AASM Membership Sections Newsletter Issue #3
26
American Academy
of Sleep Medicine
duration was 164 minutes (41% of total sleep time). He
had 68 minutes slow-wave sleep (17% of total sleep time).
There were 10 apneas (mean duration: 16 seconds; longest
38
seconds.) Additionally, he had 18 obstructive hypopneas
lasting 28 to about 48 seconds. He had two central apneas.
His overall AHI was 5.9 events per hour (supine AHI: 7.1/
hour and REM AHI: 6.6/hour). Oxygen saturation nadir
was 92%. There were 3 brief arousals during N2 sleep.
There was no observed somnambulism, seizure activities
or any vocalization. There were two episodes of increased
chin EMG during REM sleep that did not correspond to
arousals in N2 sleep.
What is your primary differential diagnosis?
1.
Sleep Terrors
2.
Sleep-Disordered Breathing related arousals
3.
Somnambulism
4.
REM Sleep Behavior Disorder
5.
Seizure Activity
6.
Fugue State
What will be your immediate management?
1.
Initiate CPAP device
2.
Drug screen
3.
MRI of brain/EEG
4.
Report to Federal Aviation Agency
5.
Treat with benzodiazepine
6.
Assess safety of bed partner and weapons’ location
Movement
REM
Stage 4
Stage 3
Stage 2
Stage 1
Wake
00:00
01:00
02:00
03:00
04:00
05:00
06:00
STAGING
Case Report continued