802 Seizure-Associated Central Respiratory Events: What’s Sleep Go To Do With It?

Abstract Introduction Seizure-related respiratory dysfunction has been reported in patients with epilepsy(PWE) on scalp EEG. We assessed this in Stereo-EEG(SEEG) recordings in patients with pharmacoresistant focal epilepsy. Methods PWE undergoing SEEG wore temperature/pressure-based airflow,RIP belts, SpO2, and EtCO2/TcpCO2. Interpretable recordings required SpO2 and at least one airflow and effort channel. Respiratory events including apneas, hypopneas(3%) and central pauses (5 to<10sec). Respiratory events, respiratory rate(RR), SpO2 nadir, total desaturation time, Peak EtCO2/TcpCO2, and hypercapnia duration were analyzed surrounding seizures. Frequency and duration of central events were compared in sleep-onset and awake seizures. Linear mixed-effects models evaluated relationships between respiratory variables and the frequency and duration of central events associated with seizures and compared respiratory variables between seizures with and without events. Results 44 seizures were recorded in 23 patients. Seizures were focal-onset in 79.5%(n=35), GTC in 20.5%(9). Respiratory events accompanied 61.4%(27) of the seizures with median duration/seizure duration of 0.40(IQR: 0.27, 0.61). Of the 47 respiratory events, 42 were central events, and 66.6%(28) were central apneas. Respiratory events occurred during the seizure in 73.8%, postictal in 26.2%; median SpO2 nadir was 90%(77.0, 93.0), total desaturation duration 104.3(50.3, 195.0)sec, peak TcpCO2 41.3(38.7, 44.8) mmHg, hypercapnia duration 157.6(51.0, 367.9) sec, and ictal-postictal RR change 3.3 ± 4.0bpm. For every 1 sec duration increase in central event duration, there was a significant increase in peak TcpCO2 0.35(95%CI [0.09,0.62],p=0.015) and TcpCO2 change 0.25(95%CI [0.02,0.49],p=0.037). Presence of central events were associated with increased peak TcpCO2(9.82[3.77,15.9], p=0.006). Seizures with central events trended greater changes in RR, SpO2, and EtCO2/TcpCO2, desaturation and hypercapnia time, with negative changes in SpO2 nadir. No significant difference on central event frequency was found between sleep-onset and awake seizures. Conclusion Central events including apneas and pauses are common in focal seizures arising from sleep and wake and are associated with hypercapnia. In addition to the significant association between TcpCO2 and the frequency and duration of central events, there is a positive trend of association of other respiratory dysfunction parameters. These findings suggest that central events may lead to a cascade of respiratory disturbance that may participate in the pathophysiology of sudden unexplained death in epilepsy. Support (if any):

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Neurophysiological seizure-onset predictors of epilepsy surgery outcome: a multivariable analysis

Journal of Neurosurgery ◽

10.3171/2019.9.jns19527 ◽

2020 ◽

Vol 133 (6) ◽

pp. 1863-1872 ◽

Cited By ~ 1

Author(s):

Hideaki Tanaka ◽

Jean Gotman ◽

Hui Ming Khoo ◽

André Olivier ◽

Jeffery Hall ◽

...

Keyword(s):

Surgical Outcome ◽

Focal Epilepsy ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Postoperative Outcome ◽

Seizure Onset ◽

Resective Surgery ◽

Scalp Eeg ◽

Surgery Outcome ◽

Intracerebral Eeg

OBJECTIVEThe authors sought to determine which neurophysiological seizure-onset features seen during scalp electroencephalography (EEG) and intracerebral EEG (iEEG) monitoring are predictors of postoperative outcome in a large series of patients with drug-resistant focal epilepsy who underwent resective surgery.METHODSThe authors retrospectively analyzed the records of 75 consecutive patients with focal epilepsy, who first underwent scalp EEG and then iEEG (stereo-EEG) for presurgical assessment and who went on to undergo resective surgery between 2004 and 2015. To determine the independent prognostic factors from the neurophysiological scalp EEG and iEEG seizure-onset information, univariate and standard multivariable logistic regression analyses were used. Since scalp EEG and iEEG data were recorded at different times, the authors matched scalp seizures with intracerebral seizures for each patient using strict criteria.RESULTSA total of 3057 seizures were assessed. Forty-eight percent (36/75) of patients had a favorable outcome (Engel class I–II) after a minimum follow-up of at least 1 year. According to univariate analysis, a localized scalp EEG seizure onset (p < 0.001), a multilobar intracerebral seizure-onset zone (SOZ) (p < 0.001), and an extended SOZ (p = 0.001) were significantly associated with surgical outcome. According to multivariable analysis, the following two independent factors were found: 1) the ability of scalp EEG to localize the seizure onset was a predictor of a favorable postoperative outcome (OR 6.073, 95% CI 2.011–18.339, p = 0.001), and 2) a multilobar SOZ was a predictor of an unfavorable outcome (OR 0.076, 95% CI 0.009–0.663, p = 0.020).CONCLUSIONSThe study findings show that localization at scalp seizure onset and a multilobar SOZ were strong predictors of surgical outcome. These predictors can help to select the better candidates for resective surgery.

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Musical pantophagy: Is there an effect on changes in preference resulting from repeated exposure?

Psychology of Music ◽

10.1177/0305735620987299 ◽

2021 ◽

pp. 030573562098729

Author(s):

Rebecca R Johnston ◽

Gina M Childers

Keyword(s):

Undergraduate Students ◽

Classical Music ◽

Effective Means ◽

Affective Response ◽

Repeated Exposure ◽

Positive Trend ◽

Preference Rating ◽

Significant Difference ◽

Music Consumption ◽

Post Test

The purpose of this research was to examine the effects of musical pantophagy, classical music consumption, and initial receptivity to select musical examples on changes in preference rating resulting from a program of repeated exposure. Participants included undergraduate students enrolled in a section of music appreciation at a large Southeastern university ( n = 67). Data were collected using a research designed preference rating measure (PRM) administered during a 5-week period within which there were eight test measures. Participants were divided into quartiles. Pre- to post-test measures resulted in a general positive trend for all participants. Comparisons of Q1 (lowest pantophagy) and Q3 (highest pantophagy) on PRMs 1–8 yielded no differences between groups, and PRM 8 was significantly different from PRM 1 for both groups. The same comparisons for Q1 (non-Classical music consumption) indicated significant difference with large effect size and for Q1 (lowest initial receptivity) indicated significant difference. Results suggest that regardless of musical pantophagy, repetition is an effective means by which to increase affective response to music, and that students who do not currently consume formal art music and who have low initial receptivity may report greater increases in affective response to music over time.

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Dopamine adjusts the circadian gene expression of Per2 and Per3 in human dermal fibroblasts from ADHD patients

Journal of Neural Transmission ◽

10.1007/s00702-021-02374-4 ◽

2021 ◽

Author(s):

Frank Faltraco ◽

Denise Palm ◽

Adriana Uzoni ◽

Lena Borchert ◽

Frederick Simon ◽

...

Keyword(s):

Gene Expression ◽

Dermal Fibroblast ◽

Sleep Onset ◽

Dermal Fibroblasts ◽

Control Group ◽

Adhd Group ◽

Healthy Controls ◽

Circadian Gene ◽

Significant Difference ◽

Circadian Preference

AbstractA link between dopamine levels, circadian gene expression, and attention deficit hyperactivity disorder (ADHD) has already been demonstrated. The aim of this study was to investigate the extent of these relationships by measuring circadian gene expression in primary human-derived dermal fibroblast cultures (HDF) after dopamine exposure. We analyzed circadian preference, behavioral circadian and sleep parameters as well as the circadian gene expression in a cohort of healthy controls and participants with ADHD. Circadian preference was evaluated with German Morningness-Eveningness-Questionnaire (D-MEQ) and rhythms of sleep/wake behavior were assessed via actigraphy. After ex vivo exposure to different dopamine concentrations in human dermal fibroblast (HDF) cultures, the rhythmicity of circadian gene expression (Clock, Bmal1, Per1-3, Cry1) was analyzed via qRT-PCR. We found no statistical significant effect in the actigraphy of both groups (healthy controls, ADHD group) for mid-sleep on weekend days, mid-sleep on weekdays, social jetlag, wake after sleep onset, and total number of wake bouts. D-MEQ scores indicated that healthy controls had no evening preference, whereas subjects with ADHD displayed both definitive and moderate evening preferences. Dopamine has no effect on Per3 expression in healthy controls, but produces a significant difference in the ADHD group at ZT24 and ZT28. In the ADHD group, incubation with dopamine, either 1 µM or 10 µM, resulted in an adjustment of Per3 expression to control levels. A similar effect also was found in the expression of Per2. Statistical significant differences in the expression of Per2 (ZT4) in the control group compared to the ADHD group were found, following incubation with dopamine. The present study illustrates that dopamine impacts on circadian function. The results lead to the suggestion that dopamine may improve the sleep quality as well as ADHD symptoms by adjustment of the circadian gene expression, especially for Per2 and Per3.

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Detection of epileptic activity in presumably normal EEG

Brain Communications ◽

10.1093/braincomms/fcaa104 ◽

2020 ◽

Vol 2 (2) ◽

Author(s):

Sara Baldini ◽

Francesca Pittau ◽

Gwenael Birot ◽

Vincent Rochas ◽

Miralena I Tomescu ◽

...

Keyword(s):

Focal Epilepsy ◽

Epileptic Activity ◽

Scalp Eeg ◽

Vigilance State ◽

Explained Variance ◽

Long Term Monitoring ◽

Interictal Discharges ◽

The Individual ◽

Term Monitoring

Abstract Monitoring epileptic activity in the absence of interictal discharges is a major need given the well-established lack of reliability of patients’ reports of their seizures. Up to now, there are no other tools than reviewing the seizure diary; however, seizures may not be remembered or dismissed voluntarily. In the present study, we set out to determine if EEG voltage maps of epileptogenic activity in individual patients can help to identify disease activity, even if their scalp EEG appears normal. Twenty-five patients with pharmacoresistant focal epilepsy were included. For each patient, 6 min of EEG with spikes (yes-spike) and without visually detectable epileptogenic discharges (no-spike) were selected from long-term monitoring recordings (EEG 31–37 channels). For each patient, we identified typical discharges, calculated their average and the corresponding scalp voltage map (‘spike-map’). We then fitted the spike-map for each patient on their (i) EEG epochs with visible spikes, (ii) epochs without any visible spike and (iii) EEGs of 48 controls. The global explained variance was used to estimate the presence of the spike-maps. The individual spike-map occurred more often in the spike-free EEGs of patients compared to EEGs of healthy controls (P = 0.001). Not surprisingly, this difference was higher if the EEGs contained spikes (P < 0.001). In patients, spike-maps were more frequent per second (P < 0.001) but with a shorter mean duration (P < 0.001) than in controls, for both no-spike and yes-spike EEGs. The amount of spike-maps was unrelated to clinical variables, like epilepsy severity, drug load or vigilance state. Voltage maps of spike activity are present very frequently in the scalp EEG of patients, even in presumably normal EEG. We conclude that spike-maps are a robust and potentially powerful marker to monitor subtle epileptogenic activity.

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COMPARISON OF RECENTLY USED PHACOEMULSIFICATION SYSTEMS USING A HEALTH TECHNOLOGY ASSESSMENT METHOD

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317000472 ◽

2017 ◽

Vol 33 (2) ◽

pp. 232-238

Author(s):

Jiannan Huang ◽

Qi Wang ◽

Caimin Zhao ◽

Xiaohua Ying ◽

Haidong Zou

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Vision System ◽

Health Technology ◽

Assessment Method ◽

Dissipated Energy ◽

Positive Trend ◽

Significant Difference ◽

Tertiary Hospitals ◽

Cataract Patients

Objectives: To compare the recently used phacoemulsification systems using a health technology assessment (HTA) model.Methods: A self-administered questionnaire, which included questions to gauge on the opinions of the recently used phacoemulsification systems, was distributed to the chief cataract surgeons in the departments of ophthalmology of eighteen tertiary hospitals in Shanghai, China. A series of senile cataract patients undergoing phacoemulsification surgery were enrolled in the study. The surgical results and the average costs related to their surgeries were all recorded and compared for the recently used phacoemulsification systems.Results: The four phacoemulsification systems currently used in Shanghai are the Infiniti Vision, Centurion Vision, WhiteStar Signature, and Stellaris Vision Enhancement systems. All of the doctors confirmed that the systems they used would help cataract patients recover vision. A total of 150 cataract patients who underwent phacoemulsification surgery were enrolled in the present study. A significant difference was found among the four groups in cumulative dissipated energy, with the lowest value found in the Centurion group. No serious complications were observed and a positive trend in visual acuity was found in all four groups after cataract surgery. The highest total cost of surgery was associated with procedures conducted using the Centurion Vision system, and significant differences between systems were mainly because of the cost of the consumables used in the different surgeries.Conclusions: This HTA comparison of four recently used phacoemulsification systems found that each of system offers a satisfactory vision recovery outcome, but differs in surgical efficacy and costs.

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Sleep Deprivation and Sleep-Onset Insomnia are Associated with Blunted Physiological Reactivity to Stressors

Military Medicine ◽

10.1093/milmed/usaa464 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 246-252

Author(s):

Devon A Hansen ◽

Brieann C Satterfield ◽

Matthew E Layton ◽

Hans P A Van Dongen

Keyword(s):

Sleep Deprivation ◽

Laboratory Study ◽

Salivary Cortisol ◽

Sleep Onset ◽

Deprivation Condition ◽

Increased Risk ◽

Significant Difference ◽

Sleep Deficiency ◽

The Impact ◽

Chronic Sleep

ABSTRACT Introduction Military operations often involve intense exposure to stressors combined with acute sleep deprivation, while military personnel also experience high prevalence of chronic sleep deficiency from insomnia and other sleep disorders. However, the impact of acute and chronic sleep deficiency on physiologic stressor responses is poorly understood. In a controlled laboratory study with normal sleepers and individuals with chronic sleep-onset insomnia, we measured responses to an acute stressor administered in a sleep deprivation condition or a control condition. Methods Twenty-two adults (aged 22-40 years; 16 females)—11 healthy normal sleepers and 11 individuals with sleep-onset insomnia—completed a 5-day (4-night) in-laboratory study. After an adaptation day and a baseline day, subjects were assigned to a 38-hour total sleep deprivation (TSD) condition or a control condition; the study ended with a recovery day. At 8:00 PM after 36 hours awake in the sleep deprivation condition or 12 hours awake in the control condition, subjects underwent a Maastricht Acute Stress Test (MAST). Salivary cortisol was measured immediately before the MAST at 8:00 PM, every 15 minutes after the MAST from 8:15 PM until 9:15 PM, and 30 minutes later at 9:45 PM. Baseline salivary cortisol was collected in the evening of the baseline day. Additionally, before and immediately upon completion of the MAST, self-report ratings of affect and pain were collected. Results The MAST elicited a stressor response in both normal sleepers and individuals with sleep-onset insomnia, regardless of the condition, as evidenced by increases in negative affect and pain ratings. Relative to baseline, cortisol levels increased immediately following the MAST, peaked 30 minutes later, and then gradually returned to pre-MAST levels. At the cortisol peak, there was a significant difference across groups and conditions, reflecting a pronounced blunting of the cortisol response in the normal sleepers in the TSD condition and the sleep-onset insomnia group in both the TSD and control conditions. Conclusions Blunted stressor reactivity as a result of sleep deficiency, whether acute or chronic, may reflect reduced resiliency attributable to allostatic load and may put warfighters at increased risk in high-stakes, rapid response scenarios.

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Presepsin and Procalcitonin Levels as Markers of Adverse Postoperative Complications and Mortality in Cardiac Surgery Patients

Blood Purification ◽

10.1159/000494207 ◽

2018 ◽

Vol 47 (1-3) ◽

pp. 140-148 ◽

Cited By ~ 9

Author(s):

Anna Clementi ◽

Grazia Maria Virzì ◽

María-Jimena Muciño-Bermejo ◽

Federico Nalesso ◽

Davide Giavarina ◽

...

Keyword(s):

Cardiac Surgery ◽

Postoperative Complications ◽

Predictive Value ◽

Renal Outcome ◽

Positive Trend ◽

Receiver Operating Characteristic Curves ◽

Primary Endpoints ◽

Significant Difference ◽

Respiratory Outcome ◽

Complications And Mortality

Backgound: This study was aimed at evaluating the presepsin and procalcitonin levels to predict adverse postoperative complications and mortality in cardiac surgery patients. Methods: A total of 122 cardiac surgery patients were enrolled for the study. Presepsin and procalcitonin levels were measured 48 h after the procedure. The primary endpoints were adverse renal, respiratory, and cardiovascular outcomes and mortality. Results: Presepsin and procalcitonin levels were significantly higher in patients with adverse renal and respiratory outcome (p < 0.001 and 0.0081). The presepsin levels were significantly higher in patients with adverse cardiovascular outcome (p = 0.023) and the procalcitonin values in patients with sepsis (p = 0.0013). Presepsin levels were significantly higher in patients who died during hospitalization (382 pg/mL, interquartile range [IQR] 243–717.5 vs. 1,848 pg/mL, IQR 998–5,451.5, p = 0.049). In addition, the predictive value for in-hospital, 30-days, and 6-months mortality was higher for presepsin, with a significant difference between the 2 biomarkers (p = 0.025, p = 0.035, p = 0.003; respectively). Presepsin and procalcitonin seem to have comparable predictive value for adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Although a positive trend was notable for presepsin and adverse renal outcome (area under the ROC [receiver operating characteristic] curves [AUC] of 0.760, 95% CI 0.673–0.833 versus procalcitonin: AUC 0.692; 95% CI 0.601–0.773): no statistically significant difference was evident between the AUC of the 2 biomarkers (p = 0.25). Conclusions: Presepsin and procalcitonin seem to have comparable predictive value for adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Also, presepsin possesses a better predictive value for in-hospital, 30-days, and 6-months mortality.

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Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial

Psychological Medicine ◽

10.1017/s0033291713002249 ◽

2013 ◽

Vol 44 (7) ◽

pp. 1521-1532 ◽

Cited By ~ 54

Author(s):

A. van Straten ◽

J. Emmelkamp ◽

J. de Wit ◽

J. Lancee ◽

G. Andersson ◽

...

Keyword(s):

Controlled Trial ◽

Sleep Onset ◽

Intervention Group ◽

Sleep Diary ◽

The Internet ◽

Control Group ◽

Sleep Onset Latency ◽

Cognitive Behavioural ◽

Co Morbidity ◽

Significant Difference

BackgroundInsomnia is a prevalent problem with a high burden of disease (e.g. reduced quality of life, reduced work capacity) and a high co-morbidity with other mental and somatic disorders. Cognitive behavioural therapy (CBT) is effective in the treatment of insomnia but is seldom offered. CBT delivered through the Internet might be a more accessible alternative. In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a randomized controlled trial (RCT).MethodA total of 118 patients, recruited from the general population, were randomized to the 6-week guided Internet intervention (n = 59) or to a wait-list control group (n = 59). Patients filled out an online questionnaire and a 7-day sleep diary before (T0) and after (T1) the 6-week period. The intervention group received a follow-up questionnaire 3 months after baseline (T2).ResultsAlmost three-quarters (72.9%) of the patients completed the whole intervention. Intention-to-treat (ITT) analysis showed that the treatment had statistically significant medium to large effects (p < 0.05; Cohen's d between 0.40 and 1.06), and resulted more often in clinically relevant changes, on all sleep and secondary outcomes with the exception of sleep onset latency (SOL) and number of awakenings (NA). There was a non-significant difference in the reduction in sleep medication between the intervention (a decrease of 6.8%) and control (an increase of 1.8%) groups (p = 0.20). Data on longer-term effects were inconclusive.ConclusionsThis study adds to the growing body of literature that indicates that guided CBT for insomnia can be delivered through the Internet. Patients accept the format and their sleep improves.

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Efficacy and Tolerability of Lacosamide for Focal Epileptic Patients: Study from Epilepsy Clinic in Makkah

CNS & Neurological Disorders - Drug Targets ◽

10.2174/1871527319666200819103316 ◽

2020 ◽

Vol 19 ◽

Author(s):

Amal Alkhotani ◽

Hanadi Abualula ◽

Yasir Almatrafi ◽

Sawsan Ghoniem ◽

Alaa Alkhotani

Keyword(s):

Focal Epilepsy ◽

Estimating Equation ◽

Repeated Measure ◽

Improvement Rate ◽

Temporal Epilepsy ◽

Voltage Gated Sodium Channels ◽

Significant Difference ◽

Epileptic Patients ◽

Medical City ◽

Seizure Rate

Background: Lacosamide characterized by a novel dual mode of action in its components, in which it has a func-tionalized amino acid that selectively pro, motes inactivation of voltage-gated sodium channels slowly among patients. Objective: To assess the effectiveness and tolerability of Lacosamide in the treatment of focal epileptic patients. Methods: This retrospective cohort study obtains data from the clinic notes or diaries of all patients during 2014 to 2019 from King Abdullah Medical City. The multivariate generalized estimating equation (GEE) repeated measure Logistic Re-gression Analysis was used to assess the change in patients’ odds of having an improvised seizure rate. Results: Majority of the focal epileptic patients were diagnosed with temporal epilepsy (57.9%), while 26.3% had frontal epileptic lesion/diagnoses. Majority of the patients (54.4%) had received a combination of old and new treatment. 57.14% of the seven patients had dizziness and headache, tremors (n = 1), loss of balance (n = 1) and increased seizure with abnormal vision acuity and psychosis (n = 1). 84.2% of the patients had reduction of their median seizure frequency at the 12-month period. However, there were no significant difference on the seizure control rate based on clinical characteristics. There were no statistically significant differences between male and female patients on their improvement rate across the four times on average. Conclusion: Lacosamide is an effective well tolerate drug for patients with focal epilepsy.

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1266 Primary Central apnea and loss of muscle atonia during REM

SLEEP ◽

10.1093/sleep/zsaa056.1260 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A481-A482

Author(s):

M Elizabeth C Hernandez ◽

Kanta Velamuri

Keyword(s):

Sleep Apnea ◽

Rem Sleep ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Central Apnea ◽

Muscle Atonia ◽

Arterial Blood ◽

Respiratory Events ◽

History Of ◽

Central Apneas

Abstract Introduction Central sleep apnea (CSA) syndrome is defined when five or more central apneas and/or hypopneas are present per hour of sleep, more than 50% of all respiratory events. CSA usually occur during NREM stage and rarely during REM. CSA is important to recognize because of complications ranging from frequent nighttime awakenings,sleepiness to adverse cardiovascular outcomes. We present a 40 year old female patient with rare CSA during REM sleep and dream enactment. Report of Case 40yo African American female with history of loud snoring, witnessed sleep apnea, and daytime fatigue. She reported nightmares, sleep talking, and acting out her dreams without injury. Epworth sleepiness score was 5 /24. Her past medical history is significant for depression and anxiety. She has no history of head trauma, no neurologic or cardiovascular disorders. Her medications include fluoxetine and,quetiapine. She denied substance use, narcotic use, or alcohol use. Her level 1 sleep study showed predominantly REM-associated central sleep apneas which is rare. She also was observed to have loss of REM sleep muscle atonia suggestive of REM Behavior disorder. Her sleep architecture was atypical with decreased N3 sleep stage. REM sleep duration was adequate. She was noted to have loss of REM muscle atonia based on AASM guidelins elevated chin EMG, excessive transient muscle activity, and witnessed movement during REM stage via video monitoring. During the study, she had an apnea/hypopnea index (AHI) of 13.1 per hour of sleep, Central apneas were predominantly noted during REM stage, 10 per hour, comprised of 50% of her respiratory events. The minimum SpO2 value with CSA was 94%. She had normal sinus rhythm. Her sleep was fragmented. A total arousals were 28.4/hour,and 7.9/hour were respiratory arousals, and the rest were spontaneous arousals. An echocardiogram showed normal left ventricular ejection fraction of 55 to 60 %. Her room air arterial blood gas was normal with PaC02 of 37 mmHg. MRI of the brain/brainstem was ordered given her atypical REM sleep. She had no acute intracranial abnormalities. There is a non specific finding of a low lying cerebellar tonsils without evidence of Chiari I malformation. Conclusion Our patient has rare idiopathic central apnea in REM stage and is third case reported. She also has loss of muscle atonia during REM with dream enactment which is also rare in her age group. Injury precaution advised.

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