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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe a case of nocturnal choking episodes caused by insular seizures. Recurrent choking spells from sleep showed no response to treatment for sleep apnea or gastroesophageal reflux. Laryngoscopy revealed no abnormalities. Although continuous EEG monitoring during events was normal, ictal SPECT imaging showed increased radiotracer uptake in the left insular region, an area involved in sensation of the upper gastrointestinal tract. The episodes remitted after initiation of an antiepileptic drug. Obstructive sleep apnea is the most common cause for presentation to a sleep center, but seizures should remain in the differential diagnosis of nocturnal choking episodes.
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PMID:A neurological cause of recurrent choking during sleep. 1911 Aug 89

A 53-year-old epileptic man had two seizures during polysomnography. Significant sleep apnea followed each (apnea-hypopnea indices (AHIs) of 22 and 20.4 for the 2 h following seizure one and 47.7 for the 53 min following seizure two). Lower hourly AHIs (range: 6.0-14.1) occurred for the remainder of the study. Results were not position-dependent. This suggests that epilepsy can transiently worsen sleep apnea, with implications for treatment.
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PMID:Sleep apnea as a transient, post-ictal event: report of a case. 1947 19

Epilepsy is a chronic condition that may be associated with several other diseases. In these cases, we should consider the following points: (1) antiepileptic drug (AED) treatment may positively or negatively affect comorbid disease, (2) drugs used for treatment of co-morbid disease may influence seizure threshold, (3) AED toxicity can be affected by a comorbid condition and (4) co-administration of AEDs with drugs used for treatment of comorbid conditions can be associated with clinically relevant drug-drug interactions. In this article, we discuss problems that are usually encountered when an appropriate AED treatment has to be selected in newly diagnosed epileptic patients who also have (an)other neurological disease(s). Comorbidity of epilepsy with cerebrovascular diseases, dementias, mental retardation, attention deficit and hyperactivity disorder, brain tumours, infections of the CNS, migraine, sleep disturbances (obstructive sleep apnoea syndrome), substance abuse and multiple sclerosis is discussed.
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PMID:Neurological comorbidity and epilepsy: implications for treatment. 1952 25

Sleep medicine is a multidisciplinary specialty that is rapidly advancing with exciting new discoveries. Some sleep disorders are diagnosed by clinical history alone, but others such as sleep apnea, narcolepsy, periodic limb movement disorder, parasomnias, and nocturnal seizures (conditions that will be addressed by other articles in this issue) usually require evaluation in the sleep laboratory. Sleep studies are used for diagnostic purposes, to assess disease severity, and to evaluate treatment efficacy. Routine sleep testing can be tailored to answer the specific clinical question at hand. In this article, the authors review the most commonly performed sleep tests in the sleep laboratory and their indications, interpretation, and limitations. These include the polysomnogram (PSG), the Multiple Sleep Latency Test (MSLT), the Maintenance of Wakefulness Test (MWT), and actigraphy. The accurate interpretation of these studies requires a comprehensive sleep and medical history.
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PMID:The use of sleep studies in neurologic practice. 1974 8

Over a century of work has confirmed crucial links between sleep and epilepsy. Seizures and some antiepileptic drugs (AEDs) adversely affect the continuity of sleep. However, sleep is fragmented in the absence of seizures or medication, suggesting that sleep instability may be an inherent component of certain forms of epilepsy. In turn, sleep instability can promote seizures, thus forming a vicious cycle. Sleep deprivation provokes seizures and epileptiform discharges in some people with epilepsy. Synchronized nonrapid eye movement (NREM) sleep facilitates seizures, whereas desynchronized rapid eye movement (REM) sleep discourages seizure occurrence. The sleep electroencephalogram (EEG) is useful in the diagnosis and localization of epilepsy, as new epileptic foci can appear in sleep and REM sleep may demonstrate the narrowest localization of the primary focus. Polysomnography (PSG) with expanded EEG aids in the differentiation of seizures and parasomnias and in the diagnosis of primary sleep disorders, such as sleep apnea, that can exacerbate seizures. Treating sleep apnea may lead to improved seizure control. These observations underscore the importance of sleep in the diagnosis and treatment of people with epilepsy.
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PMID:Sleep and epilepsy. 1974 16

Some ambiguous symptoms may delay or lead to an erroneous diagnosis. We present a case of pure sleep, generalized tonic seizures in a patient with concomitant sleep apnea syndrome. The prolonged apneic periods with tonic muscle contracture lasting minutes and occurring exclusively at night with ensuing confusional state posed diagnostic difficulties because of the negative EEG at the beginning of the workup and the absence of other epilepsy symptoms (i.e. clonic phase, tongue biting, enuresis, seizures while awake). Numerous apneas on polysomnography led to the diagnosis of sleep apnea syndrome. No effect of continuous positive airways pressure (CPAP) treatment on frequency of the nocturnal tonic epileptic fits and the repetitive character of the clinical presentation combined with the typical pathologic changes on subsequent EEGs permitted to suggest the epileptic nature of the paroxysmal events. Episodes stopped following administration of clonazepam. However, spontaneous, coincidental remission of seizures cannot be excluded since the patient remained seizure free even after discontinuation of the drug.
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PMID:Obstructive sleep apnea syndrome and nocturnal epilepsy with tonic seizures. 1993 56

Children with epilepsy have high rates of sleep problems. Melatonin has been advocated in treatment of sleep disorders, and its beneficial effect has been confirmed in insomnia. The aim of this study was to assess melatonin levels in children with intractable epilepsy and its relation to pattern of sleep and characteristics of seizure disorder, as well as the effect of melatonin therapy on those parameters. The study was conducted on 23 children with intractable epilepsy and 14 children with controlled seizures. Patients were evaluated by psychometric sleep assessment and assay of diurnal and nocturnal melatonin levels. Children with intractable epilepsy received oral melatonin before bedtime. They were reassessed after 3 months. Children with intractable epilepsy had higher scores for each category of sleep walking, forcible teeth grinding, and sleep apnea. At the end of therapeutic trial, patients with intractable epilepsy exhibited significant improvement in bedtime resistance, sleep duration, sleep latency, frequent nocturnal arousals, sleep walking, excessive daytime sleepiness, nocturnal enuresis, forcible teeth grinding, sleep apnea, and Epworth sleepiness scores. There was also significant reduction in seizure severity. Thus, use of melatonin in patients with intractable seizures was associated with improvement of both many sleep-related phenomena and the severity of seizures.
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PMID:Melatonin and sleep-related problems in children with intractable epilepsy. 2030 27

Adverse surgical outcomes appear to be more frequent in patients with known obstructive sleep apnea (OSA). However, OSA patients may present for surgery without a prior diagnosis. A 37-year-old man underwent craniotomy for surgical direct neck clipping of the right ruptured internal carotid aneurysm. His intraoperative and early postoperative courses were uneventful. At night, about 48 hr after surgery, he developed sudden generalized tonic-clonic convulsion and temporary depressed consciousness resulting in marked hypercapnea (Pa(CO2)>100 mmHg). His respiration was transiently supported by PSV mode via LMA. He soon got well without neurologic deficits. At night, about 74 hr postoperatively, a generalized convulsion was again observed with hypercapnea. Aside from the respiratory support, percutaneous cricothyroidotomy was performed using Minitrach II system for his airway control, leading to no further recurrence of seizure. He was suspected to have unrecognized OSA due to such characteristic findings of sleep apnea as obesity (BMI>30) and witnessed apneas by his family. Postoperative rapid eye movement (REM) sleep rebound has been suggested to contribute to two consecutive night appearance of seizure. Clinical suspicion for OSA should be required preoperatively and perioperative heightened awareness is recommended.
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PMID:[Case of obstructive sleep apnea possibly having led to postoperative appearance of generalized convulsion]. 2042 Jan 47

A 54-year-old man was admitted to the Sleep Laboratory, Hospital of Kaunas University of Medicine, for assessment of nocturnal seizures of unknown origin during sleep. This patient complained of increasing daytime sleepiness, morning headaches. Before the admission to the Sleep Laboratory, the treatment with depakine and clonazepam had been prescribed. Despite the treatment, the frequency of nocturnal seizures and daytime sleepiness increased. Full night polysomnography was performed. Ten central apneas were registered during all night. Two central sleep apneas with deep desaturation followed by generalized tonic-clonic seizures were documented. First sleep apnea lasted for 180 seconds and was terminated by epileptic tonic-clonic seizures. The second central sleep apnea with oxygen desaturation of 65% was detected 20 minutes later. It lasted for 200 seconds and was also terminated by epileptic tonic-clonic seizures. The conclusion was drawn that the patient had epileptic seizures caused by central sleep apneas with deep oxygen desaturation. The treatment with nasal continuous positive airway pressure device was started. The seizures disappeared completely. Clonazepam was stopped. Depakine was gradually withdrawn during the two weeks. One-year follow-up showed very good compliance, no seizures, and diminished daytime sleepiness.
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PMID:Late-onset nocturnal intractable seizure during sleep: what is the origin? 2044 85

Despite being relatively common and potentially able to have clinical and pathophysiological consequences, the comorbidity between epilepsy and sleep disorders is poorly investigated in the literature and rarely taken into consideration by clinicians in general practice. There is increasing evidence that obstructive sleep apnoea (OSA) coexists in epilepsy (in 10% of unselected adult epilepsy patients, 20% of children with epilepsy and up to 30% of drug-resistant epilepsy patients). A few lines of evidence suggest that continuous positive airway pressure treatment of OSA in epilepsy patients improves seizure control, cognitive performance and quality of life. Parasomnias and epileptic seizures can coexist in the same subject making the differential diagnosis of these conditions particularly challenging. In childhood, a frequent association between epilepsy and NREM arousal parasomnias, enuresis and rhythmic movement disorder has been documented. A particular pattern of association has been found between nocturnal frontal lobe epilepsy (NFLE) and NREM arousal parasomnias, the latter being found in the personal or family history of up to one third of NFLE patients. As far as REM parasomnias are concerned, REM sleep behaviour disorder, unrecognised or misdiagnosed, has been found to co-occur in 12% of elderly epilepsy patients. Patients with epilepsy often complain of poor, non-restorative sleep; however, insomnia in epilepsy is poorly investigated, with the literature giving conflicting prevalence data and no information on the impact of this disorder on seizure control, or on the best therapeutic approach to insomnia in this particular group of patients. A greater awareness, among clinicians, of the comorbidities between sleep disorders and epilepsy may help to prevent misdiagnosis and mistreatment. Sleep hygiene measures in epilepsy need to be more comprehensive, taking into account the various pathologies that may underlie disordered sleep in epilepsy patients.
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PMID:Comorbidity between epilepsy and sleep disorders. 2057 Jan 9


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