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Narcolepsy (and Cataplexy)
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
The first and most important symptom is severe sleepiness, which is sometimes called “somnolence” (Dement, 1993). In order to be diagnosed with narcolepsy, a person must show somnolence during the part of their day when they are trying to be awake and going about their business (Gauci et al., 2017). But it's not just feeling tired—this somnolence involves “irresistible sleep attacks” (Akintomide & Rickards, 2011, p. 507). This means that when they feel sleepy, they are unable to fight off that sleepiness and fall asleep. This is unlike a regular bout of sleepiness in which a person can resist the urge to fall asleep. If you've ever driven a car or read a book while extremely tired and forced yourself to stay awake, you have resisted sleepiness, something that a person with narcolepsy cannot do during a sleep attack. That is, narcolepsy is not like forgetting a dose of coffee; it's more like forgetting how to be awake for a little while.
Movement disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Problematic effects of DAs include somnolence, hallucinations and leg oedema. Somnolence is a feature of advanced PD irrespective of treatment but does appear to be made worse by DAs.51 Rarely, sudden episodes of sleep have resulted in motor vehicle accidents.52 This should be considered when initiating treatment in people who still drive. The leg oedema is poorly responsive to diuretic therapy but rapidly reversed by stopping the offending medication.53 DAs are also associated with dopamine dysregulation syndrome.
Respiratory Symptoms
Published in James M. Rippe, Lifestyle Medicine, 2019
Jeremy B. Richards, Richard M. Schwartzstein
The severity of daytime somnolence can be assessed and quantified by the Epworth Sleepiness Scale (ESS).60 The ESS asks patients to rank their sleepiness in eight scenarios, such as “sitting quietly after a lunch without alcohol” or “in a car, while stopped for a few minutes in traffic” (see Table 47.10).60 Patients with a high score (≥9) have increased daytime sleepiness, but the ESS has not been validated as an independent predictor of the OSA syndrome.
Modifiable child and caregiver factors that influence community participation among children with Down syndrome
Published in Disability and Rehabilitation, 2022
Nora Shields, Amy Epstein, Peter Jacoby, Rachel Kim, Helen Leonard, Dinah Reddihough, Andrew Whitehouse, Nada Murphy, Jenny Downs
Sleep was described using the sleep disturbance scale for children [18]. This 26-item scale has been evaluated in 1157 children without sleep disturbances and 147 children with clinically diagnosed sleep disturbances, with evidence of satisfactory factor structure, Cronbach’s alpha values and discriminant validity reported [18]. For this study, three of six domains were analysed: (i) disorders of initiating and maintaining sleep (seven items); (ii) sleep breathing disorders (three items); and (iii) disorders of excessive somnolence (five items). The responses to each item are scored from 1 = never to 5 = always. A score for each domain was obtained by summing the responses to the items in each domain. These scores were then normalised to T-scores using a reference population of children in the general population [18]. Child behaviour was measured using the Child’s Challenging Behaviour Scale [19]. This 11-item scale measures a parent’s report of difficult behaviours such as aggression, oppositional or uncooperative behaviour, resistance to or reliance on routine, and persistent unhappiness or discontent. Evidence of satisfactory factor analysis, internal consistency, and construct validity has been reported [19]. Items are scored using a five-point Likert response scale (1 = strongly agree, 5 = strongly disagree). The scale is scored by summing the 11 scale items after two items are reverse scored. Higher scores indicate more challenging behaviour.
Children who sustained traumatic brain injury take longer to fall asleep compared to children who sustained orthopedic injuries: actigraphy findings
Published in Brain Injury, 2021
Suncica Lah, Stefan Bodanov, Naomi Brookes, Adrienne Epps, Natalie Lynette Phillips, Arthur Teng, Sharon L. Naismith
In conclusion, this study shows evidence of both objective and subjective disturbed sleep in children who sustained moderate to severe TBI. A common theme of sleep disturbance was found across both types of measures: taking longer to fall asleep (objective) and problems initiating and maintaining sleep (subjective), but the correlation between the two was not significant. Difficulties with excessive somnolence were also found on the subjective measure of sleep. The concurrent use of objective and subjective measures when assessing sleep in children with TBI thus appears clinically warranted. No relation was found between child fatigue and objective sleep disturbance. Lack of a relation between time since injury and sleep disturbance suggests that sleep difficulties should be assessed and treated as early as possible to prevent ongoing sleep disturbance and its potential adverse impact on daily functioning.
Assessing diagnosis and managing respiratory and cardiac complications of sarcoglycanopathy
Published in Expert Opinion on Orphan Drugs, 2020
Corrado Angelini, Valentina Pegoraro
Respiratory involvement was found in 26% of the cases that required ventilatory support, with the treatment recommended at a mean age of 29.1 years. Between the different subgroups, it was not identified a difference in the frequency of patients requiring ventilator support nor in the age at which it was recommended. A practical indication of nocturnal mechanical ventilation is represented by the presence of clinical signs of hypoxemia, such as morning headache, sleep abnormality, dyspnea lying flat, and FVC below 50%. However, patients requiring ventilator support had a significant longer duration of the disease. When a specific analysis was conducted on the potential influence of scoliosis in the need of ventilator support: 69.1% of the patients requiring ventilation had scoliosis, while only 31.9% that did not require ventilation support had scoliosis [16]. These differences were statistically significant. Additionally, it was observed a nonsignificant trend of starting the ventilation earlier for patients with scoliosis compared to those patients without scoliosis. When the upper airway musculature is affected, speech and swallowing difficulties and dysphagia start to develop. Snoring, apneic episodes, and daytime somnolence point to the possibility of obstructive sleep apnea. If patients under ventilation at night, the resultant hypercapnia may cause early‐morning headache, reduced attention, and concentration with clouded consciousness [17,18].