Evaluation of Sleep Quality in Pregnancy According to Trimesters and Investigation of Related Factors

Objective:Pregnancy causes changes in the duration and quality of sleep. Insomnia, insufficient sleep time, and symptoms associated with restless legs syndrome/Willis-Ekbom disease (RLS/WED) are frequently described during pregnancy. We aimed to evaluate the deterioration in sleep quality during pregnancy according to trimesters and to examine the effect of RLS/WEH and its correlation with clinical and biochemical markers.Materials and Methods:Hundred pregnant women were included in the study prospectively and consecutively. Pregnant women were evaluated to determine their clinical characteristics, including demographic data, habits, and medical backgrounds by using a questionnaire. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), disease duration, severity, triggering factors, and family history for RLS/WEH were recorded. Complete blood count, fasting blood glucose, kidney function tests, ferritin, iron and iron binding capacity were also analyzed.Results:The mean age was 28.8±6.0 years. PSQI values were significantly higher in the third trimester (p=0.044), and ESS values were similar between trimesters (p=0.524). RLS/WEH was detected in 34% of the pregnant women; there was no difference between trimesters (p=0.188). The PSQI score was significantly higher in RLS/WEH patients (p=0.013). There was no significant difference in clinical and biochemical parameters between pregnant women with and without subjective poor sleep quality at night (PSQI >5 points).Conclusion:It is shown that night sleep quality is deteriorated in pregnant women, especially in the last trimester. The fact that the frequency of RLS/WEH is not different in pregnant women with poor sleep quality suggests the existence of other factors underlying poor sleep quality

Relationship Between Sleep-related Violence and NREM Parasomnia: A Case Report

Parasomnia constitutes an important group among the situations that can lead to sleep-related violence scene. Parasomnia attacks are characterized by complex motor behaviors of various degrees, violent behaviors may result in life-threatening and rarely lethal conditions for patients and their relatives. Here is presented a patient with right temporoparietal bone fracture, pneumocephalus and hemotympanum in right ear due to head trauma during a parasomnia attack. The diagnosis could be made by a detailed history taking and polysomnography only after many other investigations. In this context, we aimed to emphasize that not only nocturnal epilepsies, especially frontal lobe epilepsies, but also parasomnia attacks should be kept in mind in differential diagnosis of sleep-related violence

Neuronopathies and Sleep Disorders: Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis and Post-polio Syndrome

Neuronopathies are defined as diseases affecting the bodies of neuron cells. These disorders may be inherited, sporadic or acquired and may be observed in children or adults. Spinal muscular atrophies, amyotrophic lateral sclerosis and Post-polio syndrome are prototype disorders in this group. The clinical course, time for diagnosis and therapeutic processes are very compelling for the patients, their relatives and physicians. Disturbances in sleep structure, an increase in cyclic alternating pattern and sleep-related disorders, especially of sleep-related breathing disorders, are commonly reported in these patients. More importantly, changes in sleep microstructure and associated sleep-related disorders have a negative effect on the course of the neuronopathies. By contrast, beneficial outcomes on the clinical course and prognosis of neuronopathies have been reported upon the diagnosis and treatment of sleep-related disorders early in the disease course. For these reasons, investigating and treating deteriorations in the microstructure of sleep and sleep-related disorders in patients with spinal muscular atrophies, amyotrophic lateral sclerosis or Post-polio syndrome are important

Case Report / Olgu Sunumu Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: A Case Report on the Differential Diagnosis of Internal Carotid Artery Agenesis or Occlusion A Case Report on the Differential Diagnosis of Internal Carotid Artery Agenesis or

135 Congenital internal carotid artery (ICA) agenesis is a rare abnormality. People with this abnormality usually have adequate collateral circulation and remain asymptomatic for many years. However, patients may also present with pulsatile tinnitus, headache or blurred vision, or rarely with ischemic stroke or subarachnoid hemorrhage. Diagnosis is usually incidental with the performance of carotid artery Doppler ultrasonography or cervical/cranial magnetic resonance imaging owing to other symptoms. ICA agenesis might also be misdiagnosed as ICA occlusion. In this manuscript, we report a patient with ICA agenesis who initially presented with facial paresthesis and was referred to our center for interventional therapy for left-sided ICA occlusion. Keywords: Internal carotid artery, agenesis, occlusion Konjenital internal karotis arteri (ICA, internal carotid artery) agenezisi nadir görülen bir anomalidir. Bu anomaliye sahip hastaların çoğu, yeterli kollateral dolaşım sayesinde uzun zaman asemptomatik olarak kalır. Az sıklıkta hastalar pulsatil tinnitus, baş ağrısı veya bulanık görme gibi yakınmalar ve nadiren iskemik inme ya da subaraknoid kanama tablosu ile başvurabilirler. Tanı genellikle başka bir nedenle yapılmış olan karotis arteri renkli Doppler ultrasonografisi veya servikal/ kranyal manyetik rezonans görüntülemeleri sırasında tesadüfen konur. Ancak dikkatli olunmadığı takdirde ICA tıkanması olarak yanlış bir tanı konulabilir. Bu yazıda, yüzünde yanma şikayeti ile başvuran ve sol ICA tıkanıklığı tanısı ile girişimsel tedavi amacıyla merkezimize yönlendirilen ancak ICA agenezi tanısı konulan bir hasta sunulmaktadır

Factors determining the long-term compliance with PAP therapy in patients with sleep-related epilepsy

Introduction: In adult patients with epilepsy, treatment of comorbid obstructive sleep apnea syndrome (OSAS) by positive airway pressure (PAP) therapy results in improvements in the control of seizures. This is the first study investigating the long-term compliance with PAP therapy in patients with sleep-related epilepsy and OSAS. Methods: In this longitudinal study, patients with sleep-related epilepsy and OSAS were followed-up for five years. The compliance with PAP therapy was defined as the use of PAP therapy for at least four hours per night for more than 70 % of nights. Results: A total of 58 patients with sleep-related epilepsy and OSAS completed study protocol. Eleven patients (19.0 %) refused PAP treatment for OSAS, and 13 patients (22.3 %) showed irregular use. Remaining 34 patients (58.7 %) were compliant with PAP therapy. Females were found to be more compliant than males (p = 0.027), while the age was not found to correlate with the compliance (p = 0.721). Epilepsy-related factors including the types of seizures, whether pure sleep-related or mixed (p = 0.403), localization (p = 0.920) or lateralization (p = 0.697) of discharges, showed no effect on the compliance with PAP therapy. On the other hand, patients with a lower number of seizures (p = 0.042) or with a lower seizure frequency (p = 0.048) showed better compliance with PAP therapy. Polysomnographic parameters including severity of OSAS failed to show a significant correlation. Conclusion: Our findings showed that about two thirds of the study population was compliant with PAP therapy after a mean follow-up duration of almost three years. Newly-diagnosed patients, mostly females, with a lower number of total seizures and lower seizure frequency seem to be more compliant with PAP therapy, which implies the significance of investigation and treatment of OSAS as early as possible in the patients with sleep related seizures

ROLE OF DIABETES MELLITUS IN RECURRENT ISCHEMIC STROKES IN PATIENTS WITH ATRIAL FIBRILLATION

Objective: Atrial fibrillation (AF) is an important risk f actor for ischemic stroke, with a high morbidity and mortality ratios. Diabetes mellitus (DM) was reported as a strong and independent risk factor for both the occurrence of AF and ischemic stroke. In this context, here we investigated the influence of diabetes mellitus on the recurrence of ischemic stroke in patients with atrial fibrillation

The Effects of Mixed Type Abnormal Respiratory Events on the Treatment of Obstructive Sleep Apnea Syndrome

Objective: Central or mixed apneas may accompany obstructive apneas in patients with Obstructive Sleep Apnea syndrome (OSAS). There is scant evidence about the potential impact of mixed apneas on the therapy modalities. Here, apneas/hypopnoeas' central and/or mixed effects on the positive airway pressure (PAP) modes chosen to be effective in patients with OSAS were evaluated

Treatment approach to apnestic breathing in a patient with vocal cord paralysis due to Arnold Chiari malformation and tracheostomy

Arnold Chiari malformation (ACM) is herniation of brain stem structures, especially cerebellar tonsils, from the foramen magnum into the cervical spinal canal. Sleep-related respiratory disorders are reported at a higher rate in this patient group than the general population, at about 60-75%. A 43-year-old male patient was diagnosed with ACM type 1.5 at the center where he applied with complaints of weakness in the extremities, speech disorder and syncope triggered by coughing, and a decompression of posterior fossa (PFD) was applied to the patient. Since 2018, the apnea attacks, which were able to be 6-7 times a night every night, last in 30 seconds, with eyes open, inactivity and bruising, have started in the patient, so in all night-time polysomnography (PSG) examination for diagnostic purpose, apnestic breathing including continuous, central and mixed type apneas in sleep and wakefulness was detected. Different modes (CPAI BPAP-S/T, ASV) were tried with the cannula placed on the tracheostomy in the PSG performed for non-invasive mechanical ventilation therapy, but none alone was effective. In the patient, whom IVAPS/AVAPS mode was tried, all abnormal breathing events, irregular apnetic breathing pattern and oxygen desaturations were effectively controlled in all positions, wakefulness and all sleep stages with pressure support, respiratory rate and tidal volume support. PFD is recommended as the first-line treatment for the treatment of obstructive or central type apneas in ACM; Information on non-invasive mechanical ventilation therapy is insufficient. In this case, we aimed to present the difficulties in the diagnosis and treatment of sleep-related respiratory disorders in a patient whom ACM diagnosed, PFD was applied but underwent permanent trachoestomy due to bilateral vocal cord paralysis

Cyclic Alternating Pattern Analysis in Periodic Leg Movements in Sleep in Patients With Obstructive Sleep Apnea Syndrome Before and After Positive Airway Pressure Treatment

Purpose: Cyclic alternating pattern (CAP) is known to increase in many conditions of sleep disruption and sleep disorders, including obstructive sleep apnea syndrome and periodic limb movements in sleep (PLMS). Periodic limb movements in sleep associated with obstructive sleep apnea syndrome may vanish after positive airway pressure treatment, may persist, or emerge at treatment night. Here, the authors aimed to investigate the underlying pathophysiology of nonvanishing, vanishing, or newly emergent PLMS. Methods: The authors designed a prospective study and included 10 patients with nonvanishing PLMS during positive airway pressure therapy, 10 patients with vanishing PLMS, 10 patients with newly emergent PLMS, and 10 patients without PLMS at both nights. The CAP analysis was performed in detail at diagnostic polysomnography recording and at positive airway pressure titration. The changes in CAP parameters were evaluated in regard to nonvanishing, vanishing, or newly emergent PLMS. Results: Periodic limb movements in sleep related to A1 subtype of CAP were observed to decrease under positive airway pressure titration more than PLMS related to A3 subtype of CAP. The A3 subtype of CAP was higher in patients with vanishing PLMS than those with newly emergent PLMS. The newly emergent PLMS were mostly related to A1 subtype of CAP compared with A3 subtype of CAP. Conclusions: This study showed that vanishing, nonvanishing, or newly emerging PLMS may indeed represent different underlying pathophysiology. The authors suggest that organization of sleep and preservation of ultradian rhythms during titration may determine whether PLMS will be vanished or persist. Newly emergent PLMS may probably arise from a separate central generator by the activation of higher cortical areas