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This chapter discusses the case of an 11-year-old Asian-American girl who was admitted for treating sleep disturbances, excessive daytime sleepiness (EDS) and paroxysmal weakness in the sleep center. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. Nocturnal video-polysomnography (PSG) followed by a multiple sleep latency test (MSLT) were ordered. She went into REM sleep, without going into any other sleep stages at the beginning of the MSLT in three of the five naps. The diagnosis was narcolepsy with cataplexy. Sodium oxybate was administered and titrated twice nightly, which helped further decrease her cataplexy to once or twice daily. Cataplexy may take the form of prolonged waxing and waning, with partial or complete muscle atonia, called status cataplecticus. Schizophreniamay be co-morbid or an intrinsicmanifestation of narcolepsy. Obesity is frequently observed in association with narcolepsy, contributing to sleepiness.
This chapter presents the case of a 24-year-old woman who presented with 5-year history of hallucinations during night, occurring three to four times a week. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The polysomnography (PSG) study has revealed sleep latency of 11 minutes and REM sleep latency of 99 minutes. Sleep efficiency was 81% with normal distribution of sleep stages. Her apnea-hypopnea index (AHI) was 3 per hour and periodic limb movement (PLM) index was 4 per hour. The patient is awake from stage N2 sleep at 2.05am without any obvious precipitating cause. She describes seeing a woman standing by her bed. The EEG showed an alpha rhythm commencing immediately on waking and persisting for several minutes, and a review of the EEG recorded over the rest of the night showed no potentially epileptogenic activity.
This chapter presents the clinical history, examination, diagnosis, and the results of the procedures performed on a 27-year-old woman patient who was referred for evaluation of eating while asleep. Her tongue was scalloped and her hard palate was high-arched and narrow. The nasal examination was within normal limits. Cardiovascular, pulmonary, extremity and neurological examinations were within normal limits. The patient underwent diagnostic polysomnography (PSG). The patient also underwent a positive airway titration study, which showed that a continuous positive airway pressure (CPAP) setting of 8cmH2O effectively eliminated the obstructive breathing events and snoring. A diagnosis of sleep-related eating disorder (SRED) and obstructive sleep apnea (OSA) was made. This patient suffers from SRED, which is characterized by recurrent episodes of eating after an arousal from night-time sleep with negative consequences. Preliminary data suggest that SRED is a relatively common disorder and occurs more frequently in those with daytime eating disorders.
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