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1/7. Hypersomnia following uvulopalatopharyngoplasty for snoring.

    This report describes three cases who underwent uvulopalatopharyngoplasty for severe snoring and who subsequently developed progressive excessive daytime sleepiness. All three cases were shown to have sleep fragmentation as a result of non-apnoeic episodic upper airway narrowing. These cases raise the possibility that increased upper airway resistance during sleep may be exacerbated or even caused by uvulopalatopharyngoplasty. Ideally, sleep-disordered breathing should be carefully excluded before this surgery is offered as treatment for severe snoring.
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2/7. Hypersomnia with periodic breathing (an acromegalic Pickwickian).

    The syndromes of Pickwickian, Ondine's curse, and primary alveolar hypoventilation are respiratory disorders manifesting increased sleepiness and irregular respiratory rhythms. These disorders are currently grouped as hypersomnia with periodic breathing (HPB). Polygraphic techniques have lead to a reasonable hypothesis as to the pathophysiology of the multiple variants of HPB. Discernible causes of HPB have been attributed to both central and peripheral factors. Peripheral factors encompass those conditions relating to upper airway obstruction. An acromegalic person suffering the HPB syndrome secondary to laryngeal stenosis is described.
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keywords = breathing
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3/7. narcolepsy and other non-SAS hypersomnia in sleep breathing disorders clinic.

    Four of the 708 snorers (0.56%), referred to our sleep breathing disorders clinic for the past 2 years were diagnosed as having narcolepsy-cataplexy. Detecting HLA DRB1*1501/DQB1*0602 positive was informative for differentiating genuine narcolepsy from non-sleep apnea syndrome (non-SAS) hypersomnia in our clinic. A non-SAS obese boy, diagnosed as having essential hypersomnia syndrome, was found to be HLA DRB1*1502/DQB1*0601 positive. His hypocretin concentration was 206 pg/mL in the cerebrospinal fluid.
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keywords = breathing
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4/7. Maxillomandibular expansion for the treatment of sleep-disordered breathing: preliminary result.

    OBJECTIVE: To assess the outcomes of maxillomandibular expansion (MME) by distraction osteogenesis (DO) for the treatment of sleep-disordered breathing (SDB). methods: This was a prospective study of six consecutive patients with SDB. All of the patients have maxillary and mandibular constriction and were treated with MME. Variables examined include age, sex, body mass index (BMI), polysomnographic results (PSG), Epworth Sleepiness Scale (ESS), and the extent of the widening of the maxilla and mandible. RESULTS: All six patients (4 males) completed MME for the treatment of SDB. The mean age was 22.2 /- 11.4 years. The mean maxillary expansion was 10.3 /- 3.0 mm, and the mean mandibular expansion was 9.5 /- 2.9 mm. ESS improved from 10.2 /- 1.9 to 5 /- 2.9. The mean apnea/ hypopnea index (AHI) improved from 13.2 /- 15.6 to 4.5 /- 5.8 events per hour, and the mean lowest oxygen saturation (LSAT) improved from 88.2 /- 2.9% to 91.3 /- 3.3%. The mean esophageal pressure improved from -20 /- 11.3 cm H2O to -8 /- 3.6 cm H2O. No complications were encountered, and the follow-up period was 18.1 /- 9.8 months. CONCLUSION:: The result suggests that MME improves SDB in patients with maxillary and mandibular constriction and can be a valid treatment.
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5/7. Hypersomnia and periodic breathing. Report of a case and review of the literature.

    A patient with hypersomnia and periodic breathing has been studied. Both airflow obstruction and an abnormally of the respiratory control mechanism were implicated in the pathogenesis of the ventilatory arrhythmia. It is suggested that the older terms "Pickwick" syndrome and primary alveolar hypoventilation are abandoned for more descriptive terms, e.g. "hypersomnia with periodic breathing".
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6/7. Further observations on sleep abnormalities in kleine-levin syndrome: abnormal breathing pattern during sleep.

    In two adolescent and two adult patients with kleine-levin syndrome, polygraphic sleep recording performed during somnolent and non-somnolent periods revealed various forms of abnormal breathing patterns during sleep. These included periodic breathing and hypopnoeic episodes associated with brief arousals and, in one adult patient, a full blown sleep apnoea syndrome. It is suggested that abnormal breathing in sleep in this syndrome may result from central hypoexcitability.
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7/7. Polygraphic study of periodic breathing and hypersomnolence in a patient with severe hypothyroidism.

    A 67-year-old woman with primary hypothyroidism, who had Pickwickian syndrome as well, was studied electrophysiologically. A polygraphic study with simultaneous recordings of electroencephalography, actograms of the abdominal walls, the mentum and the anterior neck, and electromyogram of the intercostal muscles revealed a cyclic appearance of apnea in the sleep phase and gasping preceding arousal, which, together with macroglossia and sleep in the sitting position, suggested a cyclic obstruction of the upper airway. The obstruction appeared responsible for both alveolar hypoventilation and disturbance of consciousness.
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