Sleep
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Case Reports
Chiari malformation and sleep-disordered breathing: a review of diagnostic and management issues.
Chiari Malformation (CM) encompasses several patterns of congenital or acquired cerebellar herniation through the foramen magnum. This may result in brain-stem compression that impacts control of breathing and is associated with obstructive and central apneas. ⋯ After initial improvement following surgery there was recurrence of brain-stem compression. The only clinical expression of which was polysomnographically evident recurrence of sleep apnea.
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Recent studies show that central sleep apnea occur in about 40% of patients with heart failure and systolic dysfunction. The pathophysiological consequences of central sleep apnea may contribute to morbidity and mortality of heart failure. Three treatment modalities, oxygen, continuous positive airway pressure and theophylline have been shown to decrease periodic breathing modestly with considerable improvement in arterial oxyhemoglobin desaturation, and variable effects on sleep characteristics. However, long-term effects of central sleep apnea and its treatment on the natural history of heart failure remain to be determined.
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Obstructive sleep apnea (OSA) has been identified and recorded in paediatric patients, the potential mechanisms for OSA include anatomical abnormalities that lead to a narrowed airway space, reduced muscle tone and abnormal central ventilatory control. Several treatments have been developed and are routinely used to treat OSA in infants and children. ⋯ Surgery to correct underlying anatomical abnormalities is frequently used and usually results in an improvement in symptoms and in some cases, it is curative. Other forms of treatment include pharmacological interventions, positioning and nasopharyngeal intubation.
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Automatic CPAP therapy has been developed to constantly adapt the positive pressure level to the required needs. The automatic devices have been used in two different ways, one being to determine the pressure level to be prescribed at home for fixed CPAP therapy, and the other one to replace fixed CPAP as an home treatment. This last application should alleviate the need for a titration study. ⋯ The mean positive pressure level applied during automatic CPAP treatment is usually less than the effective pressure level measured during a conventional titration sleep study. Some results suggest that automatic CPAP therapy may improve compliance to CPAP therapy. There is a need to better define if automatic CPAP therapy may benefit to specific groups of sleep apnea patients.