Objective To analyze the causes of missed diagnosis of sleep apnea hypopnea syndrome ( SAHS) . Methods 42 missed diagnosed cases with SAHS from May 2009 to May 2011 were retrospectively analyzed and related literatures were reviewed. Results The SAHS patients often visited the doctors for complications of SAHS such as hypertension, diabetes mellitus, metabolic syndrome, etc. Clinical misdiagnosis rate was very high. Lack of specific symptoms during the day, complicated morbidities, and insufficient knowledge of SAHS led to the high misdiagnosis rate and the poor treatment effect of patients with SAHS. Conclusion Strengthening the educational propaganda of SAHS, detail medical history collection, and polysomnography monitoring ( PSG) as early as possible can help diagnose SAHS more accurately and reduce missed diagnosis.
ObjectiveTo provide the possibility to explain the relationship between genotype and phenotype, and to provide reference for the clinical treatment of Sleep-related hypermotor epilepsy (SHE). MethodsWe retrospectively analyzed the case data of the child (patient 1) diagnosed with SHE in the outpatient department of the Second Affiliated Hospital of Wenzhou Medical University in December 2017, and inquired about his family history and growth and development history. We learned that the father (patient 2) of the child had a history of epilepsy, and we also collected his medical history and growth and development history of patient 2. We carried out the basic physical examination for the two patients, and basic blood routine and blood biochemical indicators have also been done. In addition, electroencephalogram, Wechsler intelligence assessment and cranial magnetic resonance imaging were performed. After the diagnosis of patients 1 and 2, we treated them with antiepileptic drugs and make them long-term follow-up. What’more, we collected the peripheral blood of patient 1 and his father and mother, sequenced the gene, established phylogenetic tree for the mutation gene, and compared the homologous protein sequence to judge the conservation of the mutation. Moreover, in silico analysis was used to analyze the pathogenicity of the mutant gene. ResultsWe find a family with epilepsy, of whom patient 1 and his father are with epilepsy. Their clinical manifestations are atypical, and their seizures are all in sleep. After a long-term follow-up of two patients' drug treatments, it is found that patient 1 and patient 2 respond well to the drugs. Gene test shows that the mutations of DEPDC5 (c.484-1del c.484_485del) and KCNQ2 (c.1164A> T) are at the same site in both patient 1 and patient 2, and the mutation sites are first reported. What’more, the homologous protein alignment shows that the amino acids corresponding to the two mutant genes are highly conserved. ConclusionThis study mainly reports a family with sleep-related hypermotor epilepsy. Patients 1 and patient 2 have novel mutations of DEPDC5 and KCNQ2 genes. In the long-term follow-up of this study, it is found that the patients are effective the antiepileptic drugs.
Objective To investigate the effect of anti-seizure medications (ASMs) pregabalin (PGB) monotherapy on sleep structure and quality of patients with focal epilepsy. MethodsAdult patients whom newly diagnosed focal epilepsy were collected and treated with PGB monotherapy. The main outcome measures were the changes of polysomnography and video-electroencephalography (PSG-VEEG), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) in epilepsy patients with PGB and baseline. Results PGB improved significantly sleep structural parameters, including increased total sleep time (P<0.001), decreased sleep latency (P<0.001), improved sleep efficiency (P<0.001), reduced wake time after sleep onset (P<0.001), increased sleep maintenance efficiency (P<0.001) and proportion of N3 sleep stage (P<0.001). In the group with poor sleep efficiency, 86.7% of patients achieved sleep efficiency>85% after PGB treatment. The difference was statistically significant (P<0.01). PGB reduced significantly PSQI score (P<0.001) and ISI score (P<0.001). No significant change in ESS score was observed (P>0.05). ConclusionsPGB could enhance slow-wave sleep (SWS), increase sleep quality and improve insomnia in patients with epilepsy without causing daytime sleepiness.
Objectives To study the characteristics and influencing factors of sleep disorder in patients with epilepsy. Methods One hundred and eighty-four patients with epilepsy who were admitted to the outpatient department and the epilepsy center in the Second Affiliated Hospital of Zhejiang University from October 2016 to October 2017 were enrolled. Their clinical data were collected in detail and their sleep related scales were evaluated. Sleep related assessment tools: Chinese version of the Pittsburgh sleep quality index scale (PSQI), the Epworth sleepiness scale (ESS), Berlin Questionnaire (BQ), Quality Of Life In People With Epilepsy-31 (QOLIE-31), Beck Anxiety Inventory (BAI) and Beck Depression Inventory(BDI). Results Among the 184 cases of patients with epilepsy, 100 cases were male (54.3%), 84 cases were female (45.7%), 35 cases (19.0%) had sleep disorders, 89 cases (48.4%) with poor quality of life, 23 cases (12.5%) with anxiety, 47 cases (25.5%) with depression, 59 cases (32.1%) had daytime sleepiness, and 30 cases (16.3%) with OSAS. there were statistically significant differences in age, history of hypertension, seizure frequency, quality of life , anxiety and depression in epilepsy patients with sleep disorder compared those without sleep disorder (P<0.05). The seizure frequency, quality of life, anxiety and depression were analyzed by logistic regression analysis, suggesting that seizure frequency (P=0.011) and depression (P<0.001) are independent risk factors of sleep disorders. Conclusions Epileptic patients with sleep disorder have higher frequency of seizures, poorer quality of life, and are more likely to be associated with anxiety and depression, and the frequency and depression are independent risk factors of sleep disorder in patients with epilepsy.
Objective To investigate the mediating effect of nursing intervention of sleep hygiene on insomnia in patients with liver cirrhosis. Methods One hundred and eighteen cirrhotic patients with grade-A liver function and insomnia treated between June 2012 and January 2015 were divided into control group (n=52) and intervention group (n=66) with random number table method. The control group received conventional nursing only, while the intervention group was given nursing intervention of sleep hygiene. The sleep quality of patients in the two groups on admission and discharge were surveyed and compared based on Pittsburgh sleep quality index (PSQI). The nursing effect was also compared between the two groups on discharge. Results There was no statistically significant difference in total score and scores for each factor of PSQI between the two groups of patients on admission (P>0.05). However, the total score and scores for each factor of PSQI on discharge in both groups were significantly lower than those on admission (P<0.05). Besides, the scores in the intervention group were significantly lower than those in the control group (P<0.05). The effect of nursing in the intervention group was superior to that in the control group (P<0.001). Conclusions Nursing intervention of sleep hygiene can effectively improve sleep quality in cirrhotic patients with grade-A liver function. The role of nursing intervention in the treatment of insomnia should be taken seriously.
Patients with autoimmune encephalitis are mainly characterized by behavioral, mental and motor abnormalities, neurological dysfunction, memory deficits and seizures. Different antibody types of autoimmune encephalitis its pathogenesis, clinical characteristics are different, in recent years found immune related epilepsy is closely related to autoimmune encephalitis, based on autoimmune encephalitis type is more, we choose more common autoimmune encephalitis, expounds its characteristics, to help clinical diagnosis.
高血压是我国重点防治的心血管疾病, 血压的控制率备受关注。在一些血压控制不良的患者中睡眠呼吸暂停是导致顽固性高血压的重要原因。以睡眠过程中反复、频繁出现呼吸暂停和低通气为特点的睡眠呼吸暂停低通气综合征( sleep apneahypopnea syndrome, SAHS) 自20 世纪80 年代以来也受到广泛关注, 临床和基础研究取得了迅速发展。目前, 多项临床、流行病学和基础研究证实SAHS可以导致和/ 或加重高血压, 与高血压的发生发展密切相关。
ObjectiveTo investigate the renal impairment and the risk factors of renal impairment in patients with OSA. MethodsData from patients who underwent polysomnography (PSG) in our department from July 2022 to January 2023 were collected, totaling 178 cases. Based on the results of the polysomnography, the patients were divided into an OSA group (145 cases) and a non-OSA group (33 cases). According to the severity of the condition, the OSA group was further divided into mild OSA (21 cases), moderate OSA (28 cases), and severe OSA (96 cases). The Pearson correlation analysis was further conducted to analyze the relationships between serum urea nitrogen (BUN), serum cystatin C (Cys-C) concentrations, and estimated Glomerular Filtration Rate (eGFR) with various risk factors that may influence renal impairment. Moreover, multiple linear regression analysis was used to identify the risk factors affecting BUN, Cys-C, and eGFR. ResultsWhen comparing the two groups, there were statistically significant differences in age, weight, BMI, neck circumference, waist circumference, eGFR、Cys-C、BUN, LSaO2, CT90% (all P<0.05). Univariate analysis of variance was used to compare differences in BUN, Serum creatinine (SCr), Cys-C, and eGFR among patients with mild, moderate, and severe OSA, indicating that differences in eGFR and Cys-C among OSA patients of varying severities were statistically significant. Further analysis with Pearson correlation was conducted to explore the associations between eGFR, BUN, and Cys-C with potential risk factors that may affect renal function. Subsequently, multiple linear regression was utilized, taking these three indices as dependent variables to evaluate risk factors potentially influencing renal dysfunction. The results demonstrated that eGFR was negatively correlated with age, BMI, and CT90% (β=−0.95, P<0.001; β=−1.36, P=0.01; β=−32.64, P<0.001); BUN was positively correlated with CT90% (β=0.22, P=0.01); Cys-C was positively correlated with CT90% (β=0.58, P<0.001. Conclusion Chronic intermittent hypoxia, age, and obesity are risk factors for renal dysfunction in patients with OSA.
Epilepsy and sleep disorders are common health problems in the world, and sleep disorders as a common comorbidity of epilepsy patients, there are high prevalence, low attention rate, low treatment rate phenomenon. In addition, epilepsy and sleep disorders can affect each other, exacerbating the onset of their own symptoms. Therefore, timely identification and treatment of these comorbidities are crucial to improve patients' quality of life, increase daytime alertness and reduce the occurrence of seizures. This article reviews the effects of different anti-seizure programs on patients with epilepsy comorbidities sleep disorders, in order to provide references for how to better choose epilepsy treatment measures for these patients.
ObjectivesTo review the value of sleep deprivation EEG methodology in the diagnosis of epilepsy.MethodsSuch databases as Pubmed, MEDLINE, The Cochrane Library, Wanfang, VIP and CNKI Data are searched electronically and comprehensively for literature on the diagnosis of epilepsy by sleep deprivation EEG from inception to January 2021. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using Stata software.ResultsA total of 14studies involving 1221 patients were included in total. The results of meta-analysis showed that: Duration of sleep deprivation and effect value of positive rate [ r=0.670, 95%CI (0.664, 0.696), P<0.001 ], duration of the awake period records and effect value of positive rate [ r=0.659, 95%CI (0.596, 0.722), P<0.001 ], duration of sleep period records and effect value of positive rate [ r=0.67, 95%CI(0.619, 0.721), P<0.001 ], with significant differences.ConclusionsThe duration of sleep deprivation, the awake period records, and the sleep period records of sleep deprivation EEG examination, sleep deprivation time between 16 h to 24 h, the awake recording time ≥30 min, and the sleep recording time ≥ 60 min (≤ 3 h) can obviously improve the positive rate of sleep deprivation EEG.