Is Split-Night Polysomnography Valid for Women with Obstructive Sleep Apnea?

Objectives@#Split-night polysomnography (PSG) can be used for the diagnosis and treatment of obstructive sleep apnea (OSA). Recently, the American Academy of Sleep Medicine has broadened the indication of split-night PSG from severe to moderate OSA in a time window of 2 hours. However, majority pieces of evidence have been derived from the male predominant study population. The objective of this study was to investigate the diagnostic accuracy of split-night PSG in Korean women. @*Methods@#This study included 122 adult women with OSA. Apnea-hypopnea index (AHI) from the first 120 minutes of clock time (T120-AHI) and full-night AHI (FN-AHI) were compared using the concordance correlation coefficient (CCC) method and Bland-Altman plot. Receiver operating characteristic (ROC) curves and the area under the ROC curves were plotted with various cut-off points of AHI. @*Results@#The T120-AHI correlated with FN-AHI (CCC=0.77). The area under the ROC curve for T120-AHI with FN-AHI ≥15 was 0.865, with a sensitivity of 78.6% and specificity of 82.7%. @*Conclusions@#T120-AHI showed a significant correlation with the FN-AHI value in Korean female patients with OSA.

The Association between History of Body Injury during Sleep and Obstructive Sleep Apnea in REM Sleep Behavior Disorder

Objectives@#To investigate whether a history of body injury is associated with obstructive sleep apnea (OSA) in patients with rapid eye movement (REM) sleep behavior disorder (RBD). @*Methods@#We enrolled 56 consecutive patients with RBD, a history of dream-enacting behaviors, and polysomnographic evidence of REM sleep without atonia. Participants were asked whether they had any history of body injuries such as self-injury or bed-partner injury during sleep. The demographic characteristics and polysomnographic parameters of the groups with a history of injury (n=34, 60.7%) and without (n=22, 39.3%) were compared. The association between the history of injury and OSA was assessed. @*Results@#OSA [apnea-hypopnea index (AHI) ≥5/h) was associated with a history of body injury [odds ratio (OR)=6.25, 95% confidence interval (CI)=1.64–23.84]. Additionally, the logistic regression analysis showed that insomnia severity index (OR=0.87, 95% CI=0.80–0.98) and AHI (OR=1.10, 95% CI=1.02–1.18) were associated with history of body injury. @*Conclusions@#Therefore, we can conclude that history of body injury is related to obstructive sleep apnea in patients with RBD.

A New Positive Sign of Functional Weakness in Conversion Disorder: Polysomnography with Extended Surface Electromyography

Patients often present with combinations of psychological disorders that manifest with neurological symptoms and/or signs that are not attributable to identifiable structural or functional etiology associated with the nervous system. We present the case of an elderly woman with functional weakness, which was documented using polysomnography with extended surface electromyography. Our findings show that polysomnography with extended surface electromyography may be a useful diagnostic tool for functional weakness in conversion disorder.

Post-meningitis Dumping Syndrome: A Case Report and Literature Review / 대한소화기학회지

Dumping syndrome has long been associated with gastric surgery. The authors experienced an adult patient presenting with dumping syndrome after meningitis without any previous surgical procedures on the stomach and small bowel. Dysfunction of the autonomic nervous system after infective meningitis may originate from postinfectious sequelae or an immunologic mechanism. A comprehensive study and proper management of autonomic symptoms of patients with a central nervous system infection are needed.

Is Split-Night Polysomnography Valid for Women with Obstructive Sleep Apnea?

Objectives@#Split-night polysomnography (PSG) can be used for the diagnosis and treatment of obstructive sleep apnea (OSA). Recently, the American Academy of Sleep Medicine has broadened the indication of split-night PSG from severe to moderate OSA in a time window of 2 hours. However, majority pieces of evidence have been derived from the male predominant study population. The objective of this study was to investigate the diagnostic accuracy of split-night PSG in Korean women. @*Methods@#This study included 122 adult women with OSA. Apnea-hypopnea index (AHI) from the first 120 minutes of clock time (T120-AHI) and full-night AHI (FN-AHI) were compared using the concordance correlation coefficient (CCC) method and Bland-Altman plot. Receiver operating characteristic (ROC) curves and the area under the ROC curves were plotted with various cut-off points of AHI. @*Results@#The T120-AHI correlated with FN-AHI (CCC=0.77). The area under the ROC curve for T120-AHI with FN-AHI ≥15 was 0.865, with a sensitivity of 78.6% and specificity of 82.7%. @*Conclusions@#T120-AHI showed a significant correlation with the FN-AHI value in Korean female patients with OSA.

The Association between History of Body Injury during Sleep and Obstructive Sleep Apnea in REM Sleep Behavior Disorder

Objectives@#To investigate whether a history of body injury is associated with obstructive sleep apnea (OSA) in patients with rapid eye movement (REM) sleep behavior disorder (RBD). @*Methods@#We enrolled 56 consecutive patients with RBD, a history of dream-enacting behaviors, and polysomnographic evidence of REM sleep without atonia. Participants were asked whether they had any history of body injuries such as self-injury or bed-partner injury during sleep. The demographic characteristics and polysomnographic parameters of the groups with a history of injury (n=34, 60.7%) and without (n=22, 39.3%) were compared. The association between the history of injury and OSA was assessed. @*Results@#OSA [apnea-hypopnea index (AHI) ≥5/h) was associated with a history of body injury [odds ratio (OR)=6.25, 95% confidence interval (CI)=1.64–23.84]. Additionally, the logistic regression analysis showed that insomnia severity index (OR=0.87, 95% CI=0.80–0.98) and AHI (OR=1.10, 95% CI=1.02–1.18) were associated with history of body injury. @*Conclusions@#Therefore, we can conclude that history of body injury is related to obstructive sleep apnea in patients with RBD.

A New Positive Sign of Functional Weakness in Conversion Disorder: Polysomnography with Extended Surface Electromyography

Patients often present with combinations of psychological disorders that manifest with neurological symptoms and/or signs that are not attributable to identifiable structural or functional etiology associated with the nervous system. We present the case of an elderly woman with functional weakness, which was documented using polysomnography with extended surface electromyography. Our findings show that polysomnography with extended surface electromyography may be a useful diagnostic tool for functional weakness in conversion disorder.

Sleep Disorders Documented by Night Polysomnography in Patients with Chronic Insomnia Disorder

BACKGROUND: To investigate the sleep disorders related to chronic insomnia and compare the characteristics of each group. METHODS: We registered 191 patients (female 56.0%, age 61.7 years) who have complained about symptoms of insomnia for more than three months and assessed sleep disorders related chronic insomnia by analyzing their polysomnography (PSG) parameters, demographics, and questionnaires (Insomnia Severity Index, Beck Depression Inventory, Pittsburg Sleep Quality Index, and Epworth Sleepiness Scale, and World Health Organization Quality of Life Assessment Instrument abbreviated version). RESULTS: Patients were categorized into groups of primary insomnia (PI, 51.8%, n=99), comorbid insomnia with obstructive sleep apnea (CIO, 38.7%, n=74), and comorbid insomnia with periodic limb movement disorder (CIP, 9.4%, n=18). CIO was older and more obese than PI and CIP. The proportion of males was the highest in CIO. Arousal index of PSG was higher in CIO and CIP than in PI. Other parameters and the results of questionnaires were not different among groups. CONCLUSIONS: About a half of patients with chronic insomnia symptoms (48.2%) had considerable sleep disorders associated with insomnia. Our study suggests that the PSG as well as history taking and demographics are necessary to clarify the relevant conditions of chronic insomnia disorder for appropriate treatment.

Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

BACKGROUND: Miliary tuberculosis (TB) can cause diagnostic confusion for clinicians because its radiological appearance can resemble that of metastatic cancer. CASE REPORT: Here, we describe the case of a 72-yearold woman with miliary TB mimicking brain metastasis from renal cell carcinoma. The patient visited our clinic because of dysarthria and sluggish speech. A metastatic cancer such as renal cell carcinoma or brain tumor was suspected. However, the patient was diagnosed with miliary TB associated with multiple intracranial tuberculomas and a subsequent paradoxical response to anti-TB therapy. CONCLUSION: Clinicians should be aware that miliary TB can mimic metastatic cancer even in older people, especially in TB-endemic regions.

Reversible Encephalopathy Caused by Reactive Hypereosinophilia due to Toxocariasis

A 69-year-old male admitted to the psychological department due to delusion. One week later, he developed pneumonia and deep drowsy mental status. Despite improvement of pneumonia, his mental status got worse and he was referred to neurological department. The complete blood count tests showed repeated hypereosinophilia. The serologic tests revealed toxocariasis. He was treated with steroid and albendazole and his mental state rapidly improved. Toxocariasis is a common cause of reactive hypereosinophilia, which may be an underestimated etiology of reversible encephalopathy.