Split Night Polysomnogram Protocol Summary

A precious trial of a temporary mandibular advancement splint was unsuccessful in eliminating the sleep and improving his symptoms. James is now receptive to the idea of trialing CPAP.

18 study data were derived from the apnea database (PhysioNet) corresponding to MIT/BIH database. AirFlow, SaO2, Abdominal and Thoracic Movements were obtained from full PSG records. Each record includes a period of nearly eight hours and signals annotation is done minute-by-minute. A minute is labeled as an apnea case if it contains at least one condition of apnea or hypopnea, otherwise labeled as a non-apnea. The patients mean age and weight are between 27 to 63 years (4810.8) and 53 to 135 kg (86.322.2), respectively. PhysioNet data are classified in two categories: Apnea Group (Class A, more than 100 minutes of apnea, mean age: 50 years in range of 29 to 63 years) and Normal Group (class C, less than 5 minutes of apnea, mean age of 33 years

Patients using CPAP should be instructed to bring their machine on the operative day. OR booking must be notified and patients with severe sleep apnea should be scheduled as early as possible to accommodate prolonged recovery times. The OR schedule should reflect sleep apnea diagnosis to alert the perioperative team. On the day of surgery the patient’s chart should be flagged and the patients given a yellow arm band. Available CPAP machines would have to be cleared by the biomedical engineering department for hospital use. If CPAP is needed, respiratory therapy must be made aware so CPAP can be implemented as early as needed postoperatively. The anesthesia team can then formulate a plan of care tailored to the patient’s surgical needs with acknowledgement of OSA as a comorbidity. Decreased use of opioids with the use of NSAIDs, intravenous Tylenol, and other methods of pain management would be utilized by the nursing staff

After their trials, the authors concluded in their article “Attention Deficits in Patients with Narcolepsy,” that due to the loss of REM sleep that narcolepsy causes, individual often times tolerate periods of times of lessoned attention, alertness and memory, and this can create various problems in their regular routine, specifically as in their education, work, or personal relationships (Rieger et.al., 2003). Other physical symptoms that characterize narcolepsy are cataplexy and sleep paralysis. These physical symptoms are depicted in the article “What are the Symptoms?” Cataplexy is a brief attack of muscle weakness where an individual is unable to freely control one’s own muscles (“What are the Symptoms?” 2010). The most severe case of cataplexy results in complete loss of control of a voluntary muscle, in which that person is unable to move, speak, or even open one’s eyes (“What are the Symptoms?” 2010). Sleep paralysis also affects one’s ability to move and speak when falling asleep, and like cataplexy, sleep paralysis occurs when the person is completely conscious of what is happening (“What are the Symptoms?” 2010). These two physical symptoms that might come along with the

of sleep apnea are obstructive sleep apnea (OSA), central sleep apnea (CSA), and complex sleep

Obstructive sleep apnea (OSA) describes the situation when the patients are pauses in breathing or infrequent breathing during sleep and is usually associated with reduction in blood oxygen saturation. In recent decades, sleep quality has decreased significantly. Large segments of population suffer at least occasionally from sleep disorders such as, difficulty falling asleep, staying asleep, disturbing sleep patterns. Obstructive sleep apnea is a common disorder, also known as sleep apnea-hypopnea. It is recognized as an important cause of medical morbidity and motility, and it's associated with a wide range of significant medical squeal, including metabolic disease, cardiovascular disease and arterial hypertension. Smoking is a significant

I have caught up with Debbie following the repeat diagnostic sleep study. This has revealed moderate obstructive sleep apnoea with an apnoea/hypopnoea index of 22 events/hr. There was modest oxygen desaturation and mild snoring. The events themselves were largely hypopnoeas with very few apnoeas.

Obstructive sleep apnea is the most common form between both sleep apneas. OSA occurs when the upper airway collapse during sleep. Collapse of the upper airway may cause decreases in ventilation, but not complete cessation of it, with desaturation and arousal (hypopnea) and/or complete cessation of airflow for more than 10 seconds entitled apnea (Figure 1) 1. Common symptoms of OSA are frequent arousal, snoring, choking/gasping, daytime sleepiness, increased carbon dioxide (CO2) in the blood (hypercapnea), and a decrease of oxygen level in the body (hypoxia). As stated before, OSA is more common in men than in women. Other factors that influence OSA are those with an increased body mass index, thick neck/circumference, small erythematous oropharynx, position of body during sleep (most commonly the supine position), medication, alcohol, or pre-existing cardiac complications2. Usually, OSA is diagnosed by a sleep doctor monitoring the patient during a polysomnography (sleep study). Having a sleep study done is the gold standard diagnostic for assessing sleep-disordered breathing. There is monitoring of the airflow of the nose and mouth, end tidal CO2, the patient’s sleep state by electroencephalography, movement of the chest and abdomen, pulse oximetry, and blood pressure. “The apnea-hypopnea index (AHI)—the number of obstructive events per hour—is the most commonly used measurement to quantify OSA: mild OSA = 5 to 15 events/hour; moderate = 15 to 30

Thank you very much for referring Noel along for further investigation of possible obstructive sleep apnoea. He describes a very long history of snoring, but his wife has never noticed any apnoeas and he, himself, has never had any episodes of nocturnal choking or gasping. He does suffer from some symptoms of daytime lethargy, fatigue and some sleepiness in passive situations, but has always attributed this to his lifelong history of shift work. Up until six months ago, he is shift work did involve overnight shift, but now it is mainly morning and afternoon shifts. These do affect his sleep patterns, and he does find that on the morning shifts, he is only achieving about six hours of sleep, whereas he believes he needs seven to eight hours.

The patient is currently here for an initial assessment of OSA, due to symptoms related to hypersomnolence. Split night protocol was explained upon the patients arrival.

One of the most common types of sleep disorders that a person may suffer from is sleep apnea. Sleep apnea is when a person suffers from uncontrolled stops in breathing. People with this disorder usually stop breathing while asleep. This disorder is caused from blockage in the airway. When a person is asleep, the airway may become tight because the muscles that keep it open are relaxed. One form of sleep apnea is obstructive sleep apnea. In obstructive sleep apnea, blockage in the airway may be caused from clotted tissue or fat. Snoring can be caused from any air that gets through the blockage. When the snoring is stopped and the airway is completely blocked, a person may stop breathing for about ten to twenty seconds or until the brain recognizes the apnea. A less common form of

Some research has been done in analyzing the frequency and manifest (surface) content of dreams in individuals with sleep apnea. For instance, in “Dreams in Sleep Apnea Patients,” Gross and Lavie (1994) performed a study on the effect of sleep apnea on REM dreaming. Patients often had hundreds of apneic episodes per night, including during REM sleep—hence the interest in the ways sleep apnea affect dreaming. As opposed to analyzing the effect of external stimuli on dreaming, internal stimuli (such as increased blood pressure, accelerated heart rate, and decrease in oxygen) is scrutinized (Gross & Lavie, 1994). Thirty-three patients, majority male, participated in the study, spending 2 nights in the laboratory to be treated with CPAP (Gross

The heart is as yet performing at imperfect level; when resting blood hurries to lungs and which causes his heart failure worst; tolerant is additionally encountering paroxysmal nocturnal dyspnea which includes shortness of breath when slaying down resting/sleeping; hoisting the head with pillows helps the patient rest.

PSV is a weaning mode that relies on the patient to trigger the adjusted support pressure in every breath. Therefore, the patient is required to be conscious with intact respiratory drive6. Although Vt is variable in PSV, the pressure will be adjusted to deliver a Vt within a reasonable range. However, the number of triggered breaths in PSV will provide inconsistent minute ventilation that may or may not be required by the patient during sleep. So, either it causes abnormal CO26 levels or increases WOB6, both in which sleep quality might be interrupted. Therefore, high-pressure support levels in PSV attribute to central sleep apnea and more arousal events per hour. Low-pressure levels are associated with more patient-ventilatory asynchronies. Moreover, during NREM (non-rapid eye movement) sleep, the stage that proceeds the deep sleep or REM (rapid eye movement) sleep, the PaCO2 apneic threshold gets elevated7. For example, when a PaCO2 of 32 cmH2O usually triggers a central sleep apnea (CSA) during awakening hours, it takes a slightly elevated PaCO2, such as 34 cmH2O, to trigger CSA during NREM sleep. Patients who have chronic slow circulation, such as in left heart diastolic dysfunction, tend to have low awake CO28. And due to their CO2 chemoreceptor sensitivity, the difference between eupneic PaCO2, and apneic threshold, PaCO2

CPAP acts to avoid airway narrowing by supplying positive pressure to mechanically splint the airway. This splinting pressure is constant and is optimized during sleep in order to be effective in preventing narrowing or collapse of the upper airway40. CPAP levels are typically set to raise the pressure level in the entire respiratory system to the level required to overcome any collapsing forces that result from the sub-ambient pressure generated during inspiration40, 41. However, this approach exposes the patient to pressure values that are higher than the pressure needed to support the airway for much of the breathing cycle. CPAP therapy ignores the variations in pressure requirements and provides splinting at a constant pressure level. Therefore,