Spotlight on Neurostimulation in sleep medicine

Sleep ventilatory disorders are prevalent and include, commonly, both obstructive and central sleep apnea. Positive airway pressure therapy, although widely used, has inherent drawbacks, clinically. Alternative treatment modalities have been approved and hold interest within certain spheres.

Dr. Richard Knudsen of the Pacific Sleep Tech in Aiea, Hawaii reviews the first-in-class, novel “electroceuticals” in this article. These “electroceuticals” rely on the pathway of neural signal modulation via products that regulate the firing of neural circuits, in contradistinction to prescription drugs or pharmaceuticals that harbor untoward, systemic, and generalized side effects.

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Spotlight on Central sleep apnea

Central apnea is absence of airflow and ventilatory effort lasting 10 or more seconds during sleep. A central apnea index during an overnight polysomnography of 5 or more per hour of sleep is considered abnormal. A diagnosis of central sleep apnea is made when the apnea hypopnea index (AHI) is at least 5 with central apneas constituting 50% or more of the respiratory events. Central sleep apnea may occur in the setting of underlying hypo- or hyperventilation (ie, low-normal or elevated resting, awake partial pressure of arterial CO2). The International Classification of Sleep Disorders (ICSD-3rd edition) identifies 7 forms of central sleep apnea syndrome (CSAS):

  1. Primary central sleep apnea
  2. Central sleep apnea with Cheyne-Stokes breathing pattern
  3. Central sleep apnea due to medical condition without Cheyne-Stokes
  4. Central sleep apnea due to high-altitude periodic breathing
  5. Central sleep apnea due to a medication or substance
  6. Primary sleep apnea of infancy
  7. Primary sleep apnea of prematurity.

In this article, Dr. Antonio Culebras of SUNY Upstate Medical University presents the mechanisms, clinical scenarios, and treatment options for central sleep apnea.

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