Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0055
Amy K. Dadisman, N. Andrews, R. Mehra, I. Katzan
The case involves a patient with interrelated sleep symptoms related to central hypersomnia, restless legs syndrome, and sleep disordered breathing (SDB) occurring after stroke. The prevalence of SDB after stroke has been noted to be very high, up to 70%, and consists of a higher contribution of central sleep apnea compared to the general population. Recurrent stroke is associated with a higher prevalence of SDB compared to first-time stroke. Contributions to SDB as related to stroke do not appear to have consistencies in terms of location and size of stroke. Untreated SDB can also contribute to stroke risk, with mechanisms involving increased systemic inflammation, prothrombotic biochemical markers, and dysfunction of cerebral autoregulation. Although there are post-hoc subgroup data in a randomized controlled trial suggesting reduction in stroke outcomes when SDB is treated with positive airway pressure, overall there are few studies that have rigorously examined the impact of treatment. Hypersomnia can be treated with modafinil and restless legs syndrome may become manifest due to sleep fragmentation.
{"title":"Sooner Than Later If Not Right After Stroke","authors":"Amy K. Dadisman, N. Andrews, R. Mehra, I. Katzan","doi":"10.1093/MED/9780190671099.003.0055","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0055","url":null,"abstract":"The case involves a patient with interrelated sleep symptoms related to central hypersomnia, restless legs syndrome, and sleep disordered breathing (SDB) occurring after stroke. The prevalence of SDB after stroke has been noted to be very high, up to 70%, and consists of a higher contribution of central sleep apnea compared to the general population. Recurrent stroke is associated with a higher prevalence of SDB compared to first-time stroke. Contributions to SDB as related to stroke do not appear to have consistencies in terms of location and size of stroke. Untreated SDB can also contribute to stroke risk, with mechanisms involving increased systemic inflammation, prothrombotic biochemical markers, and dysfunction of cerebral autoregulation. Although there are post-hoc subgroup data in a randomized controlled trial suggesting reduction in stroke outcomes when SDB is treated with positive airway pressure, overall there are few studies that have rigorously examined the impact of treatment. Hypersomnia can be treated with modafinil and restless legs syndrome may become manifest due to sleep fragmentation.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"277 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90416406","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}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0025
N. Foldvary-Schaefer, Thapanee Somboon, Zahreddin Alsheikhtaha
This case illustrates diagnostic challenges in patients with epilepsy and suspected sleep disorders. Specifically, the symptomatic generalized epilepsy Lennox-Gastaut syndrome is an age-related epileptic encephalopathy characterized by developmental delay; multiple seizure types, including tonic seizures in drowsiness and sleep; and generalized slow spike-wave complexes on electroencephalography (EEG). Tonic seizures in sleep can be unrecognized or can be confused with sleep disorders such as sleep apnea. The case demonstrates how to identify generalized epileptic abnormalities and seizures on the limited EEG montage used in routine polysomnography and expanded EEG using the 10-20 system of electrode placement.
{"title":"Mr. Potato Head","authors":"N. Foldvary-Schaefer, Thapanee Somboon, Zahreddin Alsheikhtaha","doi":"10.1093/MED/9780190671099.003.0025","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0025","url":null,"abstract":"This case illustrates diagnostic challenges in patients with epilepsy and suspected sleep disorders. Specifically, the symptomatic generalized epilepsy Lennox-Gastaut syndrome is an age-related epileptic encephalopathy characterized by developmental delay; multiple seizure types, including tonic seizures in drowsiness and sleep; and generalized slow spike-wave complexes on electroencephalography (EEG). Tonic seizures in sleep can be unrecognized or can be confused with sleep disorders such as sleep apnea. The case demonstrates how to identify generalized epileptic abnormalities and seizures on the limited EEG montage used in routine polysomnography and expanded EEG using the 10-20 system of electrode placement.","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":"83763939","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}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0014
E. Polk, Subhra Chakrabarti, R. Mehra, Sushruta Cerejo
Obstructive sleep apnea (OSA) has been associated with significant decrements in quality of life, including daytime sleepiness, drowsy driving, and adverse health effects. Treatment of OSA with continuous positive airway pressure (CPAP) improves sleepiness symptoms, and some data support improvement in cardiometabolic outcomes. CPAP adherence, however, remains suboptimal, thereby hampering the symptom-based and health benefits that could be fully realized. Many strategies have been developed to increase PAP adherence, including behavioral interventions and an approach known as the PAP-NAP study, an intervention that focuses on improving the patient’s acceptance of PAP therapy by using regimented acclimation and desensitization techniques.
{"title":"CPAP, What’s Not to Love?","authors":"E. Polk, Subhra Chakrabarti, R. Mehra, Sushruta Cerejo","doi":"10.1093/MED/9780190671099.003.0014","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0014","url":null,"abstract":"Obstructive sleep apnea (OSA) has been associated with significant decrements in quality of life, including daytime sleepiness, drowsy driving, and adverse health effects. Treatment of OSA with continuous positive airway pressure (CPAP) improves sleepiness symptoms, and some data support improvement in cardiometabolic outcomes. CPAP adherence, however, remains suboptimal, thereby hampering the symptom-based and health benefits that could be fully realized. Many strategies have been developed to increase PAP adherence, including behavioral interventions and an approach known as the PAP-NAP study, an intervention that focuses on improving the patient’s acceptance of PAP therapy by using regimented acclimation and desensitization techniques.","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":"89375323","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}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0028
M. Irfan, Michael J Howell
Sexual behavior in sleep has only recently been recognized as a variant of non–rapid-eye-movement (NREM) arousal parasomnias. This chapter discusses a case of sexsomnia precipitated by obstructive sleep apnea, the ensuing impact on the subject and his bed partner, and evaluation and management strategies. Sexsomnia is suspected to be highly underreported and carries significant physical, psychosocial, and forensic ramifications. Polysomnography with expanded electroencephalography can help identify concurrent sleep disorders and exclude other etiologies such as epilepsy. Treatment of comorbid sleep disorders such as obstructive sleep apnea and sleep deprivation is highly effective in controlling the abnormal sexual behavior. There is a pressing need for research and expansion of current understanding to develop a standardized approach to evaluation and management of sexsomnia.
{"title":"Unwanted Overtures by Night, Remorse by Day","authors":"M. Irfan, Michael J Howell","doi":"10.1093/MED/9780190671099.003.0028","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0028","url":null,"abstract":"Sexual behavior in sleep has only recently been recognized as a variant of non–rapid-eye-movement (NREM) arousal parasomnias. This chapter discusses a case of sexsomnia precipitated by obstructive sleep apnea, the ensuing impact on the subject and his bed partner, and evaluation and management strategies. Sexsomnia is suspected to be highly underreported and carries significant physical, psychosocial, and forensic ramifications. Polysomnography with expanded electroencephalography can help identify concurrent sleep disorders and exclude other etiologies such as epilepsy. Treatment of comorbid sleep disorders such as obstructive sleep apnea and sleep deprivation is highly effective in controlling the abnormal sexual behavior. There is a pressing need for research and expansion of current understanding to develop a standardized approach to evaluation and management of sexsomnia.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89453960","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}
Pub Date : 2019-08-01DOI: 10.1093/med/9780190671099.003.0022
M. Alattar
This chapter covers the relationship between sleep-related headaches and sleep disorders such as obstructive sleep apnea (OSA). Sleep apnea headache (SAH), a type of sleep-related headache that is classified in the International Classification of Headache Disorders, is a distinct subset of headache that is caused by OSA and occurs distinctly on awakening. Once recognized, treatment of OSA is associated with significant improvement in, and often resolution of, SAH. Given the high prevalence of headaches in the general population, sleep disorders must be considered in the evaluation of patients with headaches. A comprehensive sleep evaluation should be an integral part of the assessment of headache disorders. Sleep apnea headache and other types of headaches associated with sleep are reviewed in this chapter.
{"title":"Tormented Sunrises","authors":"M. Alattar","doi":"10.1093/med/9780190671099.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780190671099.003.0022","url":null,"abstract":"This chapter covers the relationship between sleep-related headaches and sleep disorders such as obstructive sleep apnea (OSA). Sleep apnea headache (SAH), a type of sleep-related headache that is classified in the International Classification of Headache Disorders, is a distinct subset of headache that is caused by OSA and occurs distinctly on awakening. Once recognized, treatment of OSA is associated with significant improvement in, and often resolution of, SAH. Given the high prevalence of headaches in the general population, sleep disorders must be considered in the evaluation of patients with headaches. A comprehensive sleep evaluation should be an integral part of the assessment of headache disorders. Sleep apnea headache and other types of headaches associated with sleep are reviewed in this chapter.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80807342","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}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0051
Frank M. Ralls, M. Grigg-Damberger
This chapter discusses the relationship between a commonly misdiagnosed parasomnia and various precipitating factors. Expertise in differentiating a benign parasomnia from significant medical disorders in adults and children is important, as is the ability to correctly identify and modify predisposing and precipitating factors. The case presented in this chapter illustrates how making a premature decision based on a small piece of information delayed an important diagnosis and increased the risk of further morbidity. The peak prevalence of sleep terrors is 18 months of age, but they may be seen at any age during childhood. When recurrent sleep terrors recur or develop in adults, evaluation for other primary sleep disorders, including sleep apnea, restless legs, shift work, and sleep deprivation, is warranted, and polysomnography is usually indicated. Identifying and correcting precipitating factors may minimize the recurrence of sleep terrors. Treatment of sleep apnea may greatly reduce the frequency of night terrors and other parasomnias.
{"title":"Terror at Northfield","authors":"Frank M. Ralls, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0051","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0051","url":null,"abstract":"This chapter discusses the relationship between a commonly misdiagnosed parasomnia and various precipitating factors. Expertise in differentiating a benign parasomnia from significant medical disorders in adults and children is important, as is the ability to correctly identify and modify predisposing and precipitating factors. The case presented in this chapter illustrates how making a premature decision based on a small piece of information delayed an important diagnosis and increased the risk of further morbidity. The peak prevalence of sleep terrors is 18 months of age, but they may be seen at any age during childhood. When recurrent sleep terrors recur or develop in adults, evaluation for other primary sleep disorders, including sleep apnea, restless legs, shift work, and sleep deprivation, is warranted, and polysomnography is usually indicated. Identifying and correcting precipitating factors may minimize the recurrence of sleep terrors. Treatment of sleep apnea may greatly reduce the frequency of night terrors and other parasomnias.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"407 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76827908","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}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0015
Roxanne Valentino, Sally Ibrahim
This chapter describes a case of alternating leg muscle activation (ALMA) followed by discussion of this condition and the related hypnagogic foot tremor (HFT). HFT and ALMA are benign sleep-related movements of unknown etiology, typically found incidentally on polysomnography. Both HFT and ALMA are characterized by bursts of tibialis anterior activity occurring in sequences with an inter-burst interval shorter than found in periodic limb movements in sleep. There is no specific treatment for HFT and ALMA. Rather, treatment should focus on the other comorbid sleep disorders such as obstructive sleep apnea, as HFT and ALMA motor activity associated with respiratory events may be responsive to positive airway pressure therapy. In this chapter the diagnostic criteria and clinical features are summarized, and polysomnographic tracings and video samples are provided.
{"title":"Figuring Out Fitful Feet","authors":"Roxanne Valentino, Sally Ibrahim","doi":"10.1093/MED/9780190671099.003.0015","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0015","url":null,"abstract":"This chapter describes a case of alternating leg muscle activation (ALMA) followed by discussion of this condition and the related hypnagogic foot tremor (HFT). HFT and ALMA are benign sleep-related movements of unknown etiology, typically found incidentally on polysomnography. Both HFT and ALMA are characterized by bursts of tibialis anterior activity occurring in sequences with an inter-burst interval shorter than found in periodic limb movements in sleep. There is no specific treatment for HFT and ALMA. Rather, treatment should focus on the other comorbid sleep disorders such as obstructive sleep apnea, as HFT and ALMA motor activity associated with respiratory events may be responsive to positive airway pressure therapy. In this chapter the diagnostic criteria and clinical features are summarized, and polysomnographic tracings and video samples are provided.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76390858","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}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0052
H. Mar, N. Chaisson
The high prevalence of pulmonary arterial hypertension (PAH) in patients with obstructive sleep apnea (OSA) and the putative pathophysiologic connections have been extensively documented. Conversely, patients with established PAH are at risk for sleep-related ventilatory instability, including OSA, central sleep apnea, and nocturnal desaturations. This chapter reviews the prevalence and pathophysiologic interactions of these conditions, the interplay with associated disorders, and the effects of continuous positive airway pressure therapy on pulmonary hemodynamics. In patients with OSA, chronic effects of repetitive hypoxia as well as comorbidities, including chronic obstructive pulmonary disease and left-sided heart dysfunction, play a role in promoting pulmonary hypertension. Sleep disordered breathing, representing a spectrum of sleep-related breathing disorders inclusive of OSA, is highly prevalent among patients with established pulmonary hypertension. Obstructive events, central sleep apnea, and nocturnal hypoxia are within the spectrum of sleep-related breathing disorders in pulmonary hypertension. The mechanisms for these associations remain speculative.
{"title":"Pulmonary Arterial Hypertension","authors":"H. Mar, N. Chaisson","doi":"10.1093/MED/9780190671099.003.0052","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0052","url":null,"abstract":"The high prevalence of pulmonary arterial hypertension (PAH) in patients with obstructive sleep apnea (OSA) and the putative pathophysiologic connections have been extensively documented. Conversely, patients with established PAH are at risk for sleep-related ventilatory instability, including OSA, central sleep apnea, and nocturnal desaturations. This chapter reviews the prevalence and pathophysiologic interactions of these conditions, the interplay with associated disorders, and the effects of continuous positive airway pressure therapy on pulmonary hemodynamics. In patients with OSA, chronic effects of repetitive hypoxia as well as comorbidities, including chronic obstructive pulmonary disease and left-sided heart dysfunction, play a role in promoting pulmonary hypertension. Sleep disordered breathing, representing a spectrum of sleep-related breathing disorders inclusive of OSA, is highly prevalent among patients with established pulmonary hypertension. Obstructive events, central sleep apnea, and nocturnal hypoxia are within the spectrum of sleep-related breathing disorders in pulmonary hypertension. The mechanisms for these associations remain speculative.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80910898","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}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0053
Frank M. Ralls, Elyssa Glassheim, M. Grigg-Damberger
After treatment, this elderly gentleman with apparent depression rapidly became cognitively impaired and began hallucinating, eventually ending up in the psychiatric ward. This case provides insight into the complexities that may arise in the clinical evaluation and pharmacologic management of often-evolving cognitive, behavioral, and sleep-related changes in elderly individuals. This case additionally emphasizes the importance of sleep in emotional and mental stability, as well as the importance of physicians being well versed in the adverse effects of prescribed and over-the-counter medications. Mirtazapine can induce restless legs syndrome and periodic limb movements in sleep, conditions that can fragment sleep and interfere with cognition. Use of pramipexole has been shown to cause compulsive and impulsive behaviors in patients with restless legs syndrome, Parkinson disease, and multiple system atrophy. Donepezil can cause hallucinations in patients, which can be difficult to distinguish from hallucinations caused by dementia or Charles Bonnet syndrome; in these cases, establishing a timeline is integral in discovering the etiology.
{"title":"My Father Went Down the Rabbit Hole","authors":"Frank M. Ralls, Elyssa Glassheim, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0053","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0053","url":null,"abstract":"After treatment, this elderly gentleman with apparent depression rapidly became cognitively impaired and began hallucinating, eventually ending up in the psychiatric ward. This case provides insight into the complexities that may arise in the clinical evaluation and pharmacologic management of often-evolving cognitive, behavioral, and sleep-related changes in elderly individuals. This case additionally emphasizes the importance of sleep in emotional and mental stability, as well as the importance of physicians being well versed in the adverse effects of prescribed and over-the-counter medications. Mirtazapine can induce restless legs syndrome and periodic limb movements in sleep, conditions that can fragment sleep and interfere with cognition. Use of pramipexole has been shown to cause compulsive and impulsive behaviors in patients with restless legs syndrome, Parkinson disease, and multiple system atrophy. Donepezil can cause hallucinations in patients, which can be difficult to distinguish from hallucinations caused by dementia or Charles Bonnet syndrome; in these cases, establishing a timeline is integral in discovering the etiology.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87136604","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}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0037
A. Chua, L. Aboussouan
This chapter presents a case of treatment-emergent central sleep apnea (TECSA), which is also known as complex sleep apnea syndrome or continuous positive airway pressure (CPAP)–emergent central sleep apnea. In this disorder, central apnea events emerge in patients with obstructive sleep apnea (OSA) after initiation of CPAP treatment. This phenomenon has been identified in up to 20% of patients with OSA who undergo CPAP titration. Polysomnography in those with TECSA usually shows an elevated residual Apnea–Hypopnea Index and arousal index after PAP initiation and occurs primarily during non–rapid-eye-movement sleep. Several mechanisms that have been postulated will be reviewed. The phenomenon is usually self-limiting, and recommended management includes applying the lowest PAP pressure needed to achieve reasonable control and avoiding modalities that exacerbate hypocapnia.
{"title":"Help, I Can’t Breathe!","authors":"A. Chua, L. Aboussouan","doi":"10.1093/MED/9780190671099.003.0037","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0037","url":null,"abstract":"This chapter presents a case of treatment-emergent central sleep apnea (TECSA), which is also known as complex sleep apnea syndrome or continuous positive airway pressure (CPAP)–emergent central sleep apnea. In this disorder, central apnea events emerge in patients with obstructive sleep apnea (OSA) after initiation of CPAP treatment. This phenomenon has been identified in up to 20% of patients with OSA who undergo CPAP titration. Polysomnography in those with TECSA usually shows an elevated residual Apnea–Hypopnea Index and arousal index after PAP initiation and occurs primarily during non–rapid-eye-movement sleep. Several mechanisms that have been postulated will be reviewed. The phenomenon is usually self-limiting, and recommended management includes applying the lowest PAP pressure needed to achieve reasonable control and avoiding modalities that exacerbate hypocapnia.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87282347","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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