertension, daytime sleepiness (Epworth sleepiness scale [ESS]), quality of life (SF-36), New York Heart Scale (NYHA score), dyspnea (by using the Borg scale) and exercise tolerance (6-min walk test).ResultsThe mean AHI was normalized in the optimal CPAP group but not in the sham-CPAP group. The LVEF showed a significant improvement in the group of patients treated with CPAP (2.5; 95% CI: 0.6 to 4.3), which was not observed in the sham-CPAP group (0.0; 95% CI: −2.1 to 2.1). However, the change in the LVEF from baseline to 3 months was not significantly greater in the whole group (obstructive and Cheyne–Stokes events) treated with CPAP than in the control group (p: 0.07). In patients with only obstructive sleep apnea (OSA), who account for 83% of the total population, there was a significant improvement in the LVEF in the group of patients treated with CPAP but no such improvement in the sham-CPAP group. In this OSA group, the change in the LVEF from baseline to 3 months was significantly greater in the group treated with CPAP than in the sham-CPAP group (p: 0.03). The other variables studied were not modified. When the patients were divided according to the severity of the LVEF (a LVEF cut-off of 30%), improvement was observed in those with a LVEF > 30. No changes were found in the other cardiological variables.ConclusionsCPAP therapy proved to be useful in patients with associated sleep-disordered breathing and CHF. The improvement was more marked in patients with a LVEF > 30%. However, the increased LVEF in the CPAP group was not accompanied by changes in the other cardiological variables.     

Deficient blood pressure regulation in a case of hypersomnia with sleep drunkenness

In a 43-year-old man suffering from hypersomnia with sleep drunkenness, a polygraphic sleep study with direct measurement of blood pressure was carried out. The main findings were lack of blood pressure activation with arousals during the sleep period and persistence of sleep levels after morning awakening. This indicates that cardio-vascular responses to the needs of active behaviour are insufficient. Taking into account feedback mechanisms of blood pressure on alertness, this could be a cause for sleep drunkenness and daytime sleepiness. The blood pressure sustaining drug etilefrine seems to alleviate these symptoms.     

Menstruation-related periodic hypersomnia: a case study with successful treatment

A 16-year-old girl suffered from 1 to 2-week periods of hypersomnia associated with each menstruation. Serum hormone levels were normal. CSF concentrations of homovanillic acid and 5-hydroxyindolacetic acid were lower in hypersomniac than in symptom-free phases. 3-methoxy-4-hydroxyphenylethylene glycol was not affected. The sleep periods occurred only in connection with ovulatory menstrual cycles. When ovulation was inhibited by a combination of ethinylestradiol and lynestrenol, an oral contraceptive pill, the hypersomnia ceased. Thus, the hypersomnia seemed to be linked to the occurrence of ovulatory menstruations.     

Concomitant narcolepsy and sleep apnea: report of a case

A case of concomitant narcolepsy and obstructive sleep apnea evaluated in a sleep disorder center is reported. Tracheostomy decreased the frequency of the apneas but the clinical and polysomnographic features of narcolepsy remained on 3 and 6 months post-surgical follow-ups. These findings support the need for systematic use of all-night polysomnography and multiple sleep latency test in patients with excessive daytime sleepiness.     

Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenic mechanisms

Sleep apnea syndromes are a common cause of sleepiness and neurocognitive impairment and have been implicated as an independent risk factor for cardiovascular disease. While both epidemiological and sleep clinic-based studies indicate that sleep apnea syndromes are more common in men than in women, the gender difference in prevalence is more marked within the sleep clinic. Reasons for the relative failure of women to attend sleep clinics and the pathophysiologic differences that give rise to the male predominance of sleep apnea syndromes are unknown. The purpose of this review was to examine the literature with regard to these aspects, to provide clinical guidance to improve the reduced attendance of women to sleep laboratories and to stimulate research interest into the causes of these differences.     

特发性颅内压增高与阻塞性睡眠呼吸暂停一例分析

目的 通过报道及文献复习探讨特发性颅内压增高(IIH)与阻塞性睡眠呼吸暂停(OSA)之间的关系.方法 报道1例中年男性颅内压增高患者,经MRI、血管造影排除颅内病变,确诊为IIH;患者有嗜睡、肥胖等症状,进行多导睡眠图(PSG)证实合并有重度OSA,在单纯使用降颅压治疗不能获得持续有效控制高颅压症状后,改用针对OSA给予控制体重和持续正压通气等综合治疗观察临床疗效.结果 经过3个月治疗,患者体质量指数由35.7降至31.4,呼吸暂停低通气指数由72.6降至10.1,血氧饱和度从67%上升到82%,头痛、视乳突水肿等高颅压症状得到持续改善.结论 睡眠呼吸暂停是IIH的风险因素之一,尤其是肥胖男性患者;对有睡眠症状的患者进行PSG监测有助于寻找IIH中容易被忽视的重要因素即OSA;采取积极措施治疗OSA能持续有效地缓解IIH患者高颅压症状.     

Probable causal link between epilepsy and sleep apnea: case report

Patients with epilepsy were reported to have concomitant sleep apnea, but it has been rarely linked to the epilepsy itself. We present a case of a 28-year-old, obese man with secondary medically resistant partial complex epilepsy due to a brain trauma, with progressive snoring, and sleep agitation, apneas, and important daytime somnolence. It was noticed in the polysomnographic study that he had several sleep respiratory events, probably due both to the epileptic seizures and the sleep apnea syndrome as a co-morbidity. Apnea and epilepsy will be discussed. A careful video-EEG-polysomnography study is important in evaluating refractory epileptic patients and/or epileptic patients with snoring.     

Obstructive sleep apnea syndrome caused by oral cyst: a case report

A 47-year-old man with a typical obstructive sleep apnea syndrome (OSAS) secondary to a large oral cyst is reported. Although the patient also had a nasal septum deviation with narrowed air passage, removal of the cyst resulted in complete and lasting relief from clinical symptoms despite persisting sleep apnea and unchanged arousal reaction in the EEG. The concurrent mechanisms of OSAS in the present case are discussed, and the importance of searching for a curable underlying disorder in clinical overt OSAS is emphasized.     

Long-term follow-up study on patients with sleep apnea syndrome.

We did a 5-year follow-up study on sleep apnea syndrome (SAS)-related symptoms and respiratory disorder variables on 109 patients. At follow up, SAS-related symptoms were improved in a significantly higher percentage of the treatment success group than the treatment failure group. A significant deterioration of the respiratory disorder variables was recognized only in the patients 40-60 years of age. These results indicate that treatment effect for SAS might be maintained in the long term and that the natural evolution of the disorder might be prominent in middle-aged patients.     

A case of central sleep apnea strictly dependent upon REM-sleep

Central sleep apnea (CSA) is characterized by the inability to generate regular breathing patterns as a result of the loss of metabolic drive and failure of respiratory muscle control. We present the case of a 54-year-old woman with a severe CSA strictly dependent upon REM-sleep. Extensive diagnostic workup excluded typical underlying causes and serological analysis revealed acute borreliosis infection. The severity of sleep apnea decreased after repeated polysomnographic studies without a specific therapy. CSA is usually associated with non-REM stages of slow-wave-sleep. This report illustrates the clinical presentation and diagnostic implications of an unusual case of a CSA strictly associated with REM-sleep. Anecdotally reports of severe respiratory failure in borreliosis indicate the potential of this infection to destabilize breathing control but the precise impact of the infection remains controversial. In our case, a relevant neuroborreliosis was not proven, since there were no other neurologic impairments and the patient refused studies of liquor fluid.     

Significance of prolonged barbiturate therapy on severe head injuries--ICP regulation and duration of barbiturate administration

Barbiturate therapy was performed on 84 head trauma patients which were measured on GCS score of 8 or less, through October 1979 to December 1982. More than 3 g/day of thiamylal or more than 1.5 g/day of pentobarbital were administered for barbiturate therapy. Barbiturate therapy was discontinued in patients whose ICP remained less than 20 mmHg for more than 36 hours. In patients whose ICP sustained higher level, barbiturate was administered continuously until brain death was confirmed or non-filling was recognized. The patients were divided into two groups; Group I in which barbiturate therapy was carried out for 72 hours or less, and Group II in which it was administered for more than 72 hours. The patients in each group were further divided into responder and survivor (a), responder but late death (b), and no-responder or acute brain death (c), As far as age of patients concern, 19 out of 26 patients whose age was less than 20, 22 out of 35 patients whose age was 20-50 and 13 out of 23 patients whose age was more than 50 years responded well to the barbiturate therapy. But one patient died among young age, 4 patients died among middle age and 9 patients died among aged group at later stage. As for Group I (51 patients), Group I a consisted of 22 patients (mean age; 26.2 years, mean GCS score; 6.04, mean initial and maximal ICP; 11.9 and 27.8 mmHg), I b of 8 (52.5 years, 4.75, 17.0 and 27.8 mmHg), and I c of 21 (41.4 years, 4.57, 38.1 and 98.0 mmHg respectively).(ABSTRACT TRUNCATED AT 250 WORDS)