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

Urine Drug Screening at the Sleep Disorder Center

Aim Introduce UDS for all patients undergoing MSLT or MWT Eliminate false positive and negative results Optimize management of disorder Goal To have 100% of patients undergoing an MSLT or MWT to have a UD

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

Medical Student Knowledge of Narcolepsy

Background: Narcolepsy is a sleep disorder, whose main symptoms include daytime sleepiness, cataplexy, sleep paralysis, disturbed sleep, and hypnagogic hallucinations. The disorder is poorly identified in medical settings. We hypothesized that lack of knowledge of narcolepsy and its hallmark symptoms are a cause for the low levels of identification of this disorder. This was a pilot study into medical student knowledge of narcolepsy at Sidney Kimmel Medical College of Thomas Jefferson University (SKMC). Methods: Two groups of SKMC students, years 1 and 2 (before sleep medicine education) and years 3 and 4 (after sleep medicine education) were the subjects of this study. All students were sent a survey regarding their knowledge of narcolepsy. Results from these surveys were analyzed, and compared using a proportions test. Results: 24.42% of first and second year students correctly chose the pathognomonic symptom of narcolepsy compared to 62.63% of that of the third and fourth year classes (p\u3c0.0001). 5.43% of first and second year students correctly chose the pentad of narcolepsy symptoms compared to 20.19% of that of the third and fourth year classes (p\u3c0.0001). Conclusions: There is a significant difference in knowledge of narcolepsy between students who received education regarding narcolepsy at SKMC and those who have not. This suggests that the educational curriculum in sleep medicine at SKMC is effective in enhancing knowledge regarding narcolepsy. Future studies should assess other medical schools and their student’s knowledge of narcolepsy to evaluate the effectiveness of medical school education regarding sleep disorders on a national basis

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

Comparing Treatment Efficacy of Upper Airway Stimulation to CPAP for Obstructive Sleep Apnea

Introduction Upper airway stimulation (UAS) is newer treatment option for the management of Obstructive Sleep Apnea (OSA) and presents an alternative to the traditional Continuous Positive Airway Pressure (CPAP). Previously published data has shown good control of disease severity utilizing UAS with high patient tolerance and compliance. We aim to compare a cohort of patients treated with UAS and CPAP and evaluate therapy usage and disease control through use of the mean disease alleviation concept. Methods We evaluated demographic, pre and post-treatment sleep study, and therapy utilization data of cohorts of patients with OSA treated with CPAP and UAS. We compared the two groups and used the mean disease alleviation (MDA) concept to assess overall control of disease. Results We included 101 patients undergoing UAS therapy and postoperative PSG. We compared this group to a cohort of 149 patients diagnosed with moderate-severe OSA and treated with CPAP who were undergoing sleep study in our lab. We found the UAS group to be significantly older, with more severe disease, and a lower BMI. Utilizing the MDA concept, we found the UAS group to have a significantly higher utilization of therapy and disease alleviation with lower residual Apnea-Hypopnea Index (AHI) Conclusion UAS is an alternative treatment option to CPAP which is well tolerated by patients and offers good disease control

Radio Interview with Suzanne Monaghan from KYW News Radio with Dr. Karl Doghramji on weekend time change

PHILADELPHIA (CBS) — It’s that time of year again. We’re setting the clocks back to Standard Time. But the adjustment can be challenging for people dealing with sleep issues or insomnia. It’s normal to feel sleepy after the switch to Standard Time, despite the extra hour of sleep. http://philadelphia.cbslocal.com/2016/11/05/switch-back-to-standard-time/ Interview: 42 second

Dr. Karl Doghramji on Fox 29 morning news discussing sleep paralysis

Duration: 04:2

15 reasons why giving up coffee and alcohol are worth it

Caffeine, a stimulant, affects sleep adversely, Dr. Karl Doghramji, director of the Sleep Disorders Center at Thomas Jefferson University Hospital, says. It stays in your body for more than seven hours

Do Pressure Requirements Change over time with Auto titrating Positive Airway Pressure Therapy for Obstructive Sleep Apnea?

Study Objective: Prior studies have demonstrated reduced inflammation after chronic use of CPAP therapy. This may lead to reduced pressures over time as the upper airway becomes more compliant. We sought to determine if there was a reduction in 90th percentile pressure requirements in patients on Auto PAP for OSA. Methods: A retrospective chart review of 988 patients who underwent a sleep study at our sleep center was performed. Those with moderate to severe sleep apnea who were prescribed and compliant with Respironics Auto PAP were included, yielding a total of 46 patients for analysis. All statistical analysis analyses were performed using in SAS version 9.3. Results: Mean age of patients was 57.20 years and majority was male. Mean baseline AHI was 43.10. Mean follow up interval was 9.99 months. There was a trend towards decrease in pressure requirements over time, with a mean change of 0.46 cmH20 which was not significant. Patients with a baseline AHI ≥ 50 had a greater decrease in pressure requirements upon follow-up compared to those with an AHI Conclusions: Our study demonstrated that 90th percentile pressure decreased over time with continuous use of Auto CPAP in patients with severe OSA (AHI \u3e50) and in patients who lost weight. BRIEF SUMMARY: Study Rationale: Few previous studies have shown that chronic CPAP use may be lead to reduced upper airway inflammation and edema. We hypothesized that this may lead to reduced pressure requirements over time as the upper airway becomes more compliant. However, there have been no studies that have studied change in pressure requirements with Auto PAP treatment in patients not undergoing bariatric surgery. STUDY IMPACT: There was no significant change in pressure requirements for patients with moderate to severe OSA treated with Auto PAP, after a mean follow up interval of 10 months. On subgroup analysis, patients with a baseline AHI ≥ 50 (severe OSA) had a greater decrease in pressure compared to those with an AHI(non-severe OSA), potentially because they tend to lose weight on Auto CPAP while those with AHIOSA