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Madhavarapu S, Casturi L, Malhotra S. 1255 Previously unknown ventricular arrhythmia in a globally delayed pediatric patient with tuberous sclerosis. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
We present a case of previously unknown ventricular ectopy in a pediatric patient who is globally delayed. As the patient is non-verbal, it is possible the patient may have ultimately experienced heart failure or a lethal arrhythmia were it not for the polysomnogram (PSG).
Report of Case
A four year old female with Tuberous Sclerosis (TS) was referred to our pediatric sleep center for snoring. Her past medical history includes intracardiac tumors, daily seizures, and global developmental delay. Initial PSG showed moderate obstructive sleep apnea defined by an obstructive Apnea-Hypopnea Index of 6.89 and no cardiac arrhythmias. Positive airway pressure titration study was performed one year later. Premature ventricular contractions were noticed during the setup while patient was awake. Intermittent couplets and triplets occurred during sleep as well as a prolonged run of bigeminy that initiated during a period of wake after sleep onset and persisted into non-rapid eye movement sleep. She was escorted to the emergency room where a 12-lead electrocardiogram (EKG) showed sinus rhythm with non-specific interventricular conduction delay and right ventricular hypertrophy. She was discharged with a Holter monitor and subsequent analyses was concerning for frequent ventricular couplets and non-sustained runs of ventricular tachycardia. She required admission to initiate anti-arrhythmic therapy. Imaging revealed stable intracardiac tumors, but revealed scarring within sites of intramyocardial lesions. She failed different anti-arrhythmic agents before settling with amiodarone.
Conclusion
Sleep disordered breathing (SDB) can cause or worsen cardiac arrhythmias. This case highlights the importance of routine surveillance in patients with both known cardiac disease who have or are at risk of having significant cardiac arrhythmias and suspected SDB. Additionally, current guidelines for TS patients recommend EKG once every 3 to 5 years. This case may also highlight the importance of increased cardiac surveillance in this population group.
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Affiliation(s)
| | | | - Sonal Malhotra
- Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
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Affiliation(s)
- Jose Ochoa
- Department of Pediatrics, Baylor College of Medicine; Children’s Sleep Center, Texas Children’s Hospital, Houston, TX
| | - Amee A Patel
- Department of Pediatrics, Baylor College of Medicine; Children’s Sleep Center, Texas Children’s Hospital, Houston, TX
| | - Lata Casturi
- Department of Pediatrics, Baylor College of Medicine; Children’s Sleep Center, Texas Children’s Hospital, Houston, TX
| | - Daniel G Glaze
- Department of Pediatrics, Baylor College of Medicine; Children’s Sleep Center, Texas Children’s Hospital, Houston, TX
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Kancherla B, Glaze D, Patel A, Rambaud C, Casturi L. 0887 POSITIVE AIRWAY PRESSURE ADHERENCE IN CHILDREN: A RETROSPECTIVE REVIEW TO EXAMINE ADHERENCE RATES AT A MULTI-DISCIPLINARY PEDIATRIC SLEEP CENTER. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hesselbacher S, Subramanian S, Rao S, Casturi L, Surani S. Self-reported sleep bruxism and nocturnal gastroesophageal reflux disease in patients with obstructive sleep apnea: relationship to gender and ethnicity. Open Respir Med J 2014; 8:34-40. [PMID: 25352924 PMCID: PMC4209499 DOI: 10.2174/1874306401408010034] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 02/08/2023] Open
Abstract
Study Objectives : Nocturnal bruxism is associated with gastroesophageal reflux disease (GERD), and GERD is strongly associated with obstructive sleep apnea (OSA). Gender and ethnic differences in the prevalence and clinical presentation of these often overlapping sleep disorders have not been well documented. Our aim was to examine the associations between, and the symptoms associated with, nocturnal GERD and sleep bruxism in patients with OSA, and to examine the influence of gender and ethnicity. Methods : A retrospective chart review was performed of patients diagnosed with OSA at an academic sleep center. The patients completed a sleep questionnaire prior to undergoing polysomnography. Patients with confirmed OSA were evaluated based on gender and ethnicity. Associations were determined between sleep bruxism and nocturnal GERD, and daytime sleepiness, insomnia, restless legs symptoms, and markers of OSA severity in each group. Results : In these patients with OSA, the prevalence of nocturnal GERD (35%) and sleep bruxism (26%) were higher than the general population. Sleep bruxism was more common in Caucasians than in African Americans or Hispanics; there was no gender difference. Nocturnal GERD was similar among all gender and ethnic groups. Bruxism was associated with nocturnal GERD in females, restless legs symptoms in all subjects and in males, sleepiness in African Americans, and insomnia in Hispanics. Nocturnal GERD was associated with sleepiness in males and African Americans, insomnia in females, and restless legs symptoms in females and in Caucasians. Conclusion : Patients with OSA commonly have comorbid sleep bruxism and nocturnal GERD, which may require separate treatment. Providers should be aware of differences in clinical presentation among different ethnic and gender groups.
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Affiliation(s)
- Sean Hesselbacher
- Sentara Healthcare, Virginia Beach, VA, USA ; Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Shweta Rao
- Baylor College of Medicine, Houston, Texas, USA
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Casturi L, Rao R. Association of Short Sleep Duration and Body Mass Index in Teen Adolescents. Chest 2011. [DOI: 10.1378/chest.1119939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Subramanian S, Guntupalli B, Murugan T, Bopparaju S, Chanamolu S, Casturi L, Surani S. Gender and ethnic differences in prevalence of self-reported insomnia among patients with obstructive sleep apnea. Sleep Breath 2010; 15:711-5. [PMID: 20953842 DOI: 10.1007/s11325-010-0426-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 08/31/2010] [Accepted: 09/18/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders. Studies have shown that complaints of insomnia are prevalent among sleep clinic patients evaluated for OSA. Less is known about the gender and ethnic variations in this association. OBJECTIVES This paper aims to study the influence of gender and ethnicity in the prevalence of insomnia in patients with OSA and explore the association between these two disorders with an emphasis on psychophysiologic insomnia. METHODS AND MEASUREMENTS We reviewed case files, including self-reported questionnaires and polysomnography studies of 300 OSA patients [apnea-hypopnea index (AHI) of >10] from three ethnic groups--Caucasian, Hispanic, and African American, 50 patients each, male and female, seen at a tertiary care county hospital adult sleep center. Self-reported insomnia was classified as sleep onset insomnia, sleep maintenance insomnia, or insomnia with early morning awakening. Psychophysiologic insomnia was documented if the patient reported two of the following five symptoms: racing thoughts when trying to sleep, increased muscle tension when trying to sleep, fear of being unable to sleep, fear of being unable to fall back to sleep after waking up, and lying in bed worrying. Fischer exact tests for each contingency table were run using SPSS. RESULTS Among OSA patients, women were older, had higher body mass index, and lower AHI at the time of diagnosis, compared to men. Insomnia was more prevalent among patients with OSA (84%) than the reported 30% among general adult population. Sleep onset insomnia was reported more frequently by women (62%) than men (53%) (p = 0.03). Similarly self-reported psychophysiologic insomnia also showed a female preponderance (53% vs. 45%, p = 0.03). Caucasian women had the highest rate of self-reported sleep maintenance insomnia (80%). Hispanic women are more likely to complain of symptoms suggestive of psychophysiologic insomnia (58%). CONCLUSIONS There is a higher prevalence of insomnia in OSA patients. Ethnicity and gender possibly exhibit a complex and significant influence on the reported subtype of insomnia. Further larger studies may help confirm, as well as clarify, mechanisms that underlie the ethnic and gender differences that we have noted.
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Affiliation(s)
- Shyam Subramanian
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77025, USA.
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Affiliation(s)
- Amarbir Mattewal
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Lata Casturi
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Shyam Subramanian
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
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Mattewal A, Casturi L, Subramanian S. A child with REM sleep disturbance. J Clin Sleep Med 2010; 6:97-100. [PMID: 20191946 PMCID: PMC2823285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Amarbir Mattewal
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Lata Casturi
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Shyam Subramanian
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
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Bopparaju S, Casturi L, Guntupalli B, Surani S, Subramanian S. ANXIETY AND DEPRESSION IN OBSTRUCTIVE SLEEP APNEA: EFFECT OF CPAP THERAPY AND INFLUENCE ON CPAP COMPLIANCE. Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.71s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Subramanian S, Rao S, Majid H, Casturi L, Guntupalli B, Surani S. PREVALENCE AND GENDER AND ETHNIC VARIANCE OF BRUXISM AND GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN OBSTRUCTIVE SLEEP APNEA. Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.69s-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
BACKGROUND AND METHODS Sleepiness in medical residents has crucial implications for the safety of both patients and residents. Measures to improve this have primarily included an Accreditation Council for Graduate Medical Education-mandated reduction in work hours in residency programs. The impact of these work-hour limitations has not been consistent. The purpose of this study was to provide an objective assessment of daytime sleepiness in medical residents working in the medical ICU. Sleep times for 2 days/nights prior to on call and on the day/night of being on call were assessed by actigraphy and sleep diaries. On-call and post-call measurements of residents' sleepiness were measured both objectively, by means of a modified multiple sleep latency test (MSLT) [two nap sessions], as well as subjectively, by the Stanford Sleepiness Scale. RESULTS Our data showed that despite an average sleep time of 7.15 h on nights leading to being on call, the mean sleep latency (MSL) on the on-call day was (+/- SD) 9 +/- 4.4 min, and 4.8 +/- 4.1 min (p < 0.001) on the post-call day. On the post-call day, 14 residents (70%) had an MSL of < 5 min, suggesting severe sleepiness, compared to 6 residents (30%) on the on-call day. CONCLUSION Our results demonstrate that residents working in the ICU despite reductions in work hours demonstrate severe degree of sleepiness post-call.
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Affiliation(s)
- Raghu Reddy
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Kalpalatha Guntupalli
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Philip Alapat
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Salim Surani
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Lata Casturi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Shyam Subramanian
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX.
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Rebbapragada V, Subramanian S, Chanamolu S, Guntupalli K, Patel B, Casturi L, Mahaffey M. P466 Insomnia in obstructive sleep apnea: prevalence and gender and ethnic variance. Sleep Med 2006. [DOI: 10.1016/j.sleep.2006.07.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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