A case of central sleep apnea associated with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids.

Unlabelled: A 78-year-old man with history of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids syndrome, moderate persistent asthma, pansinusitis, and upper airway cough syndrome presented to the sleep medicine clinic for evaluation of sleep-disordered breathing. Brain magnetic resonance imaging showed lesions in the pons and midbrain. Diagnostic polysomnography was remarkable for central sleep apnea.

Knuckle cracking at night associated with sodium oxybate treatment.

During upward titration of a dose of sodium oxybate therapy for narcolepsy with cataplexy, a 25-year-old woman was observed by her husband to have new onset of knuckle-cracking and moaning behaviors during sleep ≥1 nights each week. The patient did previously occasionally crack her knuckles during the day (but never at night). These behaviors had not been evaluated by polysomnography.

Treatment of Obstructive Sleep Apnea: Choosing the Best Interface.

Patient interface preference is a key factor in positive airway pressure compliance. Local side effects are common. Proper mask fitting and patient education are important.

Transformed ECG Signals: Another Potential Use.

Berry RB, Wagner MH. Transformed ECG signals: another potential use. .

Use of a Transformed ECG Signal to Detect Respiratory Effort During Apnea.

Study Objectives: To evaluate the ability of a transformed electrocardiography (ECG) signal recorded using standard electrode placement to detect inspiratory bursts from underlying surface chest wall electromyography (EMG) activity and the utility of the transformed signal for apnea classification compared to uncalibrated respiratory inductance plethysmography (RIP).

Methods: Part 1: 250 consecutive adult studies without regard to respiratory events were retrospectively reviewed. The ECG signal was transformed with high pass filtering and viewed with increased sensitivity and channel clipping to determine the fraction of studies with inspiratory burst visualization as compared to chest wall EMG (right thorax).

Use of Chest Wall EMG to Classify Hypopneas as Obstructive or Central.

Study Objectives: To compare classification of hypopneas as obstructive or central based on an effort signal derived from surface chest wall electromyography (CW-EMG-EF) coupled with airflow amplitude versus classification using The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications (AASM Scoring Manual) criteria; and to characterize hypopneas classified as obstructive versus central using a resistance surrogate.

Methods: CW-EMG was recorded in the eighth intercostal space at the right midaxillary line. Five hypopneas were randomly selected from 65 consecutive adult clinical positive airway pressure titration studies meeting study criteria.

Treatment of Obstructive Sleep Apnea: Choosing the Best Interface.

Patient interface preference is a key factor in positive airway pressure compliance. Local side effects are common. Proper mask fitting and patient education are important.

Use of Chest Wall Electromyography to Detect Respiratory Effort during Polysomnography.

Study Objectives: To evaluate the ability of chest wall EMG (CW-EMG) using surface electrodes to classify apneas as obstructive, mixed, or central compared to classification using dual channel uncalibrated respiratory inductance plethysmography (RIP).

Methods: CW-EMG was recorded from electrodes in the eighth intercostal space at the right mid-axillary line. Consecutive adult clinical sleep studies were retrospectively reviewed, and the first 60 studies with at least 10 obstructive and 10 mixed or central apneas and technically adequate tracings were selected.

Management of obstructive sleep apnea in a developmentally delayed pediatric patient with aggressive behavior and Pierre Robin sequence.

This is a case of a 15-year-old nonverbal, developmentally delayed boy with history of Fragile X syndrome (FXS), autistic spectrum disorder, Pierre Robin sequence (PRS), subglottic stenosis, and ongoing obstructive sleep apnea (OSA), who required aggressive surgical intervention. OSA related symptoms included loud snoring, apneas, awakenings with gasping breaths, enuresis, and daytime sleepiness. The patient also had a history of behavioral problems including aggressive behavior, which led to his family and his health care providers experiencing challenges caring for him.

Barriers to treatment of paediatric obstructive sleep apnoea: Development of the adherence barriers to continuous positive airway pressure (CPAP) questionnaire.

Background: Continuous positive airway pressure (CPAP) treatment is often prescribed for youth as a treatment for obstructive sleep apnoea (OSA). Efficacy research in youth is limited, though some evidence suggests that it may relieve symptoms of OSA and possibly prevent future physical, emotional, and behavioural complications. However, the device must be used consistently for benefits to be realised.

Interpretation of the polysomnogram in children.

Polysomnography (PSG) is a useful tool for the diagnosis of sleep disorders in children. This multichannel study obtains information about sleep architecture, respiratory effort, movements during sleep, respiratory events, and gas exchange to facilitate the evaluation of children who have disrupted sleep or suspected SDB. Children should be studied in a sleep laboratory equipped for and staffed with personnel comfortable with and experienced in the performance of PSG in children.

A multi-method assessment of treatment adherence for children with cystic fibrosis.

Background: Adherence rates for chronic pediatric conditions are approximately 50%. The primary objective of the study was to assess rates of adherence using four different measurement methods for children with cystic fibrosis (CF).

Methods: Participants included 37 children with CF between 6 and 13 years of age and their primary caregivers.

Comparison of respiratory event detection by a polyvinylidene fluoride film airflow sensor and a pneumotachograph in sleep apnea patients.

Study Objectives: Compare the ability of a polyvinylidene fluoride (PVDF) thermal sensor and a pneumotachograph to detect respiratory events in patients with obstructive sleep apnea.

Design: Single night of monitoring, single blinded scorer.

Setting: Veterans Affairs medical center.

Comparison of steatocrit and fat absorption in persons with cystic fibrosis.

Background: Exocrine pancreatic insufficiency is a common problem in persons with cystic fibrosis causing malabsorption and poor growth. The 72-hour fecal fat study is the best qualitative measure of fat malabsorption used in clinical practice. This test has several drawbacks, which include cost and logistics.