Sleep Disorders Unit

Reus, Spain

Sleep Disorders Unit

Reus, Spain
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Flamand M.,Sleep Disorders Unit | Herlin B.,Sleep Disorders Unit | Leu-Semenescu S.,Sleep Disorders Unit | Leu-Semenescu S.,University Pierre and Marie Curie | And 9 more authors.
Sleep Medicine | Year: 2015

Background: Choking during sleep may be caused by various respiratory and non-respiratory problems. Objective: We aimed at documenting a new, rare cause of hallucinatory choking. Methods: We documented the clinical and video-polysomnographic features of 11 adult patients referred for swallowing and choking during sleep. We conducted a systematic search for similar sensations in 68 consecutive adult patients with sleepwalking/sleep terrors and in 37 patients with obstructive sleep apnea. Results: The 11 patients with sleep-related swallowing and choking were all current or former sleepwalkers. The symptoms occurred during the first third of the night. The patients consistently reported a frequent hallucinatory feeling of swallowing an unusual object (ring, nails, pebble, chewing gum, spoon, fork, electrical cables, lizard tail, needles, brush, computer, or gas container) that blocked the upper airways during sleep, followed by attempts to unblock them by spitting or swallowing water. When monitored, the choking sensations were not stereotypic, and occurred exclusively during arousals from N3 sleep, despite normal airway patency and absence of epileptic activity. The patients demonstrated simultaneous intense adrenergic stimulation and emotional distress. Of the 68 sleepwalkers, 13% had occasional choking sensations and 4% once inhaled a fictitious object. In the sleep apnea group, choking was never the motive of referral, but 38% of patients had occasional choking sensations, and 5% once inhaled something fictitious. Conclusion: Although insular seizure could also be discussed, these results suggest that sleep-related swallowing and choking syndrome may be a rare, specialized variant of the arousal disorders in some cases. © 2015 Elsevier B.V.


Brion A.,Sleep Disorders Unit | Flamand M.,Sleep Disorders Unit | Oudiette D.,Sleep Disorders Unit | Oudiette D.,University Pierre and Marie Curie | And 6 more authors.
Sleep Medicine | Year: 2012

Background/objective: Sleep-related eating disorder (SRED) may have some common clinical features with sleepwalking and with eating behavior disorders. The objective of this study was to compare clinical, sleep, and eating behavior measures in patients with SRED vs. sleepwalkers and controls. Methods: Overall, 15 patients with SRED, 21 sleepwalkers, and 20 age- and sex-matched healthy volunteers underwent interviews, completed sleep, anxiety, depression, and eating behavior scales, and had a night-time videopolysomnography. Results: Patients with SRED were mainly women, had disease onset in adulthood, suffered nightly episodes and insomnia, and had more frequent eating problems in childhood and higher current anorexia scores than sleepwalkers and controls. Unlike controls, they shared several commonalities with sleepwalkers, including a high frequency (66%) of past or current sleepwalking, a similar timing of parasomnia episodes during the first half of the night, numerous arousals from stage N3, and a similarly altered level of daytime sleepiness and anxiety, but higher awareness during parasomnia episodes. Conversely, only 10% of sleepwalkers ate during their sleepwalking episodes. On videopolysomnography, the eating episodes occurred mostly within 1. min after awakening from stage N2 (n= 9) or stage N3 (n= 6). The frequencies of restless legs syndrome, periodic leg movements, and sleep apnea were similar across the three groups. Conclusions: Patients with SRED share several clinical commonalities with sleepwalkers (although their level of awareness is higher) plus former or current eating behavior problems. It suggests that they have specialized a former sleepwalking behavior toward sleep-related eating because they are more vulnerable to eating behavior problems during the daytime. © 2012 Elsevier B.V.


Leu-Semenescu S.,Sleep Disorders Unit | Leu-Semenescu S.,University Pierre and Marie Curie | Le Corvec T.,Sleep Disorders Unit | Groos E.,Sleep Disorders Unit | And 5 more authors.
Neurology | Year: 2015

Objective: To compare the benefits and risks of lithium therapy vs abstention/other treatments in Kleine-Levin syndrome (KLS). Methods: In a KLS cohort followed in a single center, 130 patients regularly took lithium carbonate (median dose 1,000 mg/day; n 71; 40 children), valproate (n 5), contraceptive pill (n 5), or no treatment (n 49). The disease characteristics (frequency, mean, and longest durations of episodes, time incapacitated per year) were compared before and after follow-up in the lithium vs abstention groups. Results: The time between KLS onset and therapeutic onset was 69 ± 92 months. The patients were then followed up for a mean of 21.5 ± 17.8 months. Before treatment, the 71 patients treated with lithium tended to have a higher frequency of episodes per year (3.8 ± 2.9 vs 2.9 ± 2.6) and had a longer time spent incapacitated (57 ± 51 vs 37 ± 35 days) than the untreated patients. The mean (-8 ± 20 vs 2 ± 13 days) and longest (-18 ± 35 vs -5 ± 13) episode duration, the time spent incapacitated (-37 ± 65 days vs -10 ± 38), as well as the frequency of episodes per year (-2.6 ± 2.9 vs 1.3 ± 2.78) decreased significantly more in the treated than in the untreated patients. Side effects (reported by 50% of the patients) were mild and classical with lithium (tremor, increased drinking, diarrhea, and subclinical hypothyroidism). Conclusions: In this large, prospective, open-label, controlled study, the benefit/risk ratio of lithium therapy is superior to that of abstention, supporting the concept that lithium has anti-inflammatory/neuroprotective effects. Classification of evidence: This study provides Class IV evidence that for patients with KLS, lithium decreases the frequency and duration of KLS episodes. © 2015 American Academy of Neurology.


PubMed | Eduardo Anitua Foundation and Sleep Disorders Unit
Type: Journal Article | Journal: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine | Year: 2015

To estimate the frequency of obstructive sleep apnea syndrome (OSAS) in dental patients with tooth wear, and to assess the role of dentists in the identification of patients at risk of OSAS.Dental patients with tooth wear and treated with occlusal splint were prospectively recruited to perform sleep study. The severity of tooth wear was established by the treating dentist before patient referral to sleep disorders unit. Sleep questionnaires, anthropometric measurements, and validated respiratory polygraphy were performed.All patients with dental wear were offered a sleepiness analysis. Of 31 recruited patients, 30 (77% males) participated in this study. Patients mean age was 58.5 10.7 years (range: 35-90 years) and the body mass index was 27.9 3.4 kg/m(2). Tooth wear was mild in 13 patients, moderate in 8 and severe in 9. The mean apnea-hypopnea index (AHI) was 32.4 24.9. AHI < 5 was reported in 2 patients, AHI of 5-29 in 17, and AHI 30 in 11. A statistically significant association was found between AHI severity and tooth wear severity (Spearman R = 0.505; p = 0.004).Tooth wear could be a tool to identify those patients at risk of having OSAS. This highlights the importance of dental professionals to identify and refer patients with OSAS.


PubMed | French Institute of Health and Medical Research, Sleep Disorders Unit and University Pierre and Marie Curie
Type: Journal Article | Journal: Sleep medicine | Year: 2015

Choking during sleep may be caused by various respiratory and non-respiratory problems.We aimed at documenting a new, rare cause of hallucinatory choking.We documented the clinical and video-polysomnographic features of 11 adult patients referred for swallowing and choking during sleep. We conducted a systematic search for similar sensations in 68 consecutive adult patients with sleepwalking/sleep terrors and in 37 patients with obstructive sleep apnea.The 11 patients with sleep-related swallowing and choking were all current or former sleepwalkers. The symptoms occurred during the first third of the night. The patients consistently reported a frequent hallucinatory feeling of swallowing an unusual object (ring, nails, pebble, chewing gum, spoon, fork, electrical cables, lizard tail, needles, brush, computer, or gas container) that blocked the upper airways during sleep, followed by attempts to unblock them by spitting or swallowing water. When monitored, the choking sensations were not stereotypic, and occurred exclusively during arousals from N3 sleep, despite normal airway patency and absence of epileptic activity. The patients demonstrated simultaneous intense adrenergic stimulation and emotional distress. Of the 68 sleepwalkers, 13% had occasional choking sensations and 4% once inhaled a fictitious object. In the sleep apnea group, choking was never the motive of referral, but 38% of patients had occasional choking sensations, and 5% once inhaled something fictitious.Although insular seizure could also be discussed, these results suggest that sleep-related swallowing and choking syndrome may be a rare, specialized variant of the arousal disorders in some cases.


Catala R.,Sleep Disorders Unit | Catala R.,Rovira i Virgili University | Cabre A.,Rovira i Virgili University | Cabre A.,Research Unit on Lipids and Atherosclerosis | And 12 more authors.
Sleep | Year: 2013

Objective: To evaluate circulating adipocyte and epidermal fatty acid-binding protein (FABP4 and FABP5) concentrations in patients with obstructive sleep apnea (OSA), as well as the effects of continuous positive airway pressure (CPAP) treatment. Methods: Our cross-sectional study included 125 patients. After polysomnography, 58 participants met the criteria for CPAP treatment and were included in a closed cohort study of 8 weeks of CPAP treatment. General anthropometric and biochemical data and circulating FABP4 and FABP5 levels were determined in all patients at baseline and after CPAP treatment in those receiving this therapy. Results Circulating FABP4 but not FABP5 levels were higher in patients with OSA (P = 0.003). FABP4 but not FABP5 values were associated with parameters of OSA severity independently of age, gender, adiposity and insulin resistance (P < 0.05). FABP4 but not FABP5 concentrations were determinants of OSA presence (OR: 1.11, P = 0.010) and severity (OR: 1.06, P = 0.020). After CPAP treatment, FABP4 levels decreased in the more severe patients (P = 0.019), while FABP5 levels increased in all patients (P < 0.001). Conclusions FABP4 is directly associated with obstructive sleep apnea severity and did not change with continuous positive airway pressure treatment, while FABP5 was not associated with obstructive sleep apnea severity and increased with continuous positive airway pressure treatment. FABP4 and FABP5 have different associations with obstructive sleep apnea. FABP4 but not FABP5 could be considered a marker of metabolic alterations in obstructive sleep apnea patients.


[This corrects the article on p. 133 in vol. 5, PMID: 25101051.].


Hernandez Voth A.R.,University Hospital | Benavides Manas P.D.,University Hospital | De Pablo Gafas A.,University Hospital | De Atauri Rodriguez M.J.D.,Sleep Disorders Unit
Transplantation | Year: 2015

Aim Sleep-related breathing disorders (SRBD) are common in patients with lung transplantation (LT); however, there are few data about its prevalence, and none about its pathogenesis or evolution. The SRBD events consist mainly obstructive, central, and mixed apnea, as well as hypopneas. The aim of this study was to describe the prevalence of SRBD before the LT, and its evolution after a period of 1 year follow-up. Methods Prospective, observational, descriptive, and analytical study of the SRBD and its evolution in 20 LT patients. The group was studied before and at 6 and 12 months after theLT; in each phase, standard polysomnography was performed, and anthropometric, pathologic, clinical, and pharmacological data were collected. Results Prevalence of obstructive sleep apnea syndrome was 38% before the LT, 86% at 6 months, and 76% at 12 months after LT. There was a significant increase of weight, body mass index, neck circumference, blood pressure during the first year of follow-up, especially at 6 months after LT. We also observed an increase in the number of central and mixed apneas during the follow-up, although not as remarkable as obstructive apneas. There was no correlation between immunosuppressant studied drugs and any of the studied variables. Conclusions We have observed a significant prevalence of obstructive sleep apnea syndrome in patients in waiting list for LT, and LT has an important influence in the evolution of the disorder. In our series, LT has somehow affected the stability of upper airway and ventilatory mechanics. © 2015 Wolters Kluwer Health, Inc.


PubMed | Sleep Disorders Unit
Type: Comparative Study | Journal: Sleep medicine | Year: 2012

Sleep-related eating disorder (SRED) may have some common clinical features with sleepwalking and with eating behavior disorders. The objective of this study was to compare clinical, sleep, and eating behavior measures in patients with SRED vs. sleepwalkers and controls.Overall, 15 patients with SRED, 21 sleepwalkers, and 20 age- and sex-matched healthy volunteers underwent interviews, completed sleep, anxiety, depression, and eating behavior scales, and had a night-time videopolysomnography.Patients with SRED were mainly women, had disease onset in adulthood, suffered nightly episodes and insomnia, and had more frequent eating problems in childhood and higher current anorexia scores than sleepwalkers and controls. Unlike controls, they shared several commonalities with sleepwalkers, including a high frequency (66%) of past or current sleepwalking, a similar timing of parasomnia episodes during the first half of the night, numerous arousals from stage N3, and a similarly altered level of daytime sleepiness and anxiety, but higher awareness during parasomnia episodes. Conversely, only 10% of sleepwalkers ate during their sleepwalking episodes. On videopolysomnography, the eating episodes occurred mostly within 1min after awakening from stage N2 (n=9) or stage N3 (n=6). The frequencies of restless legs syndrome, periodic leg movements, and sleep apnea were similar across the three groups.Patients with SRED share several clinical commonalities with sleepwalkers (although their level of awareness is higher) plus former or current eating behavior problems. It suggests that they have specialized a former sleepwalking behavior toward sleep-related eating because they are more vulnerable to eating behavior problems during the daytime.


PubMed | Sleep Disorders Unit
Type: Journal Article | Journal: The European respiratory journal | Year: 2011

The characteristics of residual excessive sleepiness (RES), defined by an Epworth score >10 in adequately treated apnoeic patients, are unknown. 40 apnoeic patients, with (n = 20) and without (n = 20) RES, and 20 healthy controls underwent clinical interviews, cognitive and biological tests, polysomnography, a multiple sleep latency test, and 24-h sleep monitoring. The marked subjective sleepiness in the RES group (mean sd score 16.4 3) contrasted with moderately abnormal objective measures of sleepiness (90% of patients with RES had daytime sleep latencies >8 min). Compared with patients without RES, the patients with RES had more fatigue, lower stage N3 percentages, more periodic leg movements (without arousals), lower mean sleep latencies and longer daytime sleep periods. Most neuropsychological dimensions (morning headaches, memory complaints, spatial memory, inattention, apathy, depression, anxiety and lack of self-confidence) were not different between patients with and without RES, but gradually altered from controls to apnoeic patients without and then with RES. RES in apnoeic patients differs markedly from sleepiness in central hypersomnia. The association between RES, periodic leg movements, apathy and depressive mood parallels the post-hypoxic lesions in noradrenaline, dopamine and serotonin systems in animals exposed to intermittent hypoxia.

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