Clinical Sleep Disorders

Obstructive sleep apnea has an important comorbidity in type 2 diabetes, obesity, hypertension, and heart failure; yet, uncertainty exists as to the reliability of questionnaires that could predict who should be considered for sleep testing. This study evaluates whether pulse oximetry is an effective tool for early detection of sleep apnea in patients hospitalized with acute stroke. To our knowledge, it is the first study that validates the use of oximetry as a cost-effective and accurate tool to identify moderate to severe sleep apnea and help guide clinical management of sleep-disordered breathing in patients with acute stroke.

Click here to Subscribe: Click here to receive a mailed, printed copy of the complete issue: Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website. Search article archive here. All Volumes 14 13 12 11 10 09 08 07 06 05 04 03 02 01 All Words Any Words. Morgenthaler, MD 1 ; Eric J. Olson, MD 1 ; Fadi E.

• Breaking TWIG!
• Purchase The Current Issue.
• Véritable Petit Beurre LU - Mini gourmands (French Edition).
• Rain for the Wicked!
• .
• The Solution Within Yourself: Closing the gap between who you are today and who you want to be tomorrow.

Facco, MD 1 ; Corette B. Reid, PhD 3 ; Phyllis C.

Sleep disturbance in general

Silver, MD 4 ; David M. Haas, MD 5 ; Judith H. Chung, MD 6 ; Grace W. Wapner, MD 8 ; George R. Saade, MD 10 ; Brian M. Reddy, MD 12 ; William A. Kirsch, MD 2 ; Kelly A. Carden, MD 3 ; Raman K. Kristo, MD 7 ; Jennifer L. Martin, PhD 8 , 9 ; Eric J. Olson, MD 5 ; Carol L. Rosen, MD 10 ; James A. Rowley, MD 11 ; Anita V. Kasi, MD 1 ; Sheila S.

Keens, MD 1 , 2 ; Iris A.

Clinical Sleep Disorders

Perez, MD 1 , 2. Neylan, MD 1 , 2. A Structural Equation Model. The Value of a Well-Trained Ear: Sign up to receive new issue email alerts Email Address: The email field is required. Persistent sleep loss, whatever its cause, has been linked with a wide range of disorders, including poor resistance to infection, as well as psychiatric conditions, especially anxiety, depression, and alcohol and other substance abuse. For example, OSA can worsen epilepsy, hypertension and cardiac failure; treatment of the sleep disturbance can improve the underlying condition, as demonstrated, for example, in the case of epilepsy.

A sleep disorder can be the presenting symptom or early warning sign of a number of neurological disorders. Increasingly, RBD is being seen as associated with a wide variety of neurological conditions, 18 and recognised as the harbinger perhaps by many years of some of them, such as Parkinson's disease and multiple system atrophy. Insomnia is an early feature of Morvan's syndrome and fatal familial insomnia. The same can be true of serious psychiatric illness, such as depression, mania and schizophrenia. Sleep loss or disruption can be a potentially serious complication of many types of medication used in general medicine, neurology and psychiatry.

Particularly because of both public and professional unfamiliarity with the sleep disorders field, clinical manifestations of such disorders may well be misinterpreted as evidence of quite different disorders of a medical or psychiatric type. The consequence of such mistakes is, at best, delay in the correct diagnosis being made or, more seriously, the real diagnosis not being made at all.

Sleep disturbance in general Persistently not obtaining enough sleep, or having poor quality sleep because of frequent interruptions, or fragmentation by frequent subclinical arousals as in OSA , is likely to cause tiredness, fatigue, irritability, poor concentration, impaired performance possibly causing injuries or accidents at work or while driving, or depression.

Misinterpretation of individual sleep disorders The features of many individual sleep disorders are open to misinterpretations of a more specific nature. Reassurance is also appropriate about isolated sleep paralysis 26 ie, other than that associated with narcolepsy. Surveys indicate that this condition, which occurs briefly when going to sleep or on waking up, is not uncommon but usually unreported unless it is frequent. It can generate much anxiety and, again, fear of having a stroke or other neurological problem. When combined with sleep paralysis, the experience can be so complicated and bizarre including conversations with people or other beings, as well as feelings of threat and dread that a psychotic process, especially of a schizophrenic nature, may well be suspected.

Parents of the many young children who bang their heads or roll about rhythmically at night may worry that this is a sign of an emotional problem or neurological disorder, particularly epilepsy.

Night shift workers, in particular, suffer from inadequate and poor quality sleep because they are required to work when their body clock is telling them that they should be asleep. As mentioned before, this shift work disorder is associated with various forms of ill health. The psychological effects of inadequate or poor quality sleep, compounded by the disruptive influence of shift work on family and social life, are commonplace in shift workers. These physical health issues and unfortunate psychosocial consequences can easily overshadow and distract from the true origins of the shift worker's primary problems.

Clinical Sleep Disorders

They are likely to lead to referral exclusively to medical or psychiatric services without advice about the underlying sleep disorder. The effects of jet lag are usually short lived but travellers who frequently cross several time zones on each flight can develop chronic sleep disturbances that can have serious effects on mood, performance and physical well being, the true cause of which may not be appreciated.

Difficulty getting to sleep until very late and problems getting up in the morning, as well as daytime sleepiness and sleeping in late at weekends, characterise the delayed sleep phase syndrome DSPS. These features are easily misinterpreted as awkward, lazy or irresponsible behaviour, or the usual form of school refusal, especially in adolescents in whom DSPS is common. In fact, where this sleep disorder does occur in adolescence it is the result of a combination of normal pubertal biological body clock changes which shift the sleep phase later and alterations in lifestyle involving staying up late for study or social reasons.

The risk that the fundamental cause of the problem will not be recognised is increased if alcohol or hypnotic drugs are taken in an attempt to get to sleep, or stimulants to try to stay awake during the day. In the advanced sleep phase syndrome , which can be caused by normal body clock changes occurring in old age, there is a tendency to fall asleep in the evening the opposite to the effect of body clock changes at puberty. This is likely to result in early morning waking when sleep requirements have been met.

This should not be mistaken for the early morning waking associated with depression where the total amount of sleep is reduced. People with agitated sleepwalking or sleep terrors appear to be very fearful and distressed and rush about and cry out as if escaping from danger. Other sleepwalkers develop an eating disorder with excessive weight gain due to the amount of food they consume while they are still asleep at night. Yet others behave in an aggressive or destructive way causing injury to themselves or other people and, at times, sexual or other serious offences have been committed during a sleepwalking episode and, indeed, some other sleep disorders.

Young children who have confusional arousals may well be thought by their parents to be ill in some way because of the degree of behavioural disturbance involved which is akin to that of sleep terrors. If it is not known that such complicated actions are compatible with still being asleep, it is likely to be assumed that the person was awake at the time and aware of what he or she was doing, and, therefore, responsible for what had happened.

Alternatively, it might be claimed that the episodes are epileptic in nature or the result of some other physical or psychiatric state. Guidelines have been suggested for the recognition of sleepwalking automatisms, mainly for medicolegal purposes. Those who have sought medical advice may well have been treated initially, before their sleep disorder was recognised, for the complications of their OSA such as hypertension or depression rather than the OSA itself.

The usual cause at this age is enlarged tonsils and adenoids the removal of which can improve their sleep and, as a result, at least lessen any learning and behaviour problems which, otherwise, are likely to have been attributed to the other, more usual causes. Narcolepsy , 36 characterised mainly by sleep attacks, as well as more general sleepiness, is not the rarity once supposed. Its prevalence in Western societies is in the order of 0. When as is usual cataplexy, with recurrent loss of tone causing collapse or weakness of one part of the body or another, usually in response to strong emotion, is also present, there is even more scope for mistakes.

Cataplexy can be misconstrued as syncope, epilepsy or attention seeking behaviour. Other possible components of the narcolepsy syndrome ie, hallucinations, which can be especially vivid, and sleep paralysis as well as associated automatic behaviour can also be misinterpreted. Paediatricians had failed to recognise the condition as narcolepsy in all the children they had seen, possibly because of the special difficulties that can be encountered in recognising the condition at an early age, 38 but also because it is not generally realised that the onset of narcolepsy occurs before adulthood in at least a third of cases.

Hypothyroidism and hypoglycaemia are other possible misdiagnoses of narcolepsy. Violent dreams are likely to cause injury to the patient or bed partner. As mentioned earlier, RBD has many causes or associated conditions, including a strong association with neurodegenerative disorders such as Lewy body disease, multiple system atrophy, Parkinson's disease and also with narcolepsy.

There is also a link with some forms of medication, including antidepressants. Although mainly described in elderly males, it has also been reported at other ages, including children, and in women. The condition which is eminently treatable, even in the presence of neurodegenerative disease may well be confused with other dramatic parasomnias such as sleep terrors, nocturnal epilepsy or panic attacks, despite their different distinctive features. Especially if the bed partner is attacked, a psychological motive may be suspected.

Clinical diagnosis and misdiagnosis of sleep disorders

This is particularly so in NFLE, which occurs in both adults 40 and children. These and the other possible manifestations are at serious risk of being misdiagnosed especially because even ictal EEGs can be unremarkable as other dramatic events such as sleep terrors or pseudoseizures.

• Lesson Plan #4: Non-Fiction Text!
• Maximina (Spanish Edition)?
• Proxy (Avalon Novella).

The brief and often frequently occurring forms of NFLE may simply be viewed as restless sleep. Informed clinical enquiry can be valuable in reaching the correct diagnosis. The episodic, prolonged sleepiness in the Kleine—Levin syndrome , 43 accompanied by often bizarre and out of character behaviour when the patient is awake, understandably causes confusion in the minds of those who are unfamiliar with the condition. Some people with this disorder have initially been thought to perhaps have encephalitis, cerebral tumour, epilepsy, drug addiction or a psychiatric problem.

Sleep history The following outline illustrates the main clinical enquiries that should supplement usual history taking schedules.

1. CDC - For Clinicians - Sleep and Sleep Disorders.
2. Documentary Film: A Primer.
3. Best Cookie Recipes.

It's time to wake up to the importance of sleep disorders. JAMA — Sleep disorders in the elderly. Sleep Med 2 99— Abad V C, Guilleminault C. Dialogues Clin Neurosci 7 — Didden R, Sigafoos J. A review of the nature and treatment of sleep disorders in individuals with developmental disabilities. Res Dev Disabil 22 — New Oxford textbook of psychiatry. Oxford University Press, — Sleep—wake function in children with neurodevelopmental and psychiatric disorders. Semin Pediatr Neurol 4 — Sleep disorders and sleep deprivation: National Academies Press, The prevalence, cost implications, and management of sleep disorders: Sleep Breath 6 85— Stores G, Crawford C.

Medical student education in sleep and its disorders. J R Coll Physicians Lond. South Med J 94 — What's wrong with prescribing hypnotics? Drug Ther Bull 12 89— Sleep Res 21 Stores R, Wiggs L. Sleep education in clinical psychology courses in the UK. Clin Psychol Forum 14— Sleep 21 — American Academy of Sleep Medicine The international classification of sleep disorders: Diagnostic and coding manual. American Academy of Sleep Medicine, Semin Neurol 24 — Eur Neurol 55 74— Symptomatic REM sleep behaviour disorder. Neurolog Sci 28 Suppl 1 S21—S