Clinical Management of Insomnia

Throughout the book, we are guided by our main goal of providing practitioners with clinically relevant, evidence-based, and state-of-the-art information in the evaluation and management of insomnia. We have made a concerted attempt to ensure that our reviews are consistent with professional guidelines to the extent that current knowledge permits

Meningitis Presenting as Depression: A Case Report

The relationship between psychiatric and medical illness has long been recognized by clinicians. Of special importance to psychiatrists are the diagnostic dilemmas posed by medical illnesses presenting as psychiatric disorders. In a review of recent studies, LaBruzza found that at least one out of every twenty patients receiving an initial psychiatric evaluation may have an underlying medical illness which accounts for the psychiatric symptoms. This was especially true with inpatients, where between 5% and 30% of patients, with a weighted average of 12%, had medical illnesses accounting for their psychiatric complaints 11). One medical illness which can resemble psychiatric illness is aseptic meningoencephalitis, a subject about which there is a paucity of literature. We present here a case of aseptic meningoencephalitis which, because of the history and presenting symptoms, bore a strong resemblance to a major depressive episode

Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature.

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management

Disposable Equipment for Efficient Home Sleep Apnea Testing and Minimizing Human Handling at the Sleep Laboratory

As part of the disease mitigation strategy at the time of the pandemic, the Jefferson sleep laboratory has completely shifted towards utilization of the third-party vendor for HSATs. The vendor specializes in handling, shipping and disinfecting the HSAT equipment. They send the data electronically to the Jefferson sleep laboratory for interpretation. We propose a single-use, fully disposable HSAT kit (WatchPAT One) to further minimize potential virus exposures and spread. The single-use design allows no return shipment, no charging or downloading, no cleaning and no infection transmission risk. Since the equipment utilizes a different mechanism - peripheral arterial tone (PAT) signal instead of airflow, the Sleep Disorders Center will require scorer and provider staff training

MCI: CPAP Treatment of OSA

Introduction: An estimated 30 percent of adults (20% of men and 10% of women) in the US have sleep apnea. Approximately 60% of patients with Mild Cognitive Impairment (MCI) are also diagnosed with Obstructive Sleep Apnea (OSA). The suggested mechanism of this is damage to the brain due to hypoxia during sleep. Few studies have investigated the effect of Continuous Positive Airway Pressure (CPAP) treatment for OSA, on mild cognitive impairment. Methods: Patients are screened for eligibility based on specific inclusion and exclusion criteria. Potentially eligible patients who screen positive for MCI using the Telephone Interview for Cognitive Status (TICS) survey are enrolled. CPAP adherent (n=200), CPAP non-adherent (n=160), and no apnea control (n=100) groups are followed for 1 year total with study visits at zero and six months that include cognitive testing and brain MRI. Results: At Jefferson, 272 charts have been reviewed, with 2 patients enrolled in the study. Across all study sites, approximately 5000 charts have been reviewed, and 157 patients enrolled. We hypothesize that adherence with CPAP treatment of OSA will delay the progression of cognitive impairment. Discussion: MCI is a precursor to Alzheimers, for which there is currently no effective treatment. If CPAP proves to be effective in delaying the progression of cognitive impairment in patients with OSA and MCI, CPAP may have a clinically significant impact on patient morbidity, mortality, and quality of life

Sleep Paralysis

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