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Case
Summaries
Case
Study 1:
Do children suffer
from a sleep disorder? Yes, here is a case.
A young girl, 15
years old, student of class IX, studying in a boarding school, came to the
Department of Sleep Medicine at Sir Ganga Ram Hospital in April 2007 with
complaints of:
Her teachers
reported that she had difficulty in waking up for class, would sleep during
the classes and also after school hours. Often they found it difficult to wake
her up and had to call her parents. Her parents consulted many local doctors
but there was no improvement in her symptoms
A detailed
evaluation revealed that her sleep rhythm was completely disrupted. She had
delayed sleep onset by about 5-6 hours, and admitted to a feeling of
restlessness in her legs with an urge to move them at sleep onset. She used to
keep tossing and turning in bed, which slightly relieved her symptoms. She
felt tired throughout the day with increased sleepiness. She responded
positively for all the symptoms of Restless Legs Syndrome (children’s
criteria).
There was no family
history of RLS. Her investigations revealed very low levels of Iron and
Vitamin B12, she was given an Actigraph to wear around her ankle for 2 nights
that showed increased leg movements with delayed sleep onset.
She was given iron
and Vit B12 supplements and a dopamine agonist.
On follow up 2
months later she has had no further episodes of increased sleep and there is a
marked improvement in her school performance.
Thus it is essential
to make the right diagnosis, thereby give appropriate treatment.
Case
Study 2:
A 51 years old male,
presented with complaints of abnormal behaviour in sleep for 6 years, these
were accompanied with tongue bite and passage of urine in bed. He was given
treatment for epilepsy with no change in symptoms. He also had high blood
pressure for 6 year and diabetes for 10 years. On direct enquiry there is
history of snoring with excessive daytime sleepiness. Considering all the
above Obstructive Sleep Apnoea was considered and patient was advised An
overnight Sleep Study. This revealed severe Obstructive Sleep Apnoea for which
he has been advised to use CPAP & also lose weight. Representative traces
of sleep study are provided:
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