A Rare Case of Hansen's Disease Complicated by G6PD Deficiency.

We present the case of a 37-year-old Haitian male who presented with a seven-month history of skin lesions on his face and extremities, weight loss, intermittent chills, difficulty in breathing, and bilateral paresthesias in his feet. The lesions were most prominent on the pinnae of the ears. Biopsy of the lesions revealed large, rounded granulomatous infiltrates and histiocytes.

Sleep and neuromuscular disease: frequency of sleep-disordered breathing in a neuromuscular disease clinic population.

We investigated 60 adult and pediatric patients (33 male, 27 female) with various neuromuscular disorders for sleep-disordered breathing in a clinic population at a local altitude of 1,500 m. Measurements included a questionnaire concerning symptoms of sleep and daytime function, a disability index, and pulmonary function tests. We used an EdenTrace monitor for 1 night to evaluate breathing during sleep and calculated mean and minimum oxygen saturation (SpO2), total apneas, hypopneas, and respiratory disturbance index (RDI).

Nondrug treatment trials in psychophysiologic insomnia.

Background: Due to a variety of potential problems with long-term hypnotic use, patients and treating physicians often try to avoid drugs in the treatment of psychophysiologic insomnia and to use nondrug treatment strategies, but these treatments must bring relief within a limited amount of time to be acceptable to patients.

Method: Thirty patients participated in the study. All had, for a minimum of 6 months, the complaint of less than 6 hours total sleep time per night in conjunction with either: (1) spending more than 30 minutes in bed before falling asleep, or (2) awakening during the night within 2 hours of sleep onset with difficulty returning to sleep.

Cardiac failure, snoring, ventricular arrhythmias and nasal bilevel positive pressure ventilation.

Patients with stable cardiac failure who snore may present sleep hypopnea and cardiac arrhythmias. Nasal continuous positive airway pressure (CPAP) may worsen the disordered breathing. Nasal bilevel positive airway pressure (BiPAP), however, may help alleviate the breathing problem and eliminate sleep-related arrhythmias.

Excessive daytime somnolence in women with abnormal respiratory efforts during sleep.

An abnormal level of respiratory efforts, indicated by significant increase in peak negative esophageal pressure (Pes), can be associated with daytime somnolence in snoring pre-menopausal women. No drop in oxygen saturation (SaO2) or visual evidence of transient electroencephalographic (EEG) arousals can be found at repeat polysomnography. Nasal continuous positive airway pressure (CPAP) titrated on Pes measurements eliminates somnolence.

Cardiac failure and benzodiazepines.

Nine patients with stable cardiac failure and mean left ventricular ejection fraction of 30% were investigated. All had previously been prescribed a benzodiazepine hypnotic by their home physicians, but the medication had been discontinued for at least 1 month. Subjects were monitored under three conditions: 1) without any sleeping medication, 2) during nasal CPAP administration and 3) at two points during a month-long administration of the benzodiazepine that had initially been prescribed to them.

Upper airway resistance in infants at risk for sudden infant death syndrome.

To investigate the relationship between sudden infant death syndrome and upper airway obstruction, we studied 14 term infants at a mean age of 11 weeks who had been identified as being at risk for sudden infant death syndrome on the basis of clinical and family histories and polygraphic monitoring. Respiratory efforts during sleep were investigated by esophageal pressure monitoring (all 14 infants) and by monitoring of flow with a pneumotachometer (6 infants). During apparently normal sleep, increased respiratory efforts were shown by intermittent increases in the magnitude of the negativity of esophageal pressure.

From obstructive sleep apnea syndrome to upper airway resistance syndrome: consistency of daytime sleepiness.

Some patients with excessive daytime sleepiness who do not present the features of obstructive sleep apnea syndrome (OSAS) present a sleep fragmentation due to transient alpha EEG arousals lasting between three and 14 seconds. These transient EEG arousals are related to an abnormal amount of breathing effort, indicated by peak inspiratory esophageal pressure (Pes) nadir. In the studied population, these increased efforts were associated with snoring.