Case Studies in Polysomnography Interpretation

Robert C. Basner

• Publisher: Cambridge University Press
• Year: 2012
• ISBN:
  9781139786355
• Topic: Medicine
• Subtopic: Neurology

The polysomnogram is a formidable sleep medicine tool, typically incorporating multiple channels of physiologic data including EEG, ECG, EMG, respiratory flow and effort, ventilation via CO2 monitoring, oxygen saturation via pulse oximetry and ventilatory treatment modalities. Aspiring experts must constantly ask themselves questions regarding PSG interpretation such as: Am I confident in using all of these modalities? Can I accurately and consistently distinguish a seizure from a movement disorder; a servo ventilator signal from an auto-titrating continuous positive airway pressure signal; an episode of Cheyne–Stokes breathing from an episode of obstructive sleep apnea? The authors take you into their own sleep laboratories and deliver real-life cases for you to interpret with them. Such expertise is vitally useful for house staff and fellows learning sleep medicine, those seeking Board certification, technologists who score PSGs and seasoned sleep clinicians managing patients with sleep-related health disorders. The print edition includes a CD-ROM featuring all images.

Table of contents

• Cover
• Case Studies in: POLYSOMNOGRAPHYINTERPRETATION
• Title
• Copyright
• Contents
• Contributors
• Preface
• Abbreviations
• Case 1 A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation
• Case 2 A 65-year-old man with amyotrophic lateral sclerosis
• Case 3 An 80-year-old man with severe heart failure and witnessed apnea awake and during sleep
• Case 4 A 33-year-old man with a history of interstitial pulmonary fibrosis and obesity
• Case 5 A 52-year-old man being treated for sleep-related hypoventilation
• Case 6 An 81-year-old obese woman with a history of snoring
• Case 7 A 33-year-old obese man with idiopathic pulmonary fibrosis and snoring
• Case 8 A 57-year-old woman with moderate obstructive sleep apnea
• Case 9 A 57-year-old woman with potential obstructive sleep apnea
• Case 10 An 80-year-old man with heart failure and previously documented Cheyne–Stokes breathing
• Case 11 A 46-year-old obese man with loud snoring, witnessed apnea, and daytime sleepiness
• Case 12 A 60-year-old woman with severe obstructive sleep apnea
• Case 13 A 52-year-old man with valvular cardiomyopathy
• Case 14 An otherwise healthy 40-year-old man with potential obstructive sleep apnea
• Case 15 A 32-year-old man with observed severe snoring and leg shaking during sleep
• Case 16 A 20-year-old woman with extreme sleepiness who reports hypnic hallucinations, sleep paralysis, and sudden loss of muscle tone when startled
• Case 17 A 67-year-old man with chronic sleep-onset and maintenance insomnia, as well as episodes of talking and walking in his sleep
• Case 18 A 77-year-old woman with sudden episodes of loss of consciousness
• Case 19 A 32-year-old woman with frequent nocturnal episodes of sudden arousal and short chaotic movements
• Case 20 A 70-year-old woman with a history of hypertension and paroxysmal atrial fibrillation
• Case 21 A 74-year-old man with known cardiac disease and an automated implantable cardioverter-defibrillator
• Case 22 A 60-year-old man with known coronary artery disease
• Case 23 A 38-year-old man with ``restlessness´´ at night prior to sleep onset
• Case 24 A 50-year-old previously healthy man with obstructive sleep apnea and a recent history of palpitations
• Case 25 A 53-year-old man with a history of loud snoring and daytime sleepiness
• Case 26 A 27-year-old man with a 10 year history of insomnia
• Case 27 A patient´s sleeping habits shown in an actigraph
• Case 28 A patient with a possible sleep-related breathing disorder
• Case 29 A 4-month-old boy with a history of prematurity, gastroesophageal reflux, and observed pauses in breathing during sleep
• Case 30 A 7-day-old female with Pierre-Robin sequence and micrognathia
• Case 31 A 3-year-old girl with a history of static encephalopathy and severe obstructive sleep apnea
• Case 32 A 63-year-old woman with non-apneic oxyhemoglobin desaturation
• Case 33 A 24-year-old woman with a history of anxiety, asthma, and daytime sleepiness
• Case 34 A 43-year-old Chinese man with a history of obesity, difficult-to-control hypertension, and proteinuria, with daytime sleepiness and snoring
• Case 35 A 57-year-old man with a history of mild dyslipidemia who had a cerebrovascular accident several months earlier
• Case 36 A 29-year-old man who is mildly overweight, with a history of depression and attention deficit hyperactivity disorder, with difficulty falling asleep and daytime sleepiness
• Case 37 Findings in a polysomnogram
• Case 38 A 29-year-old man assessed for a diagnosis of narcolepsy
• Case 39 A 24-year-old man with symptoms of excessive daytime sleepiness
• Case 40 A 43-year-old obese man with a history of snoring
• Case 41 A maintenance of wakefulness test
• Case 42 Assessment of a sleep stage
• Case 43 Analysis of a precordial electrocardiogram finding
• Case 44 Linkage of episodes of gastroesophageal reflux with polysomnogram epochs
• Case 45 Polysomnography findings in fibromyalgia
• Case 46 A 45-year-old man presents with newly diagnosed hypertension and symptoms of snoring
• Case 47 A 10-year-old child with central congenital hypoventilation syndrome
• Case 48 A 9-year-old child with asthma, skeletal dysplasia, restrictive lung disease, and obstructive sleep apnea
• Case 49 A 21-year-old man with a history of daytime sleepiness
• Case 50 A 58-year-old woman taking fentanyl and tramadol, with witnessed pauses in breathing
• Case 51 A 37-year-old woman with bipolar disorder and a recent head injury
• Case 52 A 12-year-old boy with a history of refractory seizures
• Case 53 An 8-year-old boy with snoring and poor sleep
• Case 54 A 30-week premature infant with snoring and poor sleep at 17 months of age
• Case 55 A 75-year-old man with a history of excessive daytime sleepiness and generalized body ``weakness´´ with excitement, surprise, and anger
• Case 56 An 18-year-old woman with a 2 year history of being a ``late sleeper´´
• Case 57 An otherwise healthy 9-year-old boy who falls asleep in school
• Case 58 A 35-year-old woman who is 6 months pregnant and has a history of snoring with pauses in breathing
• Case 59 A 22-year-old graduate student with daytime tiredness
• Case 60 Interpretation of traces from polysomnography
• Case 61 An adult being assessed for obstructive sleep apnea
• Case 62 A 22-year-old woman with a 2 year history of motor activity during sleep that is increasing in frequency
• Case 63 A 43-year-old woman with a 2 year history of unusual motor activity during sleep
• Case 64 A 28-year-old man with spells of nonsensical speech and clumsy motor activity at night
• Case 65 A 5-year-old child who frequently shakes and cries in her sleep
• Case 66 A 45-year-old man with a history of gastroesophageal reflux disease taking methadone who has snoring, witnessed apnea, and excessive daytime sleepiness
• Case 67 A 49-year-old man with possible sleep apnea
• Case 68 A 25-year-old morbidly obese man with loud snoring and excessive daytime sleepiness
• Case 69 A 55-year-old man with snoring and excessive daytime sleepiness
• Case 70 A 61-year-old woman with loud snoring and daytime sleepiness
• Case 71 A 50-year-old woman with a complaint of daytime sleepiness
• Case 72 A 50-year-old obese man with a history of left ventricular failure and witnessed apnea
• Case 73 A 34-year-old man with snoring and excessive sleepiness
• Case 74 A 55-year-old man with a T11 spinal cord injury and paraplegia in association with metastatic disease, complaining of daytime sleepiness
• Case 75 A 62-year-old woman with potential obstructive sleep apnea
• Case 76 A 64-year-old morbidly obese man with severe chronic obstructive pulmonary disease and severe obstructive sleep apnea
• Case 77 A 30-year-old woman with a diagnosis of moderate obstructive sleep apnea
• Case 78 A 75-year-old man with difficulties in initiating sleep and fragmented restless sleep
• Case 79 A 4-year-old girl with mild developmental delay and a history of confusion and abnormal night-time movements of her extremities
• Case 80 A 30-year-old woman with several years of making noises at night and feeling tired
• Case 81 A 35-year-old man with excessive movement of his legs during sleep
• Case 82 A 16-year-old girl with episodes of yelling, crying, and laughing during sleep
• Case 83 A 25-year-old woman who bites her tongue during sleep
• Case 84 A 70-year-old man with abnormal night-time behavior, resulting in falls from the bed
• Case 85 A 6-year-old girl with enlarged tonsils and adenoids and a history of snoring and gasping at night
• Case 86 A 12-year-old boy with excessive daytime sleepiness
• Case 87 A 62-year-old man with congestive heart failure undergoing continuous positive airway pressure titration for obstructive sleep apnea
• Case 88 A 54-year-old morbidly obese man with a history of congestive heart failure complaining of loud snoring, excessive daytime sleepiness, fatigue, and nocturia
• Case 89 A 53-year-old man with history of central sleep apnea and congestive heart failure
• Case 90 A 33-year-old man with obesity-hypoventilation syndrome
• Case 91 A 62-year-old man with chronic obstructive pulmonary disease and obstructive sleep apnea
• Case 92 A 56-year-old woman who smokes and is obese
• Case 93 A 76-year-old man with exertional dyspnea, orthopnea and excessive daytime sleepiness
• Case 94 A 63-year-old man with snoring, witnessed apnea, fragmented nocturnal sleep, and daytime sleepiness
• Case 95 A 60-year-old woman with a history of moderate snoring and witnessed pauses in breathing plus long-term insomnia
• Case 96 A 55-year-old woman with daytime fatigue and unrefreshing sleep of several years´ duration
• Case 97 An 8-year-old child with profound developmental delay and intractable seizures being treated with antiepileptic medications and an implanted vagal nerve stimulator
• Case 98 A 9-year-old girl with a history of snoring, gasping, and chronic mouth breathing
• Case 99 A 42-year-old obese man with worsening snoring and excessive daytime sleepiness
• Case 100 A 67-year-old man with class III heart failure
• Case 101 A 62-year-old obese man with hypertension, diastolic dysfunction, mild aortic stenosis, and paroxysmal atrial fibrillation
• Case 102 A 45-year-old man with a history of snoring, morning headaches, and excessive daytime somnolence
• Case 103 A morbidly obese 3-year-old boy with a history of loud snoring and witnessed apneic episodes
• Case 104 A 59-year-old man with a history of coronary artery disease and excessive daytime somnolence
• Case 105 An 18-year-old woman treated for narcolepsy with cataplexy
• Case 106 A 20-year-old man with a history of inappropriate night-time behavior
• Case 107 An otherwise healthy college student with an isolated incident of abnormal nocturnal behavior
• Case 108 A 52-year-old man with amyotrophic lateral sclerosis, excessive sleepiness, and early morning headache
• Case 109 A 54-year-old smoker with chronic obstructive lung disease and a history of snoring, waking up gasping for air, excessive daytime sleepiness, and early morning headaches
• Case 110 A 71-year-old woman with a 10 year history of severe obstructive sleep apnea and obesity-hypoventilation syndrome, now with increased daytime sleepiness
• Case 111 A 20-year-old man with morning headache, excessive daytime sleepiness, heavy snoring, and apnea during sleep
• Case answers
• Index