Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes.

Background: Complex sleep apnea syndrome (CompSAS) is recognized by the concurrence of mixed or obstructive events with central apneas, the latter predominating on exposure to continuous positive airway pressure (CPAP). Treatment of CompSAS or central sleep apnea (CSA) syndrome with adaptive servoventilation (ASV) is now an option, but no large series exist describing the application and effectiveness of ASV.

Methods: Retrospective chart review of the first 100 patients who underwent polysomnography using ASV at Mayo Clinic Sleep Center.

Effect of a targeted obstructive sleep apnea consult to improve access and quality at a sleep disorders center.

Study Objectives: We sought to evaluate whether a targeted obstructive sleep apnea (OSA) consult (TOSAC) protocol that reduced sleep-specialist time spent with patients suspected of having OSA would improve quality of care compared with the previous clinical method for evaluation of patients internally referred for suspected OSA.

Methods: Prospective cohort design. TOSAC patients received oximetry and criteria screening prior to a split-night polysomnography and a 45-minute sleep-specialist consult, while control patients received consult, testing, and a follow-up visit (90 minutes of sleep-specialist time).

Adaptive servoventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes.

Rationale: Although continuous positive airway pressure (CPAP) is most often effective in patients with obstructive sleep apnea, optimal treatment of patients with predominantly mixed apneas, central sleep apnea syndrome/Cheyne-Stokes respiration (CSA/CSR), or complex sleep apnea (CompSAS) is less straightforward, and may require alternative ventilatory assist modalities.

Objectives: To compare the efficacy of noninvasive positive pressure ventilation (NPPV) with adaptive servoventilation (ASV) in treating patients with centrally mediated breathing abnormalities. We hypothesized that NPPV and ASV would be equivalently efficacious in improving the apnea/hypopnea index (AHI) and respiratory arousal index (RAI).

Pathologic gambling in patients with restless legs syndrome treated with dopaminergic agonists.

Pathologic gambling is an impulse control disorder previously reported to complicate dopamine agonist therapy in patients with Parkinson disease. It has not been described in association with dopamine agonist therapy of other conditions. We report three patients treated in our sleep disorders center who developed pathologic gambling while receiving treatment with dopamine agonists for restless legs syndrome.

Recurrent hyper- and hyposomnia: a new diagnostic entity? Polysomnographic findings and a 30-year follow-up.

Objectives: This study reports on the sleep evaluation and follow-up of a professional woman who, in her 30s and 40s, had a decade of severe episodic fluctuations in the length of her sleep (12 vs. 4 h).

Background: Severe psychogenic fluctuations in the duration of sleep have not previously been described except in bipolar disorders.

Compliance with CPAP in elderly patients with OSA.

Background: Obstructive sleep apnea (OSA) is common in the general population and especially in the geriatric age group. Nasal continuous positive airway pressure (CPAP) is a highly effective treatment but can be difficult for some patients to use.Objective: We investigated the question if older patients were less compliant with CPAP therapy than younger patients and may not realize its benefits.