Neurocognitive, mood changes, and sleepiness in patients with REM-predominant obstructive sleep apnea.

PURPOSE: This article focuses on recent evidence linking rapid eye movement (REM) obstructive sleep apnea (OSA) (REM-OSA) to neurocognitive dysfunction and mood changes; the proposed mechanisms for increased risk of neurocognitive dysfunction in REM-OSA, and future research prospects. METHODS: PubMed and Google Scholar records were examined for articles utilizing pre-defined keywords. In this work, we mainly included studies published after 2017; nevertheless, critical studies published prior to 2017 were considered. RESULTS: REM-OSA is an under-recognized stage-related sleep-disordered breathing in which obstructive respiratory events happen chiefly in stage REM. The disorder is commonly seen amongst younger patients and females and has recently been linked to cardiometabolic complications. Although less symptomatic than non-REM-OSA and non-stage-specific OSA, current findings indicate that REM-OSA may have neurocognitive repercussions and mood changes and could be linked to insomnia, increased dreams, and nightmares. CONCLUSION: Currently available evidence indicates that REM-OSA may present with insomnia and nightmares and could affect cognitive function and mood.

Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach.

PURPOSE OF REVIEW: Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA, in which obstructive events occur primarily during REM sleep. This review discusses REM-OSA definitions, its cardiometabolic correlates, associated comorbidities and treatment, and addresses diagnostic ambiguities and therapeutic pitfalls. RECENT FINDINGS: Current evidence indicates that REM-OSA is prevalent among younger age groups and women and is independently associated with cardiometabolic complications, particularly hypertension, metabolic complications such as insulin resistance and metabolic syndrome. However, currently, there is no consensus on the accepted diagnostic criteria for REM-OSA. Available data suggest that adherence to positive airway pressure (PAP) therapy in patients with REM-OSA is suboptimal. Moreover, the currently accepted criteria for good adherence to PAP therapy of 4 h/night, 70% of the days may not be suitable for REM-OSA, as it will not cover most of the REM sleep periods. In addition, further research is needed to assess the impact of REM-OSA treatment on cardiometabolic outcomes. SUMMARY: Patients with REM-OSA are at an increased risk of cardiometabolic complications. A high index of suspicion is needed to diagnose this disorder, and close follow-up is required to enhance adherence to therapy.

Exploding Head Syndrome: A Case Series of Underdiagnosed Hypnic Parasomnia.

Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of sudden loud noise or a sense of explosion in the head that usually occurs at sleep onset. This paper is a report of 6 patients diagnosed with EHS through a structured clinical interview and video-polysomnography (vPSG) recordings. We also reviewed the available literature that addressed the presentation and clinical and PSG characteristics of EHS. The case series included 4 men and 2 women of a mean age of 44.2 years (between 13 and 77 years). Their episodes were variable in expression, between a sudden firecracker-like explosion to a gun-shot sound, mostly as if happening inside the head. EHS is always associated with distress but never with pain. Five out of 6 patients had other sleep-related problems with a close relationship of EHS symptoms to comorbid sleep disorder manifestations and exacerbations. The vPSG recordings of 5 patients were unremarkable. An attack of EHS was documented in 1 patient, arising during stage N2 of sleep. Three patients responded well to reassurance and treatment for the comorbid sleep disorder. The other 3 patients responded well to amitriptyline (10-50 mg). EHS is a well-characterized, underrecognized hypnic parasomnia with a benign course. Amitriptyline seems to be effective in persistent cases.

Management of Aerosol during Noninvasive Ventilation for Patients with Sleep-Disordered Breathing: Important Messages during the COVID-19 Pandemic.

With the advent of COVID-19 infection and its rapid spread, preventive strategies are being developed worldwide, besides following the universal infection control guidelines. Prevention of spread through aerosol generation is one of the essential strategies in this regard, particularly for patients with sleep-disordered breathing at home and during hospital admission. Aerosols are produced, at home and in health care facilities, by natural processes and aerosol-generating procedures. To address this impinging problem, aerosol-generating procedures, like non-invasive ventilation (NIV), are to be handled meticulously, which might warrant isolation and sometimes device/interface modifications.