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Biomedical subjects

F Cirignotta

Publications and source records attributed to F Cirignotta.

At least 19 recordsLinked to original sources
PubMed2001

Unreliability of automatic scoring of MESAM 4 in assessing patients with complicated obstructive sleep apnea syndrome.

BACKGROUND: Portable devices are used for unattended recording of patients with suspected obstructive sleep apnea syndrome (OSAS). The MESAM 4 (MAP; Martinsried, Germany) is a computerized ambulatory polysomnographic system that records four parameters: breathing noise, heart rate, arterial oxygen saturation (SaO(2)), and body position. DESIGN AND METHOD: We evaluated the reliability of the oxygen desaturation index (ODI) automatically calculated by the MESAM 4 device in evaluating patients with "complicated" OSAS. These patients present SaO(2) drops due to apneas associated with a fall in baseline SaO(2) during sleep, as occurs in the "overlap syndrome." Ten patients with complicated OSAS underwent nocturnal MESAM 4 recordings, and we compared the visual and automatic scorings of the ODI. RESULTS: The ODI obtained with visual scoring was significantly higher than ODI automatically calculated by the MESAM 4 in all patients. In some patients, this difference was so significant that it could bias clinical judgment of OSAS severity. We demonstrated that the system did not identify those desaturation events that were superimposed on a fall in baseline SaO(2). The error depends on the algorithm by which the device recognizes the desaturation events and calculates the baseline SaO(2). CONCLUSION: Automatic analysis of MESAM 4 recordings may be misleading in evaluating OSAS patients who have a fall in baseline SaO(2) during sleep. In this case, visual scoring performed by a trained polysomnographer is recommended.

Adult↗
PubMed2000

Wernicke-korsakoff encephalopathy and polyneuropathy after gastroplasty for morbid obesity: report of a case.

BACKGROUND: Gastric partitioning is a surgical procedure for the treatment of morbid obesity that may engender neurological complications, such as Wernicke encephalopathy and polyneuropathy. SETTING: A specialist hospital. PATIENT: A 36-year-old woman developed Wernicke-Korsakoff encephalopathy and polyneuropathy 3 months after gastroplasty for morbid obesity. A magnetic resonance scan documented the diagnosis, and a clear improvement occurred after parenteral thiamine treatment. In our patient and in previously described cases of the literature, postsurgical vomiting is a constant finding that seems to be the precipitating factor of neurological complications of gastric partitioning. CONCLUSION: Persistent vomiting after gastroplasty for morbid obesity should be considered an alarming symptom to treat immediately with appropriate measures.

Adult↗
PubMed2000

Isolated sleep paralysis: a web survey.

Isolated Sleep Paralysis (SP) occurs at least once in a lifetime in 40-50% of normal subjects, while as a chronic complaint it is an uncommon and scarcely known disorder. A series of messages written by subjects who experienced at least one episode of SP, containing more or less detailed descriptions of this disorder, were collected from the Sleep Web site of the University of California in Los Angeles between January 1996 and July 1998. Two hundred and sixty-four messages fulfilling the International Classification of Sleep Disorders (ICSD) (Thorpy, 1990) minimal criteria for SP were analyzed. A wide spectrum of severity was evident, with a frequency of episodes ranging from one in a lifetime to almost every night, and a variety of emotional and hallucinatory experiences associated with SP episodes were reported. Clinical similarities between the recurrent form of isolated SP and channelopathies (in particular, periodic paralyses) are discussed. An activation of limbic system structures is suggested in order to explain some of the most common subjective experiences associated with SP.

Adolescent↗
PubMed1996

Central alveolar hypoventilation (Ondine's curse) treated with negative pressure ventilation.

A 22 year old woman with central alveolar hypoventilation (CAH) underwent repeated nocturnal polysomnographic recordings to assess the efficacy of negative pressure ventilation (NPV) administered by pneumowrap. The NPV successfully prevented hypoxia during most of the recording time; however, a sudden severe hypoxic episode not related to an apnoea occurred during a recording night with NPV. This made home use advisable together with an ear oximeter fitted with an alarm.

Adult↗
PubMed1994

Natural evolution of sleep apnoea syndrome: a five year longitudinal study.

We wanted to investigate the natural evolution of Obstructive Sleep Apnoea Syndrome (OSAS). We therefore followed 58 patients who refused any treatment at the time of diagnosis. Of the eligible patients 32 subjects enrolled in instrumental follow-up. The effects on daytime somnolence, daytime lung function and nocturnal respiratory disturbances were retrospectively evaluated by repeating Multiple Sleep Latency Test (MSLT), spirometry and polysomnography after a follow-up period of at least 5 years (5.7 +/- 0.2 SEM yrs). In the patient group as a whole the mean Apnoea+Hypopnoea Index (AHI), the mean low arterial oxygen saturation (Sao2) and the mean Body Mass Index (BMI) did not change over time. The only significant differences were the increase in mean duration of apnoeas (21.0 vs 23.5 s) and hypopneas (13.5 vs 16.3 s) and the decrease in AHI < 80% (13.3 vs 7.9). No correlations were found between the changes in AHI or mean low Sao2 and age, BMI, AHI, mean low Sao2, pulmonary function tests or arterial blood gases at baseline. No significant changes were observed in systemic blood pressure, pulmonary function tests, blood gases analysis or MSLT. "Improved" (n = 6) and "worsened" (n = 7) groups were defined by a reduction or increase in AHI over 35% of baseline value. At baseline the "worsened" group tended to have lower AHI and higher mean low Sao2 compared with the "improved" group. In the "worsened" group the BMI rose significantly from 26.0 to 29.2, AHI rose significantly from 14.1 to 51.3 and mean low Sao2 decreased from 92 to 90 (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Body Mass Index↗
PubMed1993

Paroxysmal periodic motor attacks during sleep: clinical and polygraphic features.

Three patients complained of paroxysmal motor attacks during sleep. Videopolygraphic recordings showed that motor activity could be divided into events of increasing behavioural complexity. Simpler motor events often represented the initial fragment of more complex attacks. Clinical features suggested the attacks represented frontal lobe epileptic seizures. The attacks recurred during NREM sleep with a periodic repetition every 20-60 sec. This periodicity could be related to the analogous physiological oscillation during light sleep and the periodicity of K complexes, exerting a facilitating influence upon epileptic mechanisms.

Adult↗
PubMed1993

Breathing disorders during sleep in chest wall diseases.

Chest wall deformity due to kyphoscoliosis may present with two altered breathing patterns during sleep; 1) progressive O2 desaturation particularly during REM sleep and 2) central apnoea also during REM sleep but rarely accompanied by O2 desaturation. No typical breathing pattern abnormality is seen in the rigid spine syndrome.

Adult↗
PubMed1992

Dystonic attacks related to sleep and exercise.

Two unrelated children displayed attacks of paroxysmal jerky 'puppet-like' movements lasting 2-3 min. The attacks were not kinesigenic and occurred during wakefulness precipitated by physical exercise and during NREM sleep, spontaneous or upon arousal and awakenings. Paroxysmal dystonic choreoathetosis was excluded by the absent family history, and paroxysmal kinesigenic dystonia by the absence of triggering effects by sudden movements and efficacy of anticonvulsants. Pattern and duration of involuntary movements were not those typical of nocturnal paroxysmal dystonia. Our cases emphasize that overlap exists among the different clinical categories of paroxysmal dyskinesia.

Arousal↗
PubMed1991

Atrial natriuretic peptide and catecholamines in obstructive sleep apnea syndrome.

Nocturnal polyuria with repeated micturitions during the night is a clinically evident feature of obstructive sleep apnea syndrome (OSAS). These effects are reversed by continuous positive airway pressure (CPAP). There is some evidence that atrial natriuretic peptide (ANP) and catecholaminergic activity may be implicated in the pathogenesis of these symptoms. We studied these biochemical parameters in six patients with severe OSAS during two nights: the first (basal) in their normal conditions and the second during CPAP treatment. CPAP treatment reversed apnea episodes in all our patients. A significant (p less than 0.035) reduction of nocturnal urine volume (from 902 +/- 297 to 447 +/- 130 ml; mean +/- SD), sodium excretion (from 150 +/- 33 to 89 +/- 35 mEq/12 h), noradrenaline excretion (from 95 +/- 101 to 52 +/- 16 micrograms/g creatinine), noradrenaline plasma concentrations (from 325 +/- 96 to 259 +/- 75 pg/ml), ANP plasma concentrations (from 35 +/- 20 to 19 +/- 5 pg/ml) was observed during the night under CPAP application. These data suggest that in OSAS patients the high ANP plasma concentration is responsible for the observed elevated diuresis and sodium excretion. These effects are rapidly reversible, as they are reversed during the first CPAP treated night.

Adult↗
PubMed1991

HLA complement markers in Italian narcoleptic patients with special emphasis on BfF subtyping.

Thirty narcoleptic patients (29 out of 30 of Mediterranean origin) were studied for HLA polymorphisms (only 24 were investigated for HLA class III). We found that these patients are characterized by DR2, DQW2 phenotype (p less than 0.0001) as those of Anglo-Saxon origin so far studied and by the complotype: BfS, C4A3, C4B1. Just 1 of 7 BfF patients has the Fb subtype detected by isoelectric focusing technique (p = 0.007). The only patient of Black origin (his mother is Eritrean) is completely different from other patients (DR3,5; DQW2,W3; C4A4,4; C4B1,2), supporting the hypothesis that it is not the DR2, DQW1 phenotype per se involved in this syndrome. Subdividing the subjects according to different clinical features, we cannot demonstrate genetic heterogeneity.

Adolescent↗
PubMed1990

Breathing disorders in males with acquired encephalopathy.

Six boys affected by acquired encephalopathy with an abnormal breathing pattern in wakefulness were studied. Polygraphic recordings showed two different patterns in our population. In two brothers a periodic breathing pattern was recorded in the awake and sleep states. In the others, central apneas with or without tachypnea and O2 desaturation were observed only during wakefulness. The analogy of these patterns with those of genetic syndromes such as familial encephalopathy and the Rett syndrome led us to postulate the aspecificity of this finding and the importance of further studies to elucidate the role of impaired behavioural and automatic breathing system control.

Apnea↗
PubMed1990

Restless legs syndrome and nocturnal myoclonus: initial clinical manifestation of familial amyloid polyneuropathy.

Restless legs syndrome was the first isolated clinical manifestation in four siblings of a family with familial amyloid polyneuropathy. Clinical and electrophysiological evidence of peripheral neuropathy appeared after a variable time interval. Polysomnography showed abnormal sleep patterns and nocturnal myoclonus in all patients. The restless legs syndrome responded favourably to clonazepam.

Aged↗
PubMed1990

Paroxysmal arousals during sleep.

Six patients complained of distressing sudden awakenings with abnormal motor activity during sleep causing insomnia. Polysomnography showed paroxysmal short-lasting arousals during NREM, especially slow-wave sleep, associated with complex movements and autonomic activation. Ictal and interictal EEG never showed epileptic discharges except in 1 patient who also had a tonic-clonic seizure during sleep. Carbamazepine was the only effective medication in 2 patients. Paroxysmal arousals represent a sleep disturbance that may be related to deep epileptic foci.

Adult↗