[Excessive daytime sleepiness, central type sleep apnea and myotonic dystrophy]

Treatment of sleep central apnea with non-invasive mechanical ventilation with 2 levels of positive pressure (bilevel) in a patient with myotonic dystrophy type 1

We are reporting a case of a 29 year-old female with diagnosis of myotonic dystrophy type 1 (Steinert’s disease) with excessive daytime sleepiness, muscle fatigue, snoring, frequent arousals, non-restorative sleep, and witnessed apneas. Pulmonary function tests revealed a mild decrease of forced vital capacity. Nocturnal polysomnography showed an increase of apnea/hypopnea index (85.9 events/h), mainly of central type (236), minimal oxygen saturation of 72%, and end-tidal carbon dioxide values that varied from 45 to 53 mmHg.

Bi-level positive airway pressure titration was initiated at an inspiratory pressure (IPAP) of 8 and an expiratory pressure (EPAP) of 4 cm H₂O. IPAP was then gradually increased to eliminate respiratory events and improve oxygen saturation. An IPAP of 12cm H₂0 and an EPAP of 4cm H₂O eliminated all respiratory events, and the oxygen saturation remained above 90%.

Bi-level positive airway pressure treatment at spontaneous/timed mode showed an improvement in snoring, apneas, and Epworth sleepiness scale decreased from 20 to 10. This case illustrates the beneficial effects of Bi-level positive airway pressure support in central sleep apnea syndrome of a patient with myotonic dystrophy type 1.

[Dermatoglyphics and body composition in obstructive sleep apnea]

Obesity is the main risk factor for obstructive sleep apnea syndrome (OSAS) and genetic patterns can modulate the pathogenesis of the disease. The aim of this study is to describe the anthropometrics and dermatoglyphics features among OSAS carriers. We collected information on Body Mass Index (BMI), Conicity Index (CI), Body Fat Mass (BFM), somatotype and fingerprints. Thirty-one cases of OSAS were compared to an equal number of controls. Membership to the obese category is based on observed BMI and BFM. The CI distribution among cases shows a strong central obesity component. The endomorph-mesomorph somatotype category predominates among cases showing high adiposity and relative muscle-skeletic development, such as relative linearity of great mass per unit of height. Increased morbidity, as given by more serious indices of apnea, correlates positively with higher mesomorphic predominance in the body composition. Analysis of dermatoglyphic data does not show significant statistical differences between OSAS--patients and controls.

Sleep apnoea in infancy and childhood. Considering two possible causes: obstruction and neuromuscular disorders

Two aspects of sleep apnoea in infancy and childhood are considered. First of all the obstructive sleep apnoea syndrome is reviewed; its causes, and types, and clinical differences depending on the age of the affected patient. Difficulties of diagnosis are discussed, as well as methods used to confirm the presence of the syndrome. Then means of treatment are considered, both medical and surgical. The second part of the paper is concerned with a particular group of children, especially at risk of sleep apnoea; those suffering from neuromuscular disorders as these are likely to be of special interest to paediatric neurologists. These include neuropathies, myopathies such as Duchenne muscular dystrophy and myotonia, and disorders of the neuromuscular junction.