RESUMO
This chapter will focus on the office management of psychiatric patients with sleep disorders. Psychiatric aspects of insomnia, the parasomnias, circadian rhythm disorder and disorders of excessive sleepiness will be reviewed. The antidepressants, electroconvulsive therapy, amino acids and bright lights.
Assuntos
Transtornos Mentais/complicações , Transtornos do Sono-Vigília/terapia , Aminoácidos/uso terapêutico , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/complicações , Transtorno Depressivo/complicações , Eletroconvulsoterapia , Humanos , Hipnóticos e Sedativos/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/terapia , Transtornos do Humor/complicações , Transtornos da Personalidade/complicações , Fototerapia , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/tratamento farmacológicoRESUMO
As awareness and understanding of obstructive sleep apnea has increased so has the number of treatments for this disorder. Options include surgical procedures: tracheostomy, palatopharyngoplasty (PPP), and mandibular advancement. Other treatments are medication, nasal CPAP, Tongue Retaining Device, and a position alarm. With these numerous choices available, it is important that reliable indicators be developed to guide treatment choice. And although PPP surgery is a one-time intervention with possibility of permanent correction, reports of percentages of successful treatment have varied widely from 85% to 0%. This has led us to investigate predictors of successful treatment. Twenty-two patients treated with PPP following their diagnosis by standard clinical polysomnography were restudied an average of 8 weeks later. When 11 successful cases were compared to 11 unsuccessful cases, successes were found to be initially more severely apneic (mean AI = 90.55 versus 49.45). Palatopharyngoplasty appears to be most appropriate for the sleep apnea patient whose apnea index is 70 or above and less effective for milder cases.
Assuntos
Síndromes da Apneia do Sono/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palato/cirurgia , Faringe/cirurgia , Síndromes da Apneia do Sono/diagnósticoRESUMO
Forty patients with obstructive sleep apnea (OSA) were either treated by submucous resection, alone or by palatopharyngoplasty (PPP). Before surgery, each patient underwent a thorough sleep evaluation for the diagnosis of OSA. Of the 23 patients treated by submucous resection alone, eight had more than a 50% reduction in their apnea index and were considered successfully treated. Of the remaining 15, ten received a supplemental tongue retaining device (TRD). Five of the ten were markedly improved. The overall success rate in this group was 57%. Of the 17 patients treated by submucous resection and PPP, ten were treated successfully. Six of the remaining seven patients were subsequently treated with a TRD, which was successful in four. The overall success rate in this group was 82%.