A chapter in a book: "Teaching Pearls in Noninvasive Mechanical Ventilation", 2022
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Over the years... more Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Over the years, extensive research has fostered a better understanding of its pathogenesis and defining its different phenotypes; nevertheless, positive airway pressure (PAP) therapy has remained as the ‘gold standard’ treatment option. Perceptibly, PAP therapy is fraught with challenges and, at times, undesired side effects. All these therapeutic pitfalls not only determine the outcome but also have a close correlation with patient compliance. Treatment-emergent central sleep apnea (TECSA) (complex apnea) is one of such challenges that need to be prognosticated in high-risk patients, and cautiously managed, whenever it does not follow the common course of gradual remission over time.
Purpose of review Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA... more Purpose of review Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA, in which obstructive events occur primarily during REM sleep. This review discusses REM-OSA definitions, its cardiometabolic correlates, associated comorbidities and treatment, and addresses diagnostic ambiguities and therapeutic pitfalls. Recent findings Current evidence indicates that REM-OSA is prevalent among younger age groups and women and is independently associated with cardiometabolic complications, particularly hypertension, metabolic complications such as insulin resistance and metabolic syndrome. However, currently, there is no consensus on the accepted diagnostic criteria for REM-OSA. Available data suggest that adherence to positive airway pressure (PAP) therapy in patients with REM-OSA is suboptimal. Moreover, the currently accepted criteria for good adherence to PAP therapy of 4 h/night, 70% of the days may not be suitable for REM-OSA, as it will not cover most of the REM sleep periods. In addition, further research is needed to assess the impact of REM-OSA treatment on cardiometabolic outcomes. Summary Patients with REM-OSA are at an increased risk of cardiometabolic complications. A high index of suspicion is needed to diagnose this disorder, and close follow-up is required to enhance adherence to therapy.
Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of s... more Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of sudden loud noise or a sense of explosion in the head that usually occurs at sleep onset. This is a report of six patients diagnosed with EHS through a structured clinical interview and video-polysomnography (vPSG) recordings. We also reviewed the available literature that addressed the presentation and clinical and PSG characteristics of EHS. The case series included four men and two women of a mean age of 44.2 years (between 13 and 77 years). Their episodes were variable in expression, between a sudden firecracker-like explosion to a gun-shot sound, mostly as if happening inside the head. It is always associated with distress but never pain. Five out of six patients had other sleep-related problems with a close relationship of EHS symptoms to comorbid sleep disorder manifestations and exacerbations. The vPSG of five patients were unremarkable. An attack was documented in one patient arising in stage N2. Three patients responded well to reassurance and treatment for the comorbid sleep disorder. The other three patients responded well to amitriptyline (10-50 mg). EHS is a well-characterized under-recognized hypnic parasomnia with a benign course. Amitriptyline seems to be effective in persistent cases.
Background The purpose of the paper was to describe cases of abnormal sexual behavior during slee... more Background The purpose of the paper was to describe cases of abnormal sexual behavior during sleep in Saudi Arabian patients and classify them under the pertinent subtype. Methods Patients diagnosed with abnormal sexual behavior during sleep received a clinical interview and underwent video-polysomnography recordings at the University Sleep Disorders Center, King Saud University Medical City, Riyadh. Results Three men and one woman between 27 and 46 years of age reported abnormal sexual behaviors during sleep, with duration of symptoms ranging from 4 months to 3 years. Episodes consisted of masturbation without seeking the participation of a sleeping partner (case no. 1), attempts at sexual intercourse with inappropriate and uncharacteristic vocalizations and behaviors (cases no. 2 and 3), and rapid eye movement (REM) behavior disorder (RBD) presenting with abnormal sexual behavior (case no. 4). The frequency of the episodes ranged from 1-3 per week to 2-3 per night. Cases 1, 2, and 3 were amnestic of these events and expressed surprise to their partners' account of their behavior. However, case no. 4 had a full recall of the event. Conclusions Sexsomnia (a non-REM parasomnia) is characterized by abnormal sexual behavior during sleep ranging from masturbation to inappropriate attempts at achieving sexual intercourse followed by total amnesia of the event. Nevertheless, REM behavioral disorder can, at times, present as abnormal sexual behavior during sleep, like sexual dream enactments, which may mimic sexsomnia. Therefore, the condition warrants diagnostic consideration as abnormal sleep-related sexual behavior.
Teaching Pearls in Noninvasive Mechanical Ventilation, 2022
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Over the years... more Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Over the years, extensive research has fostered a better understanding of its pathogenesis and defining its different phenotypes; nevertheless, positive airway pressure (PAP) therapy has remained as the ‘gold standard’ treatment option. Perceptibly, PAP therapy is fraught with challenges and, at times, undesired side effects. All these therapeutic pitfalls not only determine the outcome but also have a close correlation with patient compliance. Treatment-emergent central sleep apnea (TECSA) (complex apnea) is one of such challenges that need to be prognosticated in high-risk patients, and cautiously managed, whenever it does not follow the common course of gradual remission over time.
The emergence of COVID-19 brought all healthcare services around the globe to immense strain; hos... more The emergence of COVID-19 brought all healthcare services around the globe to immense strain; hospitals abandoned elective care for acute care. Like all other elective services, sleep medicine services suffered a partial deadlock due to the closing down of the sleep disorders diagnostic and therapeutic services, although clinical consultations and follow-ups, carried on remotely, allowed some mitigation. Since there is dire need to resume the services, we tried to formulate the principles and guidelines to work in this exigent healthcare setting. Principles and guidelines are based on epidemiological and infection control guidelines besides recommendations of various healthcare organizations and sleep societies, after a requisite web search to extract the data.
Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of s... more Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of sudden loud noise or a sense of explosion in the head that usually occurs at sleep onset. This paper is a report of 6 patients diagnosed with EHS through a structured clinical interview and video-polysomnography (vPSG) recordings. We also reviewed the available literature that addressed the presentation and clinical and PSG characteristics of EHS. The case series included 4 men and 2 women of a mean age of 44.2 years (between 13 and 77 years). Their episodes were variable in expression, between a sudden firecracker-like explosion to a gun-shot sound, mostly as if happening inside the head. EHS is always associated with distress but never with pain. Five out of 6 patients had other sleep-related problems with a close relationship of EHS symptoms to comorbid sleep disorder manifestations and exacerbations. The vPSG recordings of 5 patients were unremarkable. An attack of EHS was documented ...
With the advent of COVID-19 infection and its rapid spread, preventive strategies are being devel... more With the advent of COVID-19 infection and its rapid spread, preventive strategies are being developed worldwide, besides following the universal infection control guidelines. Prevention of spread through aerosol generation is one of the essential strategies in this regard, particularly for patients with sleep-disordered breathing at home and during hospital admission. Aerosols are produced, at home and in health care facilities, by natural processes and aerosol-generating procedures. To address this impinging problem, aerosol-generating procedures, like non-invasive ventilation (NIV), are to be handled meticulously, which might warrant isolation and sometimes device/interface modifications.
BackgroundThe purpose of the paper was to describe cases of abnormal sexual behavior during sleep... more BackgroundThe purpose of the paper was to describe cases of abnormal sexual behavior during sleep in Saudi Arabian patients and classify them under the pertinent subtype.MethodsPatients diagnosed with abnormal sexual behavior during sleep received a clinical interview and underwent video-polysomnography recordings at the University Sleep Disorders Center, King Saud University Medical City, Riyadh.ResultsThree men and one woman between 27 and 46 years of age reported abnormal sexual behaviors during sleep, with duration of symptoms ranging from 4 months to 3 years. Episodes consisted of masturbation without seeking the participation of a sleeping partner (case no. 1), attempts at sexual intercourse with inappropriate and uncharacteristic vocalizations and behaviors (cases no. 2 and 3), and rapid eye movement (REM) behavior disorder (RBD) presenting with abnormal sexual behavior (case no. 4). The frequency of the episodes ranged from 1–3 per week to 2–3 per night. Cases 1, 2, and 3 were amnestic of these events and expressed surprise to their partners’ account of their behavior. However, case no. 4 had a full recall of the event.ConclusionsSexsomnia (a non-REM parasomnia) is characterized by abnormal sexual behavior during sleep ranging from masturbation to inappropriate attempts at achieving sexual intercourse followed by total amnesia of the event. Nevertheless, REM behavioral disorder can, at times, present as abnormal sexual behavior during sleep, like sexual dream enactments, which may mimic sexsomnia. Therefore, the condition warrants diagnostic consideration as abnormal sleep-related sexual behavior.
We propose a novel principle of operating heat machines in a fully unitary (coherent) fashion by ... more We propose a novel principle of operating heat machines in a fully unitary (coherent) fashion by mixing few hot and cold thermal field modes in nonlinear interferometers. Such devices, specifically, interferometers containing Kerr-nonlinear intermode cross-couplers, are shown to enable autonomous concentration of the energy predominantly in a desired output mode, at the expense of the other modes. Their phase-coherent operation is reversible and it is approximately reversible even if intermode entanglement is neglected. Such few-mode coherent heat machines radically depart from the existing thermodynamic paradigm which treats heat machines as open systems dissipated by heat baths.
M little adjustments to meet tangible demands is often a pleasant experience. However, radical ch... more M little adjustments to meet tangible demands is often a pleasant experience. However, radical changes in daily routine are almost always fraught with harmful outcomes and often long‐term adverse sequelae. Sleep and circadian clock/ rhythm are some such biological processes that are sensitive changes. There is growing evidence to support the idea of maintaining a regular sleep/wake pattern and circadian rhythm synchrony to keep a healthy body and mind.[1] Fiddling with the biological clock due to any social or socioeconomic reason results in deleterious physiological and metabolic effects.[1] “Daylight saving time” (DST) and its close cohort “Delaying the starting times of school and office/work during Ramadhan” are the two adopted protocols that fall into this category. DST has been in debate for decades, and we need to put its cohort (Ramadan month sleep pattern) in the same seat.
With the advent of COVID -19 infection and its rapid spread, preventive strategies are being deve... more With the advent of COVID -19 infection and its rapid spread, preventive strategies are being developed worldwide, besides following the universal infection control guidelines. Prevention of spread through aerosol generation is one of the essential strategies in this regard, particularly for patients with sleep-disordered breathing at home and during hospital admission. Aerosols are produced, at home and in health care facilities, by natural processes and aerosol-generating procedures. To address this impinging problem, aerosol-generating procedures, like non-invasive ventilation (NIV), are to be handled meticulously, which might warrant isolation and sometimes device/interface modifications.
A chapter in a book: "Teaching Pearls in Noninvasive Mechanical Ventilation", 2022
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Over the years... more Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Over the years, extensive research has fostered a better understanding of its pathogenesis and defining its different phenotypes; nevertheless, positive airway pressure (PAP) therapy has remained as the ‘gold standard’ treatment option. Perceptibly, PAP therapy is fraught with challenges and, at times, undesired side effects. All these therapeutic pitfalls not only determine the outcome but also have a close correlation with patient compliance. Treatment-emergent central sleep apnea (TECSA) (complex apnea) is one of such challenges that need to be prognosticated in high-risk patients, and cautiously managed, whenever it does not follow the common course of gradual remission over time.
Purpose of review Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA... more Purpose of review Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA, in which obstructive events occur primarily during REM sleep. This review discusses REM-OSA definitions, its cardiometabolic correlates, associated comorbidities and treatment, and addresses diagnostic ambiguities and therapeutic pitfalls. Recent findings Current evidence indicates that REM-OSA is prevalent among younger age groups and women and is independently associated with cardiometabolic complications, particularly hypertension, metabolic complications such as insulin resistance and metabolic syndrome. However, currently, there is no consensus on the accepted diagnostic criteria for REM-OSA. Available data suggest that adherence to positive airway pressure (PAP) therapy in patients with REM-OSA is suboptimal. Moreover, the currently accepted criteria for good adherence to PAP therapy of 4 h/night, 70% of the days may not be suitable for REM-OSA, as it will not cover most of the REM sleep periods. In addition, further research is needed to assess the impact of REM-OSA treatment on cardiometabolic outcomes. Summary Patients with REM-OSA are at an increased risk of cardiometabolic complications. A high index of suspicion is needed to diagnose this disorder, and close follow-up is required to enhance adherence to therapy.
Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of s... more Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of sudden loud noise or a sense of explosion in the head that usually occurs at sleep onset. This is a report of six patients diagnosed with EHS through a structured clinical interview and video-polysomnography (vPSG) recordings. We also reviewed the available literature that addressed the presentation and clinical and PSG characteristics of EHS. The case series included four men and two women of a mean age of 44.2 years (between 13 and 77 years). Their episodes were variable in expression, between a sudden firecracker-like explosion to a gun-shot sound, mostly as if happening inside the head. It is always associated with distress but never pain. Five out of six patients had other sleep-related problems with a close relationship of EHS symptoms to comorbid sleep disorder manifestations and exacerbations. The vPSG of five patients were unremarkable. An attack was documented in one patient arising in stage N2. Three patients responded well to reassurance and treatment for the comorbid sleep disorder. The other three patients responded well to amitriptyline (10-50 mg). EHS is a well-characterized under-recognized hypnic parasomnia with a benign course. Amitriptyline seems to be effective in persistent cases.
Background The purpose of the paper was to describe cases of abnormal sexual behavior during slee... more Background The purpose of the paper was to describe cases of abnormal sexual behavior during sleep in Saudi Arabian patients and classify them under the pertinent subtype. Methods Patients diagnosed with abnormal sexual behavior during sleep received a clinical interview and underwent video-polysomnography recordings at the University Sleep Disorders Center, King Saud University Medical City, Riyadh. Results Three men and one woman between 27 and 46 years of age reported abnormal sexual behaviors during sleep, with duration of symptoms ranging from 4 months to 3 years. Episodes consisted of masturbation without seeking the participation of a sleeping partner (case no. 1), attempts at sexual intercourse with inappropriate and uncharacteristic vocalizations and behaviors (cases no. 2 and 3), and rapid eye movement (REM) behavior disorder (RBD) presenting with abnormal sexual behavior (case no. 4). The frequency of the episodes ranged from 1-3 per week to 2-3 per night. Cases 1, 2, and 3 were amnestic of these events and expressed surprise to their partners' account of their behavior. However, case no. 4 had a full recall of the event. Conclusions Sexsomnia (a non-REM parasomnia) is characterized by abnormal sexual behavior during sleep ranging from masturbation to inappropriate attempts at achieving sexual intercourse followed by total amnesia of the event. Nevertheless, REM behavioral disorder can, at times, present as abnormal sexual behavior during sleep, like sexual dream enactments, which may mimic sexsomnia. Therefore, the condition warrants diagnostic consideration as abnormal sleep-related sexual behavior.
Teaching Pearls in Noninvasive Mechanical Ventilation, 2022
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Over the years... more Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Over the years, extensive research has fostered a better understanding of its pathogenesis and defining its different phenotypes; nevertheless, positive airway pressure (PAP) therapy has remained as the ‘gold standard’ treatment option. Perceptibly, PAP therapy is fraught with challenges and, at times, undesired side effects. All these therapeutic pitfalls not only determine the outcome but also have a close correlation with patient compliance. Treatment-emergent central sleep apnea (TECSA) (complex apnea) is one of such challenges that need to be prognosticated in high-risk patients, and cautiously managed, whenever it does not follow the common course of gradual remission over time.
The emergence of COVID-19 brought all healthcare services around the globe to immense strain; hos... more The emergence of COVID-19 brought all healthcare services around the globe to immense strain; hospitals abandoned elective care for acute care. Like all other elective services, sleep medicine services suffered a partial deadlock due to the closing down of the sleep disorders diagnostic and therapeutic services, although clinical consultations and follow-ups, carried on remotely, allowed some mitigation. Since there is dire need to resume the services, we tried to formulate the principles and guidelines to work in this exigent healthcare setting. Principles and guidelines are based on epidemiological and infection control guidelines besides recommendations of various healthcare organizations and sleep societies, after a requisite web search to extract the data.
Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of s... more Exploding head syndrome (EHS) is an under-recognized parasomnia characterized by a complaint of sudden loud noise or a sense of explosion in the head that usually occurs at sleep onset. This paper is a report of 6 patients diagnosed with EHS through a structured clinical interview and video-polysomnography (vPSG) recordings. We also reviewed the available literature that addressed the presentation and clinical and PSG characteristics of EHS. The case series included 4 men and 2 women of a mean age of 44.2 years (between 13 and 77 years). Their episodes were variable in expression, between a sudden firecracker-like explosion to a gun-shot sound, mostly as if happening inside the head. EHS is always associated with distress but never with pain. Five out of 6 patients had other sleep-related problems with a close relationship of EHS symptoms to comorbid sleep disorder manifestations and exacerbations. The vPSG recordings of 5 patients were unremarkable. An attack of EHS was documented ...
With the advent of COVID-19 infection and its rapid spread, preventive strategies are being devel... more With the advent of COVID-19 infection and its rapid spread, preventive strategies are being developed worldwide, besides following the universal infection control guidelines. Prevention of spread through aerosol generation is one of the essential strategies in this regard, particularly for patients with sleep-disordered breathing at home and during hospital admission. Aerosols are produced, at home and in health care facilities, by natural processes and aerosol-generating procedures. To address this impinging problem, aerosol-generating procedures, like non-invasive ventilation (NIV), are to be handled meticulously, which might warrant isolation and sometimes device/interface modifications.
BackgroundThe purpose of the paper was to describe cases of abnormal sexual behavior during sleep... more BackgroundThe purpose of the paper was to describe cases of abnormal sexual behavior during sleep in Saudi Arabian patients and classify them under the pertinent subtype.MethodsPatients diagnosed with abnormal sexual behavior during sleep received a clinical interview and underwent video-polysomnography recordings at the University Sleep Disorders Center, King Saud University Medical City, Riyadh.ResultsThree men and one woman between 27 and 46 years of age reported abnormal sexual behaviors during sleep, with duration of symptoms ranging from 4 months to 3 years. Episodes consisted of masturbation without seeking the participation of a sleeping partner (case no. 1), attempts at sexual intercourse with inappropriate and uncharacteristic vocalizations and behaviors (cases no. 2 and 3), and rapid eye movement (REM) behavior disorder (RBD) presenting with abnormal sexual behavior (case no. 4). The frequency of the episodes ranged from 1–3 per week to 2–3 per night. Cases 1, 2, and 3 were amnestic of these events and expressed surprise to their partners’ account of their behavior. However, case no. 4 had a full recall of the event.ConclusionsSexsomnia (a non-REM parasomnia) is characterized by abnormal sexual behavior during sleep ranging from masturbation to inappropriate attempts at achieving sexual intercourse followed by total amnesia of the event. Nevertheless, REM behavioral disorder can, at times, present as abnormal sexual behavior during sleep, like sexual dream enactments, which may mimic sexsomnia. Therefore, the condition warrants diagnostic consideration as abnormal sleep-related sexual behavior.
We propose a novel principle of operating heat machines in a fully unitary (coherent) fashion by ... more We propose a novel principle of operating heat machines in a fully unitary (coherent) fashion by mixing few hot and cold thermal field modes in nonlinear interferometers. Such devices, specifically, interferometers containing Kerr-nonlinear intermode cross-couplers, are shown to enable autonomous concentration of the energy predominantly in a desired output mode, at the expense of the other modes. Their phase-coherent operation is reversible and it is approximately reversible even if intermode entanglement is neglected. Such few-mode coherent heat machines radically depart from the existing thermodynamic paradigm which treats heat machines as open systems dissipated by heat baths.
M little adjustments to meet tangible demands is often a pleasant experience. However, radical ch... more M little adjustments to meet tangible demands is often a pleasant experience. However, radical changes in daily routine are almost always fraught with harmful outcomes and often long‐term adverse sequelae. Sleep and circadian clock/ rhythm are some such biological processes that are sensitive changes. There is growing evidence to support the idea of maintaining a regular sleep/wake pattern and circadian rhythm synchrony to keep a healthy body and mind.[1] Fiddling with the biological clock due to any social or socioeconomic reason results in deleterious physiological and metabolic effects.[1] “Daylight saving time” (DST) and its close cohort “Delaying the starting times of school and office/work during Ramadhan” are the two adopted protocols that fall into this category. DST has been in debate for decades, and we need to put its cohort (Ramadan month sleep pattern) in the same seat.
With the advent of COVID -19 infection and its rapid spread, preventive strategies are being deve... more With the advent of COVID -19 infection and its rapid spread, preventive strategies are being developed worldwide, besides following the universal infection control guidelines. Prevention of spread through aerosol generation is one of the essential strategies in this regard, particularly for patients with sleep-disordered breathing at home and during hospital admission. Aerosols are produced, at home and in health care facilities, by natural processes and aerosol-generating procedures. To address this impinging problem, aerosol-generating procedures, like non-invasive ventilation (NIV), are to be handled meticulously, which might warrant isolation and sometimes device/interface modifications.
Uploads
bahammam by Rouf Pirzada
This is a report of six patients diagnosed with EHS through a structured clinical interview and video-polysomnography (vPSG) recordings. We also reviewed the available literature that addressed the presentation and clinical and PSG characteristics of EHS.
The case series included four men and two women of a mean age of 44.2 years (between 13 and 77 years). Their episodes were variable in expression, between a sudden firecracker-like explosion to a gun-shot sound, mostly as if happening inside the head. It is always associated with distress but never pain. Five out of six patients had other sleep-related problems with a close relationship of EHS symptoms to comorbid sleep disorder manifestations and exacerbations. The vPSG of five patients were unremarkable. An attack was documented in one patient arising in stage N2. Three patients responded well to reassurance and treatment for the comorbid sleep disorder. The other three patients responded well to amitriptyline (10-50 mg).
EHS is a well-characterized under-recognized hypnic parasomnia with a benign course. Amitriptyline seems to be effective in persistent cases.
Papers by Rouf Pirzada
This is a report of six patients diagnosed with EHS through a structured clinical interview and video-polysomnography (vPSG) recordings. We also reviewed the available literature that addressed the presentation and clinical and PSG characteristics of EHS.
The case series included four men and two women of a mean age of 44.2 years (between 13 and 77 years). Their episodes were variable in expression, between a sudden firecracker-like explosion to a gun-shot sound, mostly as if happening inside the head. It is always associated with distress but never pain. Five out of six patients had other sleep-related problems with a close relationship of EHS symptoms to comorbid sleep disorder manifestations and exacerbations. The vPSG of five patients were unremarkable. An attack was documented in one patient arising in stage N2. Three patients responded well to reassurance and treatment for the comorbid sleep disorder. The other three patients responded well to amitriptyline (10-50 mg).
EHS is a well-characterized under-recognized hypnic parasomnia with a benign course. Amitriptyline seems to be effective in persistent cases.