Treatment outcome of obstructive sleep apnea syndrome in a patient with schizophrenia: case report

A case of a patient with comorbid schizophrenia and obstructive sleep apnea syndrome (OSAS) who was treated with nasal continuous positive airway pressure (nCPAP) is presented. This treatment led to significant improvement of schizophrenic and depressive symptoms, with only a partial, albeit not trivial, effect on his cognitive functioning. These encouraging results of treatment of OSAS in schizophrenia with nCPAP suggest the need for further and more systematic investigation of sleep and its disorders in psychotic patients.     

Treatment of obstructive sleep apnea syndrome with a Kampo-formula, San'o-shashin-to: A case report

The following describes a 76-year-old male with obstructive sleep apnea syndrome successfully treated with a Kampo-formula, San'o-shashin-to (Formula medicamentorum tres ad dispellendi cordis). Polysomnography, performed before and after administration of San'o-shashin-to, revealed that the apnea index decreased from 11.1 events/hour to 4.1 events/hour, and that the apnea plus hypopnea index decreased from 18.4 events/hour to 10.7 events/hour. The patient was normo-weight (body mass index: 20.4 kg/m2), and events of sleep apnea and hypopnea were mostly noted during a non-rapid eye movement sleep. It is possible that San'o-shashin-to has some alleviating effects on the upper airway resistance during sleep.     

Parental report of sleep problems in Down syndrome

Background Children with Down syndrome (DS) suffer from sleep problems, including sleep maintenance problems, as well as snoring, and other symptoms of disordered breathing. To examine sleep in DS, we gave parents a questionnaire assessing their child's sleep. Materials and methods The parents of 35 children with DS (mean age = 12.65 years, range = 7–18 years) completed the 33‐item Children's Sleep Habits Questionnaire. Results Eighty‐five per cent of our sample had sleep disturbance scores in the clinical range (mean = 48.63, SD = 7.15, range = 34–64). Our sample also had significantly elevated scores on the Bedtime Resistance, Sleep Anxiety, Night Wakings, Parasomnias, Sleep Disordered Breathing and Daytime Sleepiness subscales. Conclusions Children with DS are at risk for developing symptoms of sleep disordered breathing, and may have additional sleep problems that are unrelated to sleep disordered breathing.     

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.     

Mania resulting from continuous positive airways pressure in a depressed man with sleep apnea syndrome

The authors report the case of a 50-year-old man, with no previous history of bipolar illness, hospitalized with a very severe depression and who was resistant to a 7-weeks treatment of venlafaxine and trazodone (the respective daily doses were 300 and 50 mg which were stable during the last 4 weeks). A diagnosis of sleep apnea syndrome led to the use of the continuous positive airways pressure technique (CPAP). A few days after starting CPAP, he presented a mood switch, first hypomanic, then mixed. The authors discuss the contribution of the sleep apnea syndrome to the appearance and the maintenance of the depressive disorder.     

A case report of obstructive sleep apnea in a patient with bipolar affective disorder

A patient with a bipolar mood disorder developed obstructive sleep apnea which altered the clinical presentation of the mood disorder and affected compliance with prophylactic treatment. Significant improvements in the management of her mood disorder and in her life adjustment followed surgical relief of the upper airway obstruction.     

气道正压通气对睡眠呼吸暂停综合征的疗效

目的:了解阻塞型睡眠呼吸暂停综合征(OSAS)患者在经鼻持续气道正压通气(nCPAP)治疗前后的睡眠特征和心身状况变化。方法:nCPAP治疗35例OSAS患者,治疗前、后分别采用多导睡眠分析仪对患者进行检查,分析治疗前、后多导睡眠图(PSG)各项指标改变。结果:治疗后患者临床症状消除,睡眠结构、最低血氧饱和度及呼吸紊乱指数等各项指标均有明显改善(P<0·01)。结论:nCPAP治疗不仅使睡眠呼吸暂停综合征(SAS)患者嗜睡、疲乏等临床症状消失,明显改善睡眠结构,而且改善心身健康状况。     

Early-onset Moyamoya syndrome in a patient with Down syndrome: case report and review of the literature

Moyamoya disease is a chronic occlusive cerebrovascular disorder. It can occur as a primary disease or as a syndrome associated with a variety of conditions. Usually it takes 1 to 2 years to develop a classic moyamoya pattern. We report a 20-month-old girl with Down syndrome and moyamoya syndrome who presented with seizure and hemiparesis. To our knowledge, this is the youngest case reported with moyamoya syndrome and Down syndrome. The prognosis and current treatment of moyamoya syndrome and its relation to Down syndrome are reviewed. There is some reason to speculate that the abnormalities associated with Down syndrome might create a vulnerability for the development of moyamoya syndrome.     

酒精所致精神障碍合并Madelung’s病伴睡眠呼吸暂停综合征1例

正1病例患者男性,51岁,因嗜酒29年,乱语、凭空视物9年,再发20余天,于2017年12月28日入院。患者于29年前开始饮酒,以黄酒为主,每日约1 kg,饮酒时间不固定,若不饮酒,有时会出现心慌、出汗、手抖等症状。2008年5月患者在家属劝说下停止饮酒,停饮后心慌、手抖,并开始出现胡言乱语、凭空视物,称家中被水淹了,周围都是蚊子、苍蝇老     

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.     

Sleep positions in children with Down syndrome and obstructive sleep apnea

ObjectivesTo assess sleep positions in children with both Down syndrome (DS) and obstructive sleep apnea (OSA) and determine if there is a preferred sleep position by severity of apnea.MethodsA single-center retrospective review of patients with both DS and OSA was performed. Caregivers reported sleep position utilized greater than 50% of observed sleep time. Accuracy of this report was confirmed through review of hypnograms from polysomnography studies.ResultsEighty-two patients met inclusion criteria. Median body mass index (BMI) was 26.6 and 56% of patients had a prior tonsillectomy and/or adenoidectomy. The mean obstructive AHI (OAHI) was 25.33 with 90.4% having severe OSA, 9.6% having moderate OSA, and no patients having mild OSA. Reported sleep positions were skewed towards lateral/decubitus (82.9%) compared to prone (11.0%) and supine (6.1%). This was consistent with hypnogram data where 71% of total sleep time in lateral/decubitus positions compared to prone (13%) and supine (6%). The median changes in sleep position per patient was 5 (IQR: 3–6). Lower BMI (p < 0.001, 95% CI: 0.32–1.13) and tonsillectomy (p < 0.001, 95% CI: 7.7–18.19) were associated with lower OAHI. Sleep position was not associated with age (p = 0.19), sex (p = 0.66), race (p = 0.10), ethnicity (p = 0.68) nor history of tonsillectomy (p = 0.34). Preferred sleep position was not correlated with OAHI (p = 0.78, r = 0.03) or OSA severity (p = 0.72, r = 0.03).ConclusionsThis study highlights the possibility that children with DS may have preferential sleep positions that cater to optimized airflow in the context of OSA although further prospective study is needed.     

Continuous positive airway pressure improves the quality of sleep and oxygenation in obstructive sleep apnea syndrome

We tested the effects of continuous positive airway pressure (CPAP) in 8 patients with obstructive sleep apnea syndrome (OSAS). The comparison of a nocturnal polygraphic study performed during spontaneous breathing with a study during CPAP administration performed the following night showed a significant reduction in stage 1 and increase in REM, the abolition of obstructive apneas and a significant increase in mean oxyhemoglobin saturation. Most patients reported marked relief of symptoms after the first night of treatment. However 3 patients, though confirming the improvement refused further CPAP. We conclude that CPAP is an effective measure for prevention of apneas in OSAS and that in compliant patients it may be regarded as a short-term measure when a permanent correction of the causes is planned, or as a long-term treatment when the latter is not feasible.

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Sommario Abbiamo provato gli effetti dell’applicazione di ventilazione a pressione positiva continua (CPAP) su otto pazienti affetti da sindrome dell’apnea ostruttiva nel sonno (OSAS). Il paragone tra uno studio poligrafico notturno eseguito durante respirazione spontanea, ed uno eseguito la notte successiva durante applicazione di CPAP ha mostrato significativa riduzione dello stadio 1 ed aumento del REM, la scomparsa delle apnee ostruttive ed un aumento significativo della saturazione ossiemoglobinica media. Inoltre la maggioranza dei pazienti ha notato una sensibile attenuazione della sintomatologia già dopo la prima notte di trattamento. Tre pazienti però pur confermando il miglioramento non hanno accettato di proseguire la terapia nelle notti successive. Si può concludere che la CPAP è un’efficace forma di prevenzione delle apnee nell’OSAS e che nei pazienti adattabili può essere considerata per una terapia di breve durata se può essere previsto un intervento correttivo della patologia di base o come una terapia di lunga durata negli altri casi.

     

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.     

The immediate effects of nasal continuous positive airway pressure treatment on sleep pattern in patients with obstructive sleep apnea syndrome

We studied the immediate effects of continuous positive airway pressure (CPAP) applied nasally on the pattern of sleep in 12 patients, aged 30-58 years, with obstructive sleep apnea syndrome. All patients demonstrated a moderate to severe syndrome on the control night; apnea index ranged 28-83 apneas/h sleep. Nasal CPAP completely abolished all obstructive apneas and allowed apnea-free breathing in all 12 patients. Nasal CPAP had a marked effect on the sleep pattern. It significantly reduced stage I/II non-rapid eye movement (NREM) sleep and markedly increased stage III/IV NREM and REM sleep on the first treatment night. Stage I/II NREM sleep decreased from a control of 62.7 +/- 2.3% to 29.1 +/- 2.3% on the first treatment night. Stage III/IV NREM sleep increased from a control of 6.7 +/- 1.6% to 31.5 +/- 1.6%. The rebound in this sleep stage was especially marked in 3 patients aged 55-58 years. REM sleep increased from a control of 18.4 +/- 2.0% to 30.6 +/- 2.0% on the first treatment night. There was an increase in REM density. All patients were treated for another 2 nights and their sleep pattern analyzed on the third night. All sleep stages were still significantly different to the control night. The possible mechanisms involved are discussed.     

Effects of nasal continuous positive airway pressure on panic disorder comorbid with obstructive sleep apnea syndrome

BackgroundsBoth obstructive sleep apnea syndrome (OSAS) and panic disorder (PD) are common disorders that often coexist. Continuous positive airway pressure (CPAP) has been established as the first-line treatment for OSAS. In this study, we examined the efficacy of CPAP on PD comorbid with OSAS by conducting a randomized crossover study using sham CPAP as control.MethodsPD patients (n = 12) with an apnea hypopnea index (AHI) of 20/h or higher completed the study. At baseline, the subjects were asked to write their own records pertaining to the frequency of attacks and their score on the panic disorder severity scale (PDSS), and then they participated in the randomized crossover trial period, which measured optimal CPAP and sham CPAP set at 4 cmH₂O during nighttime sleep for each 4-week assignment.ResultsThe frequency of panic attacks, total PDSS score, and the frequency of alprazolam use for alleviating the attack symptoms were significantly decreased during the optimal CPAP period than during the baseline period and the sham CPAP period. Among the PDSS subitems, the frequency of attacks, panic distress, work impairment, and social impairment showed significant improvements during the optimal pressure period.ConclusionOur results suggest that OSAS contributes to PD aggravation, and a combination of pharmaceutical treatment for PD and OSAS-specific treatments such as CPAP could be recommended for patients with PD comorbid with OSAS.     

Change in frequency of periodic limb movements during sleep with usage of continuous positive airway pressure in obstructive sleep apnea syndrome

There is evidence that visuo-spatial capacity can become overloaded when processing a secondary visual task (Dual Task, DT), as occurs in daily life. Hence, we investigated the influence of the visuo-spatial interference in the identification of emotional facial expressions (EFEs) in early stages of Parkinson's disease (PD). We compared the identification of 24 emotional faces that illustrate six basic emotions in, unmedicated recently diagnosed PD patients (16) and healthy adults (20), under two different conditions: a) simple EFE identification, and b) identification with a concurrent visuo-spatial task (Corsi Blocks). EFE identification by PD patients was significantly worse than that of healthy adults when combined with another visual stimulus.