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This chapter describes the case of a 7.5-month-old Caucasian infant with a birthweight of 3.9 kg, born full term to a 35-year-old mother. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The patient's pediatrician suspected an upper respiratory tract infection and treated her with "Infants' Cold Formula" with no relief. A soft-tissue X-ray of her neck revealed hypertrophy of her adenoids, which were obstructing the nasal airway. There was paradoxical inward rib-cage motion during inspiration throughout much of the study. Tachypnea was present, particularly during REM sleep. The diagnosis based on the polysomnography (PSG) results was severe obstructive sleep apnea (OSA), pediatric. The patient's symptoms and O2 saturation improved immediately thereafter. A follow-up sleep study 2 months later revealed that the patient no longer demonstrated an obstructive breathing pattern or impairment in gas exchange.
This chapter presents the clinical history, examination, and the results of the procedures performed on a 30-year-old male shift worker who was admitted for the evaluation of uncontrolled daytime sleepiness and generalized muscle hypotonic attacks. The patient was also falling to the ground without loss of consciousness. The chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The results of polysomnography (PSG) showed that the patient had a total sleep time of 400 minutes and a total wake time of 40 minutes, with a sleep efficiency of 91%. The diagnosis was narcolepsy with cataplexy. Sodium oxybate was administered in increasing doses, and the progression after a year and a half was satisfactory; no episodes of cataplexy occurred during regular work hours. After 4 months of treatment with sodium oxybate, the patient did not complain of daytime sleepiness.
This chapter discusses the case of a 54-year-oldwoman with disturbing respiratory noise during nocturnal sleep. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. EMG investigation of laryngeal muscle activity was subsequently performed during wakefulness and sleep, placing fine-wire electrodes in the posterior cricoarytenoid, cricothyroid and thyroarytenoid muscles. The specialist made a diagnosis of nocturnal inspiratory stridor based on the characteristics of the noise present only during sleep, particularly during NREM sleep. A diagnosis of REM-sleep behavior disorder (RBD) was also made due to the characteristic clinical history of violent motor behaviors during sleep associated with polysomnography (PSG) evidence of REM sleep without atonia. Tracheostomy and continuous positive airway pressure (CPAP) are effective treatments of stridor; however, they do not always prevent death in multiple-system atrophy.
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