NREM Parasomnias: An Important Comorbidity in Epilepsy Patients of Pediatric Age

Objectives: We here aimed to investigate our pediatric group of patients to reveal the comorbidity of epilepsy and non-rapid eye movement (NREM) parasomnias and their clinical and polysomnographic characteristics.Methods: We retrospectively investigated all patients at the age of 18 or younger internalized within the last two years patients for a full night polysomnographic evaluation in our Sleep and Wake Disorders Unit. The diagnosis of epilepsy was made on the basis of clinical findings and electroencephalography findings; and the diagnosis of NREM parasomnia was made according to the International Classification of Sleep Disorders.Results: A total of 29 male (67.4%) and 14 female (32.6%) patients were investigated. Nineteen (44.2%) out of 43 patients were diagnosed as epilepsy. Nine (47.4%) of the patients with epilepsy also had delta-alpha paroxysms (DAP) and partial wakefulness during sleep – which are the characteristics polysomnographic features of NREM parasomnias.Conclusion: We observed a high comorbidity of epilepsy and NREM parasomnia in pediatric group of patients investigated in our sleepcenter. The arousal parasomnias are increasingly being reported to be more common in patients with epilepsy, probably due to shared commonphysiopathological mechanism characterized by pathological arousals originating in abnormal thalamo-cortical circuits produced by the central pattern generators

A Case Report of Rathke’s Pouch Diagnosed in a Patient Presenting with Excessive Daytime Sleepiness

Narcolepsy is a sleep disorder classified among central hypersomnias and, is characterized mainly by excessive daytime sleepiness. In its pathophysiology, the deficiency of hypocretin produced from hypothalamus was demonstrated, and suggested to be secondary to autoimmune process. Narcolepsy usually presents as a primary disorder, but may be observed following intracranial tumors, multiple sclerosis, encephalitis, head trauma or infections/vaccines. In this case report a narcolepsy patient diagnosed with Rathke’s pouch tumor, who was complaining of excessive daytime sleepiness was presented

Excessive Fragmentary Myoclonus: Case Report

Excessive fragmentary myoclonus is defined as a “normal variant” under the subgroup of sleep related movement disorders. It has no known clinical consequences. Here a 72 year-old man, in whom polysomnography recordings revealed continuous excessive fragmentary myoclonus during wakefulness and sleep was presented and it was aimed to emphasize this benign clinical table which is not to be defined as a disease but a normal variant. It is of great importance especially for clinicians scoring polysomnography to be aware of this normal variant in order for differential diagnosis of sleep related movement disorders

Exitus Secondary to Respiratory Arest in a Patient with Obstructive Sleep Apnea During Polysomnographic Investigation

Obstructive sleep apnea syndrome (OSAS) has severe, life-threatening complications such as hypertension, stoke, ischemic heart disease or rhythm problems. A 40-year old woman was referred to our sleep laboratory due to witnessed apnea during her hospitalization in endocrinology yard because of hypertension, hipophyseal microadenoma and Cushing syndrome. Her past medical history revealed that she had snoring, sweating at night, tiredness in morning and excessive daytime sleepiness for the last 10 years. In polysomnography investigation, we observed continuous obstructive hypopneas during NREM sleep stage with an index of 60 (times per an hour). As she started to have REM sleep stage, she had a central apnea lasting for 100 seconds, followed by bradicardia and cardiac arrest; the patient was lost in spite of urgent intervention. Here we aimed to attract attention of physicians from all disciplines to OSAS, which is a neurological life-threatening condition but all complications could be removed by non-invasive mechanical ventilation therapy. Especially in the presence of hypertension, obesity and cardiac disorders, OSAS should be questioned in detailed and be treated immediately. Otherwise, delay in diagnosis and treatment would result in lethal consequences, as in the patient reported here

The Influence of the Treatment of Obstructive Sleep Apnea Syndrome on Depression, Anxiety, and Quality of Life

Introduction: Psychiatric diseases may co-exist with obstructive sleep apnea syndrome (OSAS). We examined the presence of this comorbidity on the quality of life and sexual life, and the beneficial effects of OSAS treatment. Materials and Methods: A total of 79 consecutive patients newly admitted to the Sleep Disorders Unit were investigated with a psychiatric interview and whole-night polysomnography. DSM-IV-TR criteria were used and the Beck Depression and Anxiety Scales (BDS and BAS), the 36-item Short Form health survey (SF-36), and the Arizona Sexual Experiences Scale (ASEX) were administered. After one month of treatment with non-invasive mechanical ventilation, all investigations were repeated. Results: Of 48 patients with OSAS, major depression was present in 13 patients (27%), anxiety disorders in 3 patients (6.2%), and major depression and anxiety disorders were both present in 11 patients (22.9%). Following one month of OSAS treatment, major depression was observed in 5 patients (10.4%), anxiety disorder in 1 patient (2.0%), and both major depression and anxiety disorder (p=0.001) were found in 9 patients (18.7%). After treatment, significant improvements were detected in both BDS (p=0.001) and BAS scores (p=0.002). There was no significant difference in ASEX scores (p=0.165). Comparison of SF36 sub-scales scores before and after OSAS treatment demonstrated significant improvements in quality of life measures. The significance was more pronounced in patients with severe OSAS. Discussion: It is of great importance to keep in mind the comorbidity of OSAS and psychiatric diseases such as drug resistant depression and anxiety disorders, as treatment of OSAS provides a marked benefit in depression, anxiety, and also in quality of life

In Case Sleep Related Bruxism is Resistant to Treatment…

The diagnosis of sleep-related bruxism is easily established clinically. When there is no identifiable underlying cause, it is classified as primary or idiopathic. However, secondary-symptomatic-forms are much more commonly observed and should therefore be questioned. In this case report, a 17 year-old boy was presented who admitted to our Sleep and Disorders Unit complaining of bruxism in his sleep but diagnosed as having secondary sleep related bruxism associated with arousals secondary to periodic leg movements in sleep. Especially in cases resistant to treatment, secondary conditions and possible underlying sleep disorders should be well-questioned and polysomnography should be performed even it is not necessary for the clinical diagnosis of sleep related bruxism

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

Prevalence of sleep disorders in the Turkish adult population epidemiology of sleep study

Sleep disorders constitute an important public health problem. Prevalence of sleep disorders in Turkish adult population was investigated in a nationwide representative sample of 5021 Turkish adults (2598 women and 2423 men, response rate: 91%) by an interviewer‐administered questionnaire. Insomnia was defined by the DSM‐IV criteria, habitual snoring and risk for sleep‐related breathing disorders (SDB) by the Berlin questionnaire, excessive daytime sleepiness (EDS) by the Epworth sleepiness scale score, and restless legs syndrome (RLS) by the complaints according to the International Restless Legs Syndrome Study Group criteria. Mean age of the participants was 40.7 ± 15.1 (range 18 to 90) years. Prevalence rates (men/women) were insomnia 15.3% (10.5%/20.2%; P < 0.001), high probability of SDB 13.7% (11.1%/20.2%; P < 0.001), EDS 5.4% (5.0%/5.7%; P: 0.09), RLS 5.2% (3.0%/7.3%; P < 0.001). Aging and female gender were associated with higher prevalence of sleep disorders except for habitual snoring. Prevalence rates of the sleep disorders among Turkish adults based on the widely used questionnaires were close to the lower end of the previous estimates reported from different parts of the world. These findings would help for the assessment of the health burden of sleep disorders and addressing the risk groups for planning and implementation of health care

Yığma duvarların yatay yük kapasitesi için bir alt-sınır limit analiz çözümü.

Masonry exists from very past centuries around the world which is used not only for sheltering, most of historical architectural masterpieces are masonry structures. Masonry offers advantages in many areas such as easy supply of materials, easy to construct and thermal durability of materials. However, the analysis of masonry buildings is not a easy task. Various reasons such as the diversity of materials used and the lack of characteristic properties of these materials, lack of design regulations and the fact that the analysis methods used for today's reinforced concrete and steel structures are not suitable for masonry buildings complicate the analysis of masonry buildings. Because these structures are non-engineered structures, it is difficult and time-consuming to apply complex analysis methods for masonry buildings. Limit analysis is a very useful and fast method for non-engineered buildings such as masonry buildings. In this study, it is provided to obtain lateral load capacity by using lower-bound limit analysis method. Starting from a wall with no opening with the lower bound theorem based on the provision of static equilibrium and yield conditions, the walls with various openings were calculated and the maximum lateral load they were able to take was found. In this way, the openings had an effect on the lateral load capacity of the wall and a comparison was made. In addition, various properties of the wall have been changed to support the assumptions about the masonry wall. Matlab2017b program was applied for the application of the lower-bound theorem.Thesis (M.S.) -- Graduate School of Natural and Applied Sciences . Earthquake Studies