The role of electroencephalography in the early diagnosis of non-convulsive status epilepticus in elderly patients with acute confusional state: Two possible strategies?

Non-convulsive status epilepticus (NCSE) can pose considerable diagnostic challenges, especially in the elderly, because of the wide differential diagnosis with common underlying causes of acute confusional state in this age group. We reviewed the proposed electroencephalography (EEG) strategies to improve the diagnostic yield of non-convulsive status epilepticus in the elderly population. Specifically, a debated topic of clinical relevance is the exact role of the EEG in the early diagnosis of NCSE in the elderly. Two EEG strategies have been proposed to improve the diagnostic yield of NCSE: emergent abbreviated EEG (EAEEG) recordings with reduced montages, and continuous EEG (CEEG) monitoring. Both approaches appear to be potentially advantageous, but at the same time subject to intrinsic limitations. Our literature review found initial evidence that the diagnostic yield for NCSE of prolonged EEG recordings is superior to routine EEGs. Further research is needed to confirm these preliminary findings and to explore strategies to improve the feasibility of a more widespread use of prolonged recordings within acute clinical settings

Morbidity and mortality risk ratios are elevated in severe supine dominant OSA: a long-term follow-up study

Purpose: Obstructive sleep apnoea (OSA) is a common public health problem. Sleeping position dependency has been related to OSA, and around half of OSA patients suffer from positional OSA where majority of the respiratory events occur in supine position. The consequences of supine dominant OSA have not been thoroughly investigated in long-term follow-up studies. The aim of the study was to retrospectively investigate the effects of supine dominant OSA on morbidity and mortality risk ratios during long-term follow-up and compare the findings with a non-supine OSA group at different OSA severities.Methods: Ambulatory polygraphic recordings of 793 patients with median follow-up time of 194.5\ua0months were retrospectively analysed. The risk ratios of morbidity and mortality of supine dominant OSA and non-supine OSA patients were compared.Results: Supine dominant OSA patients, having majority of the obstruction events occurring in supine position, showed higher mortality and morbidity risk ratios in severe OSA category than the non-supine OSA patients. In severe category, the observed risk ratios were statistically significant.Conclusions: The increased risk ratios of mortality and morbidity found further emphasises that supine OSA might have more severe health consequences than non-positional OSA especially in severe OSA. Severe OSA occurring in supine position was shown to be more deleterious than non-supine OSA based on long-term mortality and morbidity evidence

Peri-apneic hemodynamic reactions in obstructive sleep apnea

Obstructive sleep apnea (OSA) increases cardiovascular morbidity and mortality. Little is known on acute peri-apneic hemodynamic alterations due to apneas. We assessed these rapid changes and how duration of apnea might contribute to them. Eight patients with severe OSA were studied with polysomnography including continuous blood pressure monitoring. Peri-apneic hemodynamic alterations, heart rate, blood pressure, stroke volume, cardiac output and peripheral resistance, were assessed in short (27 s) apneas. Systolic and diastolic blood pressure along with heart rate elevated significantly in both apneas. These changes occurred within first 10 beats immediately after apnea. In contrast to short apneas long apneas caused sudden increase of 0.7 l in cardiac output. Acute and pronounced peri-apneic hemodynamic alterations were seen during both short and long apneas. These described rapid hemodynamic changes might escape autoregulatory mechanisms of several organs, thus making OSA patients vulnerable to acute cardiovascular events

Desaturation event characteristics and mortality risk in severe sleep apnea

Obstructive sleep apnea (OSA) is a public health problem with severe health consequences. The current OSA severity estimation is based on the average number of breathing cessation and desaturation events per hour of sleep, neglecting the individual event characteristics. The aim of the current study was to evaluate desaturation event morphology in deceased and matched control patients with severe OSA. 12 deceased and 12 AHI, age, BMI and follow-up time matched alive control patients with severe OSA were analyzed. Desaturation event durations, depths, and areas of the deceased and alive control patients were compared. Also the effect of different baseline level selection in the desaturation depth analysis was investigated. Patient demographics, apnea-hypopnea-index (AHI) and oxygen-desaturation-index (ODI) did not differ statistically significantly between the groups. The average oxygen saturation levels were statistically significantly lower 89.8% vs. 93.2% (p=0.002) in the deceased patients compared to the alive controls. The median desaturation event duration 31.8s vs. 25.9s (p=0.017), depth 15.0% vs. 9.5% (p=0.006) and area 349.9s% vs. 201.4s% (

Length of individual apnea events is increased by supine position and modulated by severity of obstructive sleep apnea

Positional obstructive sleep apnea (OSA) is common among OSA patients. In severe OSA, the obstruction events are longer in supine compared to nonsupine positions. Corresponding scientific information on mild and moderate OSA is lacking. We studied whether individual obstruction and desaturation event severity is increased in supine position in all OSA severity categories and whether the severity of individual events is linked to OSA severity categories. Polygraphic recordings of 2026 patients were retrospectively analyzed. The individual apnea, and hypopnea durations and desaturation event depth, duration, and area of 526 included patients were compared between supine and nonsupine positions in different OSA severity categories. Apnea events were 6.3%, 12.5%, and 11.1% longer (p < 0.001) in supine compared to nonsupine position in mild, moderate, and severe OSA categories, respectively. In moderate and severe OSA categories desaturation areas were 5.7% and 25.5% larger (p < 0.001) in supine position. In both positions the individual event severity was elevated along increasing OSA severity category (p < 0.05). Supine position elevates apnea duration in all and desaturation area in moderate and severe OSA severity categories. This might be more hazardous for supine OSA patients and therefore, estimation of clinical severity of OSA should incorporate also information about individual event characteristics besides AHI

Screen-printed EEG electrode set for emergency use

There is a need for an easy-to-use EEG electrode set allowing that EEG could be recorded immediately when an unconscious patient arrives at the emergency room. In addition, easy-to-use EEG electrode sets could be useful in many situations in intensive care unit, e.g., for long-term monitoring of patients with status epilepticus. In this study, we developed a novel disposable screen-printed EEG electrode set, called here BrainStatus, which consists of 16 hydrogel-coated electrodes (12 recording, 2 reference and 2 ground electrodes) and evaluated its performance by signal quality measurements and EEG recordings in two patients. The quality of EEG signal was excellent even without abrading of skin and comparable to EEG recorded with conventional cup electrodes. The clinical referral question could be answered in both cases based solely on recordings with BrainStatus. BrainStatus was demonstrated to allow MRI and CT imaging without any signs of significant imaging artifacts. We consider that the introduced screen-printed EEG electrode set may be a solution for EEG registrations when the conventional 10-20 electrode setup is not available or feasible. However, further studies with a larger number of patients are warranted to clarify the true diagnostic accuracy and applicability of this approach

Length of Individual Apnea Events Is Increased by Supine Position and Modulated by Severity of Obstructive Sleep Apnea

Positional obstructive sleep apnea (OSA) is common among OSA patients. In severe OSA, the obstruction events are longer in supine compared to nonsupine positions. Corresponding scientific information on mild and moderate OSA is lacking. We studied whether individual obstruction and desaturation event severity is increased in supine position in all OSA severity categories and whether the severity of individual events is linked to OSA severity categories. Polygraphic recordings of 2026 patients were retrospectively analyzed. The individual apnea, and hypopnea durations and desaturation event depth, duration, and area of 526 included patients were compared between supine and nonsupine positions in different OSA severity categories. Apnea events were 6.3%, 12.5%, and 11.1% longer ( &lt; 0.001) in supine compared to nonsupine position in mild, moderate, and severe OSA categories, respectively. In moderate and severe OSA categories desaturation areas were 5.7% and 25.5% larger ( &lt; 0.001) in supine position. In both positions the individual event severity was elevated along increasing OSA severity category ( &lt; 0.05). Supine position elevates apnea duration in all and desaturation area in moderate and severe OSA severity categories. This might be more hazardous for supine OSA patients and therefore, estimation of clinical severity of OSA should incorporate also information about individual event characteristics besides AHI