Delayed Central Sleep Apnoea Following Cervical Laminectomy

Background: Egypt is ranked the third country in the world with highest mortality rates due to road traffic accidents. The commonest cause of accidents was inattention of the driver. Driver inattention can be caused by practicing any activity other than driving or by sleepiness. Sleep at wheels can be caused by poor sleep habits, shift work, sleep disordered breathing, other sleep disorders as chronic insomnia, illicit drug abuse and medical disorders.

Methods: A cross sectional study including 324 male commercial drivers. The following data was collected history of accidents, the driving behavior including mean daily driving hours mean driving years mean daily sleep duration, shift work, seat belt, tea/coffee while driving and driving after meals. The sleepiness was assessed by history of excessive daytime sleepiness, Epworth sleepiness scale, Functional outcome of sleep questionnaire, chronic insomnia, nodded while driving, naps, risk for obstructive sleep apnea and history of comorbidities. Assessment of urine tetra hydrocanabinol (the major active ingredient in marijuana and hashish) was done. Driver’s characteristic included education level, vehicle type license class road and nature of work.

Results: Prevalence of ever exposure to accidents is 25%. Independent predictors of accidents were urine THC (OR=5.3), nodding during driving (OR=4.6), Berlin questionnaire (OR=2.5), STOP Bang questionnaire (OR=1.5), FOSQ (OR= 0.9), mean daily total sleep hours (continuous) (OR=0.9).

Conclusion: Accidents were common among studied group of drivers. It is recommended to screen drivers for urine THC, identify nodding during driving, Berlin questionnaire, STOP Bang questionnaire, FOSQ and mean daily total sleep hours to predict the driver with high risk of the sleep related accidents.

Objectives: To analyze dreams characteristics and their relation with the psychological status in postmenopausal women.

Material and Methods: 200 non-hysterectomized women were interviewed: Group I, premenopausal and Group II, postmenopausal. The last three dreams, the prevalence of nightmares and important situations in daily life were documented. The What’s My M3 test was used to evaluate the psychological status. Comparison among the groups was done with Mann Whitney U test and Chi square. Results: After excluding those with hormonal treatment or who didn’t met the inclusion criteria remained in group I, 76 and in group II 95 women. The median of age was 46 (40-50) and 61 (50-84) years for group I and II respectively. There weren’t any differences among the groups in the What’s My M3 score. The frequency of nightmares was greater in group II: group I, 31.8% and group II, 68.2%. In both groups, dreams were related with daily activities and also were a greater percentage of women with nightmares and What’s My M3 score ≥ 33. Actual diseases were related with nightmares (p < 0.023).

Conclusions: Nightmares were more frequent in postmenopausal women and had a relationship with the psychological status in both groups.

Sleep deprivation is emerging as a major health concern due to the changing life style in the current 24X7 society. Each one of us has experienced insomnia, acute or chronic, at some point of our lives. 

Sleep is an important process for human beings in order to keep many biological functions in a healthy recycle. However, several factors affecting sleep could induce too many sleep disorders in modern society, such as sleep deprivation. Sleep deprivation has complex biological consequences inducing different biological effects, such as neural autonomic control changes, increased oxidative stress, altered inflammatory and coagulatory responses and accelerated atherosclerosis. This mini review summarizes consequence of sleep deprivation and its effects on the treatment of depression in different studies in order to have a better understanding of the impact of sleep deprivation on the equilibrium at multiple levels of sleep deprivation.

Purpose: The aim of this study was to analyze sleep instability using Cyclic Alternating Pattern (CAP) during NREM sleep in patients with non-refractory Temporal Lobe Epilepsy (TLE) compared to control subjects.

Material and Methods: Our sample comprised 13 patients who underwent a neuroimaging examination and were diagnosed with non-refractory TLE, and 13 normal subjects. The sleep parameters and CAP analyses were assessed according to international criteria. We used the Mann-Whitney U-test with a significance level of 5%.

Results: The age of our subjects were similar between patients and the control group (33.8 ± 8.5 y.o. vs 26.1 ± 9.2 y.o., respectively), and all of them showed normal sleep efficiency. Patients with non-refractory TLE showed an increase in the CAP rate and longer CAP time compared to the control group (p < 0.001). We found a higher arousal index during NREM sleep compared to normal controls (10.2 ± 2.9 versus 6.3 ± 1.7; p = 0.001, respectively). However, the arousal index during REM sleep was similar in both groups (p=0.075). A subgroup analysis performed on both genders showed no significant differences.

Conclusion: Patients with non-refractory TLE showed an increased in CAP rate and arousal index compared to normal control subjects. Sleep instability might be associated with epilepsy itself and may reflect the relationship between the epileptic foci and systems responsible for sleep maintenance and stability. CAP may serve as a useful marker of endogenous circadian rhythms in mild disorders. Further studies are required to elucidate the role of sleep instability in TLE.

Obesity has become an epidemic worldwide. The health hazards and consequences of obesity are multiple. We will try to briefly go through the interrelationship between obesity and various sleep disorders in this mini review. Poor dietary behaviors resulting in obesity will also affect the sleep quality and might lead to breathing related sleep disorders. Improving dietary habits and prevention of obesity should be included within the management plan of various sleep disorders. Obesity is not only linked to sleep related breathing disorders but also affects sleep quality, duration, circadian pattern, restless leg syndrome, and sleep-related eating disorder.

Objectives: Sleep impairment and sleep disorders have various repercussions on the quality of life of an individual, affecting his professional, academic performance and mental health. The objective of this study was to assess the influence of sleep characteristics and comorbidities on the quality of sleep of medical students from a University Center, as well as their consequences.

Methods: Subjects were evaluated for sleep habits, sleep disorders, comorbidities, quality of sleep, impact on work and social relations, and memory complaints.

Results: The mean of hours of sleep for the group (n=135) was 6.42, the mean Epworth Sleepiness Scale score was 10.4, the mean Pittsburgh Sleep Quality Index score was 6.98. Significant associations between poor quality of sleep and number of hours of sleep (p= 0.00), Beck Depression Inventory scores (p= 0.03) and Beck Anxiety Inventory scores (p = 0.00) were detected. Depressive disorder was a factor for the worst PSQI results (linear regression analysis, p = 0.01).

Conclusion: Sleep deprivation, depressive and anxiety symptoms are related to a poor quality of sleep among medical students, influencing work and social life. Thus, we alert medical schools to be aware of the workload and attributions of these students and also of the possible depressive symptoms, anxiety symptoms and suicidal ideation between medical students.

Competitive Eating (CE), in recent times, has developed an international reputation (particularly in the United States, Canada, Japan and Australia) as a progressive sporting interest with burgeoning groundswell participatory and spectator support [1]. Speed Eaters or “Wolfers” such as the notable Joey “Jaws” Chestnut, multiple title holder of the July 4 Nathan’s Hot Dog Eating Contest [2], have had to suffer the ignominious “slings and arrows” of assumptions regarding the dangers of the sport, and the messages it sends in the context of rising obesity concerns [3], without any documented controlled trials to confirm such charges. Contrarily, we propose the hypothesis that CE may in fact be protective against onset of OSA, a condition that affects as many as 24% of men and 9% of women [4]. Such an hypothesis could be tested via a randomised controlled clinical trial, with recruited participants keen to transition from amateur consumption (or ‘best available eating practice’) to CE, randomly allocated to immediate entry to training and competition or to ongoing usual eating for 6 months. Both groups would undergo formal in laboratory polysomnography at commencement and 12 months, and then control group participants could still contract to CE thereafter. Such a design would permit support or refutation of our hypothesis. The study could perhaps also incorporate Electromyography (EMG) assessment of masticatory muscles and upper airway dilators (such as Genioglossus) in both groups (performed via needle electrode placement on the evening of polysomnography), to elucidate potential underlying mechanisms and for accurate physiological phenotyping [5]. MRI imaging for anatomical assessment would add further supportive data. Others have published on unusual upper airway muscle strengthening modalities as in didgeridoo playing [6] in controlled trials, and treatment effects have been noted. A negative may be progressive weight gain, and height, weight, body mass index and neck circumference would need to be recorded in both groups at 0, 6 and 12 months.

Summer schedules affect all ages of sleepers. The student out of term for the summer break to the worker spending more time in outdoor activities given the mild weather lead impact the sleepers’ sleep rest cycle. Research findings have indicated measured advances in both readiness for sleep and sleep times with earlier rise times. The amount of light variability with the summer months for many locations to be of a longer interval, directly corresponds to these advanced sleep timings.

Aim: To describe severe facial disfigurement in a patient with familial Progressive Muscular Dystrophy

(PMD) treated with a Bi-level Positive Airway Pressure (BiPAP) device.

Study design and methods: A 41-year-old female with PMD was treated with BiPAP from the age of 21in

order to improve sleep-disordered breathing and nighttime hypoventilation.

Results: Severe mid face retrogantism was noted with a reverse over jet between upper and lower incisors

of 12 millimeters in centric relation.

Conclusion: We present a rare case of severe facial disfigurement secondary to orthopedic forces from

a BiPAP device in a patient with familial PMD. The simple addition of a forehead or chin support may minimize these changes.