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  • Print publication year: 2010
  • Online publication date: November 2010

Case 9 - Extreme dreams

from Part IV - Parasomnias

Summary

This chapter presents the clinical history, examination, and the results of the procedures performed on a patient who was a 14-year-old young woman who, according to her parents, has had problems sleeping for several years. The results of the studies showed that the patient had a total of 144 sleep-related respiratory events, with an apnea-hypopnea index (AHI) of 22.47 per hour. There were 140 central apneas and four hypopneas, with 126 events occurring in NREM sleep. The diagnosis was Chiari 1 malformation with associated central sleep apnea. The patient also had a syrinx from C3 through the thoracic cord. Treatment of Chiari 1 malformation involves suboccipital decompression (posterior fossa craniectomy), with or without upper cervical laminectomy. In this case too, the patient underwent suboccipital decompression, and remained in the hospital for 4 days, with some immediate post-operative sleep-related apneas but subsequent significant improvement of sleep.

Suggested reading

Historical
SchenckCH, BundlieSR, EttingerMG, MahowaldMW.Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986; 9: 293–308.
General
BoeveBF, SilberMH, SaperCB, et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 2007; 130: 2770–88.
IranzoA, SantamaríaJ, TolosaE.The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases. Sleep Med Rev 2009; 13: 385–401.
SchenckCH, BundlieSR, MahowaldMW.Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder. Neurology 1996; 46: 388–93.

Historical

SchenckCH, BundlieSR, EttingerMG, MahowaldMW.Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986; 9: 293–308.

General

BoeveBF, SilberMH, SaperCB, et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 2007; 130: 2770–88.
IranzoA, SantamaríaJ, TolosaE.The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases. Sleep Med Rev 2009; 13: 385–401.
SchenckCH, BundlieSR, MahowaldMW.Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder. Neurology 1996; 46: 388–93.