Showing papers by "Ching Li Chai-Coetzer published in 2014"

Ambulatory management strategies for obstructive sleep apnea.

Abstract: The prevalence of obstructive sleep apnea (OSA) has been steadily rising over recent decades and patient access to laboratory-based sleep services and specialist consultations have become increasingly limited, resulting in potential delays in treatment. As a result, there has been growing interest in the use of non-sleep laboratory methods for diagnosing and managing OSA, including the use of screening questionnaires, portable sleep monitoring devices, and home autotitrating continuous positive airway pressure. There is also evidence in support of a role for alternative health care professionals, such as sleep-trained nurses and primary care physicians in the diagnosis and treatment of OSA. In this review, we compare the different types of home monitoring devices, discuss the limitations of portable monitoring compared with full laboratory polysomnography, and summarize the results from published comparative effectiveness studies which have evaluated ambulatory models of care for the management of OSA. We also consider how future models of care that may be needed to deal with the burden of disease will evolve and some of the issues that prevent the translation of such models of care in many countries.

Rapid eye movement behaviour disorder

Abstract: A 70-year-old man was referred to a specialist sleep service in December 2010 by his general practitioner at the prompting of his wife. He reported a 7–8-year history of near-nightly, increasingly severe sleep disturbance with vivid dreams which would occur in the latter half of the night. Bedclothes were often found strewn around the room, and he would wake in unusual positions. The dreams usually related to being chased or attacked, and the patient could recall them in great detail. While asleep, the patient frequently shouted in response to the dreams. Violent motor responses to the dreams were also common — the patient had kicked, punched and attempted to choke his wife while asleep, he had fallen out of bed, and he had leapt into wardrobes and onto bedside tables. The patient and his wife had suff ered injuries. He had surrounded his bed with mattresses to prevent further injury, and had taken to restraining himself to the frame of his bed with two belts strapped fi rmly around his waist and chest. He reported being aware of the violent behaviour. His wife had moved into a separate bedroom for her own safety.