854 Sexsomnia in a Divorce Proceeding and its Custody Implications

Abstract Introduction Sexsomnia is a NREM parasomnia under the subtype of Confusional Arousals, defined as abnormal sexual behaviors emerging from partial arousals during slow-wave sleep. Case reports suggest that is more common in men. Precipitating factors include Obstructive Sleep Apnea, insufficient sleep, alcohol and fatigue/stress and history of NREM parasomnias. Report of case(s) A 37-year-old male with bruxism (using mouth guard) and anxiety for 7 years, who presented to the sleep clinic for a second opinion to discuss concerns around the safety of his children due to his sleep related sexual behavior. Sexsomnia was first noted with the stressors related to becoming a parent (fostering children and having biological children). Sexual behavior reported by the couple was mostly provoked with spouse’s touch during sleep. Behaviors ranging from fondling to aggressive sexual intercourse were reported to occur 1 to 3 times/week. There were no injuries during episodes which only occurred in the bedroom with the spouse and the patient was amnestic of his behavior. Due to marital discord provoked by other stressors, he began to sleep alone in the basement. A video-polysomnogram revealed no parasomnia, sleep apnea, or other sleep arousal disorders. Normal REM with atonia was observed. The patient was treated with Duloxetine 20mg for anxiety after the initial sleep visit. His condition contributed to marital separation. In the divorce proceedings, the spouse argued for denial of visitation rights related to his sleep-sexual behaviors noting that the children may be at risk. After separation, his anxiety and stress levels lowered in conjunction with therapy and medication. Follow up after 2 months found the patient asymptomatic. He placed an alarm on his bedroom door, to alert him and others during sleep. There are no published reports to provide a prediction as to whether his condition would-be supporting restrictions in overnight visitation by the foster and biological children. Conclusion In this case, there was a precedent condition (bruxism) and precipitating stress and anxiety, known to provoke NREM parasomnia. The absence of polysomnographic evidence is not unusual. Forensic repercussions, in particular prospective calculations of risk, are poorly described in the literature. Support (if any):

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Feasibility of Powered Intracapsular Tonsillectomy in Pediatric Patients with Tonsil Problem, Including Recurrent Tonsillitis: A Single Surgeon’s Experience

ORL ◽

10.1159/000509479 ◽

2020 ◽

Vol 82 (6) ◽

pp. 335-342

Author(s):

Heejin Kim ◽

Sung Won Li ◽

Sung Min Park ◽

Sung Kyun Kim ◽

Seok Jin Hong ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Postoperative Pain ◽

Pediatric Patients ◽

Recurrent Tonsillitis ◽

Obstructive Sleep ◽

History Of ◽

The Mean ◽

Intracapsular Tonsillectomy

Introduction: Powered intracapsular tonsillectomy (PIT) is a technique that protects the tonsillar capsule by using a microdebrider, resulting in faster wound-healing and reduced suffering. Many studies have found PIT to be effective, particularly in pediatric patients with obstructive sleep apnea (OSA). However, previous studies have not included patients with a history of recurrent tonsillitis. Objective: The aim of this study was to determine the efficacy of PIT in pediatric patients even with a history of recurrent tonsillitis, and therefore, we want to expand the indication for PIT and reveal its safety. Methods: A total of 886 pediatric patients underwent PIT between February 2013 and March 2016. All patients rated their postoperative pain using a visual analog scale (VAS) and completed the Korean obstructive sleep apnea (KOSA)-18 questionnaire for assessment of their quality of life (QOL). There were 539 males and 347 females. Their mean age was 6.2 years (range 2–14 years). The majority (77.7%) underwent the operation for OSA, and the rest (22.3%) had a history of recurrent tonsillitis. To compare the efficacy of PIT with traditional tonsillectomy, we selected 191 patients who underwent extracapsular tonsillectomy (ECT), a conventional technique, during the same time period. The median follow-up period was 16.7 months. During the follow-up period, instances of delayed bleeding and recurrent pharyngitis were monitored. Results: In comparison to the patients who underwent ECT, the PIT group showed significantly fewer cases of postoperative bleeding (p = 0.027). Thirteen patients in the PIT group (1.5%) visited the hospital during the follow-up period for pharyngitis, while 8 in the ECT group (4.2%) visited for pharyngitis. The mean postoperative pain score, as assessed by a VAS, was 4.6 ± 3.2, and pain improved within an average of 2.9 days after surgery in the PIT group. The mean KOSA-18 score for the QOL of the patients was 65.9 preoperatively and 35.6 postoperatively in the PIT group. Conclusions: Pediatric tonsillectomy using PIT is valid for reducing postoperative pain and improving the QOL of OSA patients. PIT is also effective and safe for patients with a history of recurrent tonsillitis.

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Abstract 17143: Obstructive and Central Sleep Apnea and Risk of Incident Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.17143 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Patricia Tung ◽

Yamini S Levitzky ◽

Rui Wang ◽

Stuart F Quan ◽

Daniel J Gottlieb ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Health Study ◽

Apnea Hypopnea Index ◽

Community Based ◽

Obstructive Sleep ◽

History Of

INTRODUCTION: Prior studies have documented a higher prevalence of atrial fibrillation (AF) in those with obstructive sleep apnea (OSA). OSA has been associated with AF recurrence following cardioversion and ablation, and with prevalent and incident AF in cross-sectional and retrospective studies. Central sleep apnea (CSA) also has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have evaluated the association of CSA with AF in population studies. METHODS: We assessed the association of OSA and CSA with incident AF among 3,420 subjects without a history of AF in the Sleep Heart Health Study (SHHS), a prospective, community-based study designed to evaluate the cardiovascular consequences of sleep disordered breathing. Subjects underwent overnight polysomnography at baseline and were followed over time for the development of incident AF, documented at any time after baseline polysomnogram until the end of follow-up. OSA was defined as an obstructive apnea-hypopnea index ≥ 5 and CSA was defined as a central apnea index ≥ 5. RESULTS: At baseline, the sample include 1499 men (44.4%) with a mean age of 62.4 (±10.9); 1569 (45.9%) subjects met criteria for mild to severe OSA and 54 (1.6%) for CSA. Over a mean follow-up of 8.2 years, 382 cases of incident AF were identified. The prevalence of both OSA and CSA was higher among those who developed AF compared to those who did not (OSA 49% vs 44%, p=0.001 and CSA 5% vs 1.2%, p=0.001). After adjustment for multiple AF risk factors, CSA was associated with an approximately 2-fold increased odds of incident AF (RR=2.38, 95% CI, 1.15-4.94; p = 0.02). The association persisted after exclusion of 258 subjects with a history of heart failure (RR=2.78, 95% CI, 1.28-6.04; p = 0.01). We did not find a significant association of OSA with incident AF (Table). CONCLUSION: In our prospective, community-based cohort baseline CSA was associated with incident AF.

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817 A Case of Parasomnia Overlap Disorder in a Patient on Lithium

SLEEP ◽

10.1093/sleep/zsab072.814 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A319-A319

Author(s):

Amanda Bachuss

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Case Reports ◽

Psychotropic Medications ◽

Obstructive Sleep ◽

History Of ◽

Sleep Behaviors ◽

One Year ◽

Family Gathering ◽

Out Of Area

Abstract Introduction The literature contains few case reports of parasomnia overlap disorder. There are also few case reports of lithium inducing sleep walking behaviors. Here we seek to present a case of a patient with multiple parasomnias, is taking a number of psychotropic medications for bipolar I disorder, and is on PAP for OSA. Report of case(s) The patient is a 43 year old male with a history of occasional mild sleep walking since childhood that remitted approximately 10 years prior to the onset of treatment, but returned when he traveled out of area for a family gathering approximately one year prior to presentation in the sleep clinic. He reported not only the return of sleepwalking, on a nightly basis, as well as more severe symptoms (including enuresis and violence/aggression). He also reported several episodes of dream enactment, as well as a history of sleep paralysis and vivid hypnogogic hallucinations, both of which had been improved in the last year. He denied any history of cataplexy. He did complain of symptoms of significant RLS symptoms. He was partially compliant with CPAP for obstructive sleep apnea, though the sleep behaviors continued regardless of CPAP usage. His psychiatrist had started him on clonazepam (titrated to 2mg/night) prior to his intake in the sleep clinic, but with minimal benefit. His other medications included propranolol 40mg BID, lithium 900mg/1200mg, oxcarbazepine 600mg bid, lamictal 225mg bid, lurasidone 80mg qday, and benztropine 2mg bid. Attended polysomnography demonstrated five episodes of sleep behaviors, as well as loss of atonia during REM, and severe obstructive sleep apnea (AHI of 61.2). Conclusion The patients various parasomnias could be due to the side effects of his psychotropic medications, represent a genetic or structural defect that is causing the various parasomnias, or be due to or worsened by his undertreated obstructive sleep apneas. His workup and treatment is still ongoing, but he has continued on clonazepam 2mg but taken 2 hours earlier, and has started a new APAP. Because of the severity of his bipolar disorder (including severe suicidal ideation), he is not a candidate to tapering the lithium or to taking serotonergic antidepressants. Support (if any):

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Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.08.10650 ◽

2020 ◽

Vol 103 (8) ◽

pp. 725-728

Keyword(s):

Bariatric Surgery ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Lifestyle Modification ◽

Apnea Hypopnea Index ◽

Morbidly Obese ◽

Obese Patients ◽

Obstructive Sleep ◽

Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

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Spontaneous haemorrhage of an adrenal angiomyolipoma: case report

African Journal of Urology ◽

10.1186/s12301-019-0006-1 ◽

2019 ◽

Vol 25 (1) ◽

Author(s):

Danielle Whiting ◽

Ian Rudd ◽

Amit Goel ◽

Seshadri Sriprasad ◽

Sanjeev Madaan

Keyword(s):

Case Reports ◽

Case Presentation ◽

Open Adrenalectomy ◽

Large Size ◽

History Of ◽

Loin Pain ◽

Benign Tumours ◽

Spontaneous Haemorrhage ◽

Mesenchymal Tumours

Abstract Background Angiomyolipomas are rare mesenchymal tumours arising from the perivascular epithelioid cells consisting of variable amounts of adipose, thick-walled blood vessels and smooth muscle cells. These benign tumours commonly occur in the kidney with only a few case reports of adrenal angiomyolipomas which have the potential to reach a large size and haemorrhage. Case presentation A 45-year-old lady presented with a 3-week history of right loin pain, nausea and vomiting. A CT scan revealed a right adrenal angiomyolipoma measuring 6.3 × 6.8 cm with associated haemorrhage. The lesion was successfully treated with right open adrenalectomy, and histology confirmed the diagnosis of adrenal angiomyolipoma. The patient remained well with no evidence of recurrence at the 36-month follow-up. Conclusion Adrenal angiomyolipomas are rare benign tumours that have the ability to reach a large size and potential to bleed. Here, we report the second case of spontaneous haemorrhage in an adrenal angiomyolipoma, which was successfully treated with open adrenalectomy.

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4-Year Follow-up of Treatment With Dental Appliance or Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

CHEST Journal ◽

10.1378/chest.121.3.739 ◽

2002 ◽

Vol 121 (3) ◽

pp. 739-746 ◽

Cited By ~ 134

Author(s):

Marie-Louise Walker-Engström ◽

Åke Tegelberg ◽

Bo Wilhelmsson ◽

Ivar Ringqvist

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep ◽

Dental Appliance

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845 Progressive external ophthalmoplegia in sleep apnea presenting as floppy eyelid syndrome

SLEEP ◽

10.1093/sleep/zsab072.842 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A329-A329

Author(s):

Pratibha Anne ◽

Rupa Koothirezhi ◽

Ugorji Okorie ◽

Minh Tam Ho ◽

Brittany Monceaux ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Surgical Treatment ◽

Sleep Apnea ◽

Genetic Disorder ◽

Deltoid Muscle ◽

Progressive External Ophthalmoplegia ◽

Ataxic Gait ◽

Pressure Setting ◽

Obstructive Sleep ◽

History Of

Abstract Introduction Floppy eye lid syndrome (FES) is known to be associated with Obstructive sleep apnea (OSA) and chronic progressive external ophthalmoplegia (CPEO) is a rare genetic disorder with mitochondrial myopathy that may present with isolated eye lid ptosis in the initial stages. In a patient with loud snoring and obesity, treating obstructive sleep apnea may improve Floppy eyelid syndrome. Report of case(s) 52-year-old African – American male with past medical history of Hypertension, obesity, glaucoma, CPEO status bilateral blepharoplasty with failed surgical treatment. Patient was referred to Sleep medicine team to rule out Obstructive Sleep Apnea aa a cause of possible underlying FES and residual ptosis. On exam, patient was noted to have bilateral brow and eyelid ptosis and mild ataxic gait. MRI brain with and without contrast was unremarkable. Deltoid muscle biopsy was suggestive of possible congenital myopathy and mild denervation atrophy. Polysomnogram showed severe OSA with AHI of 74.1 per hour and patient was initiated on Auto CPAP at a pressure setting of 7–20 cm H2O. CPAP treatment improved snoring, OSA and subjective symptoms of excessive day time sleepiness but did not improve the residual ptosis. Conclusion Treatment of severe OSA in a patient previously diagnosed with CPEO and failed surgical treatment with bilateral blepharoplasty, did not alter the course of residual ptosis/ floppy eyelids even though his other sleep apnea symptoms have improved. Support (if any) 1. McNab AA. Floppy eyelid syndrome and obstructive sleep apnea. Ophthalmic Plast Reconstr Surg. 1997 Jun;13(2):98–114. doi: 10.1097/00002341-199706000-00005. PMID: 9185193.

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419 STOP-Bang Score and History of Radiation Predicts Risk of Obstructive Sleep Apnea in Cancer Patients: A Machine Learning Study

SLEEP ◽

10.1093/sleep/zsab072.418 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A166-A166

Author(s):

Ankita Paul ◽

Karen Wong ◽

Anup Das ◽

Diane Lim ◽

Miranda Tan

Keyword(s):

Machine Learning ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cancer Patients ◽

Prediction Accuracy ◽

Screening Tools ◽

Cancer Type ◽

Sleep Study ◽

Obstructive Sleep ◽

History Of

Abstract Introduction Cancer patients are at an increased risk of moderate-to-severe obstructive sleep apnea (OSA). The STOP-Bang score is a commonly used screening questionnaire to assess risk of OSA in the general population. We hypothesize that cancer-relevant features, like radiation therapy (RT), may be used to determine the risk of OSA in cancer patients. Machine learning (ML) with non-parametric regression is applied to increase the prediction accuracy of OSA risk. Methods Ten features namely STOP-Bang score, history of RT to the head/neck/thorax, cancer type, cancer stage, metastasis, hypertension, diabetes, asthma, COPD, and chronic kidney disease were extracted from a database of cancer patients with a sleep study. The ML technique, K-Nearest-Neighbor (KNN), with a range of k values (5 to 20), was chosen because, unlike Logistic Regression (LR), KNN is not presumptive of data distribution and mapping function, and supports non-linear relationships among features. A correlation heatmap was computed to identify features having high correlation with OSA. Principal Component Analysis (PCA) was performed on the correlated features and then KNN was applied on the components to predict the risk of OSA. Receiver Operating Characteristic (ROC) - Area Under Curve (AUC) and Precision-Recall curves were computed to compare and validate performance for different test sets and majority class scenarios. Results In our cohort of 174 cancer patients, the accuracy in determining OSA among cancer patients using STOP-Bang score was 82.3% (LR) and 90.69% (KNN) but reduced to 89.9% in KNN using all 10 features mentioned above. PCA + KNN application using STOP-Bang score and RT as features, increased prediction accuracy to 94.1%. We validated our ML approach using a separate cohort of 20 cancer patients; the accuracies in OSA prediction were 85.57% (LR), 91.1% (KNN), and 92.8% (PCA + KNN). Conclusion STOP-Bang score and history of RT can be useful to predict risk of OSA in cancer patients with the PCA + KNN approach. This ML technique can refine screening tools to improve prediction accuracy of OSA in cancer patients. Larger studies investigating additional features using ML may improve OSA screening accuracy in various populations Support (if any):

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The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Respiration ◽

10.1159/000517031 ◽

2021 ◽

pp. 1-10

Author(s):

Wei-Hsiu Chang ◽

Hsien-Chang Wu ◽

Chou-Chin Lan ◽

Yao-Kuang Wu ◽

Mei-Chen Yang

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Nervous System ◽

Autonomic Nervous System ◽

Sleep Apnea ◽

Obstructive Sleep ◽

Mild Obstructive Sleep Apnea ◽

Positional Dependency ◽

Over Time

Background: Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. Objectives: The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). Methods: This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. Results: In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, p = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, p = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, p = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, p = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust R2 = 0.056, p = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. Conclusions: In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.

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