The sleep architecture of Saudi Arabian patients with Kleine-Levin syndrome

OBJECTIVES

To establish baseline sleep architecture during an acute attack of Kleine-Levin syndrome (KLS) in a cohort of Saudi Arabian KLS patients and compare these characteristics with other published cohorts. Methods: This was a retrospective cohort study of the polysomnographic characteristics of 10 typical symptomatic Saudi Arabian KLS patients attending the University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia between 2002 and 2015. Data were captured by nocturnal polysomnography during an acute attack of hypersomnia and compared with other published cohorts identified via a systematic literature search.  Results: Self-reported time asleep during episodes (11.1±6.7 hours) and recorded total sleep time (TST) (322.5±108.7 minutes) were generally shorter than other published cohorts. Sleep efficiency was poor at 75.0%±25.1%, with low relative amounts of rapid eye movement (REM) sleep (16.5±5.9% of TST) and deep non-REM sleep (stage N3; 10.5±6.0% of TST) and high relative amounts of non-REM sleep (stage N1; 7.0±4.3% of TST). The sleep architecture of Saudi Arabian KLS patients was similar to other published cohorts.  Conclusions: Sleep architecture of our cohort was relatively normal and broadly similar to other published studies, the main features being low sleep efficiency and low relative amounts of REM and stage N3 sleep. Time-course polysomnography studies with functional imaging may be useful to further establish the exact pathophysiology of this disease.

Long-term adherence to continuous positive airway pressure in patients with rapid eye movement-only obstructive sleep apnea: a prospective cohort study

Background

Obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep is a special form of OSA that occurs predominantly during REM sleep. No study has assessed the long-term adherence to continuous positive airway pressure (CPAP) among patients with REM-only OSA. To objectively assess the long-term adherence to CPAP therapy among patients with REM-predominant (REM-only) OSA.

Methods

This was a prospective observational cohort study that included consecutive patients who were diagnosed with OSA. Patients were divided into the following two groups: (I) REM-only OSA [an apnea hypopnea index (AHI) of ≥5, with a REM-AHI/NREM-AHI of >2, an NREM-AHI of <15, and a minimum of 15 min of REM-sleep duration], and (II) non-stage specific OSA. Follow-up was performed at 1, 6 and 12 months after the initiation of CPAP-therapy.

Results

The study included 175 patients; 30 met the criteria for REM-only OSA, and the remaining patients constituted the non-stage specific OSA group. The number of hours of CPAP use per day was significantly lower in the REM-only OSA group at 1, 6 and 12 months compared to the non-stage specific OSA group. At 12 months, the number of hours used per day was 3.8±1.8 and 5.1±2.1 hours in the REM-only and non-stage specific OSA groups, respectively (P=0.003). Approximately 80% of the enrolled participants in both groups were still using CPAP at the end of the study; 23.3% of REM-only OSA patients met the criteria for good adherence (>4 hours/day), and 56.7% met the criteria for partial adherence.

Conclusions

CPAP adherence is lower among patients with REM-only OSA compared to patients with non-stage specific OSA.

Comparison of the efficacy, safety and cost of cefixime, ceftriaxone and aztreonam in the treatment of multidrug-resistant Salmonella typhi septicemia in children

An increase in the incidence of Salmonella typhi strains resistant to chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole causing enteric fever in Egyptian children stimulated the evaluation of alternative drugs. Children with positive blood cultures were treated with cefixime, ceftriaxone or aztreonam, and the efficacy, safety and cost of these regimens were evaluated and compared. Cefixime (7.5 mg/kg) was given orally twice daily to 50 children for 14 days, ceftriaxone (50 to 70 mg/kg) was given im once daily for 5 days to 43 children and aztreonam (50 to 70 mg/kg) was given im every 8 hours for 7 days to 31 children. Children in the 3 groups were comparable with regard to age, sex, duration and severity of illness before admission. All children were cured. A significant difference (P < 0.05) in duration of treatment before becoming afebrile seemed to favor ceftriaxone (3.9 days) over aztreonam (5.5 days) and cefixime (5.3 days). During the 4-week follow-up period relapses occurred in 3 (6%) children in the cefixime group, in 2 (5%) in the ceftriaxone group and in 2 (6%) in the aztreonam group. Safety and efficacy were comparable for all 3 drugs. Ceftriaxone was most cost-effective on an inpatient basis, because of a more rapid clinical cure, and cefixime was the most cost-effective on an outpatient basis, because of drug cost.