Editors' note: Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring

Abstract

In the article “Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring”, Sivathamboo et al. reported moderate to severe sleep-disordered breathing (SDB, defined by an Apnea-Hypopnea Index ≥15) in 26.5% of 370 consecutive patients with epilepsy and/or psychogenic nonepileptic seizures (PNES) admitted for inpatient video-EEG monitoring in a cross-sectional, single-center study. Additional testing for the participants included polysomnography. In response, Dr. Sethi concurs that identifying and treating SDB in patients with epilepsy and/or PNES can potentially improve their quality of life and epileptic seizure control, but also notes that the cost of inpatient polysomnography in every patient admitted for seizure monitoring is prohibitive. He suggests overnight pulse oximetry as a more practical option to screen for severe obstructive sleep apnea or other SDB with the option of referring identified patients for formal polysomnography. In their reply, the authors agree that overnight oximetry has been evaluated extensively for severe SDB, but note that normal oximetry does not rule out SDB, particularly in this high-risk population. Although acknowledging the additional time and resource commitment needed to acquire and report a full polysomnogram, they argue that when the patients are already being monitored in a hospital, concurrent polysomnography may be preferable to home-based monitoring, particularly given uncertainties about the sensitivity and specificity of such strategies for severe SDB in this population. They note that such enhanced in-hospital monitoring may also help identify relationships between seizures and respiratory events. In the article “Age and sex differences in burnout, career satisfaction, and well-being in US neurologists,” LaFaver et al. quantitatively and qualitatively analyzed responses to a 2016 survey of US neurologists (1,091 men and 580 women) and found that emotional exhaustion, depersonalization, fatigue, and overall quality of life generally became more favorable among older neurologists despite initial worsening of some of these variables with age. Whereas more women than men met burnout criteria, sex was not an independent predictor of the variables studied after adjusting for age. Women neurologists provided more negative comments regarding workload, work-life balance, leadership, deterioration of professionalism, and erosion of their academic mission by productivity demands. In response, Philip et al. postulate that life experience may mitigate burnout by fostering appreciation for relatively favorable aspects of the profession. They also note the importance of understanding how individual differences in reported factors such as age or sex and understudied aspects such as psychological makeup contribute to differences in professional outcomes, even within similar systems or cultures. In their reply, the authors agree that understanding both external and individual factors associated with burnout can facilitate the design of helpful interventions. They add that lower burnout among older neurologists may also relate to them cutting back clinical responsibilities or to loss of the most burned-out older neurologists from clinical practice. Highlighting the potential dangers of overgeneralizations regarding this issue based on demographic factors, they urge advocacy and action toward better coaching and mentoring for physicians and a more flexible view of work schedules and allocation of needed resources as feasible.