Sleep-related Breathing Disorders Research Articles

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Sleep disorders are very important in clinical practice due to their prevalence and impact on health and quality of life. The most common problems are insomnia, excessive daytime sleepiness, respiratory disorders, or abnormal movements or behaviors during sleep. A detailed, targeted case history, specifically recording the impression of bedfellows or family members, is essential. Sleep tests performed in the laboratory (polysomnography and multiple sleep latency test) are fundamental in the diagnosis of certain sleep disorders (such as sleep-related breathing disorders or central hypersomnias) or in specific populations (such as children or individuals with comorbid medical disorders). Technological advances allow the use of other methods to evaluate a patient's sleep, such as respiratory polygraphy, actigraphy, or applications connected to smart devices. Advances in the research of the physiopathology of these disorders has allowed for the development of specific medications and new treatments. However, a multidisciplinary approach is essential for the proper management of these diseases, which includes improving sleep hygiene and cognitive behavioral therapy.

Sleep-Related Breathing Disorder and its Relation to Anesthetic Practice

Sleep-Related Breathing Disorder and its Relation to Anesthetic Practice

Prevalence of sleep-related breathing disorders and associated risk factors among people with dementia: A meta-analysis

ObjectiveSleep-related breathing disorders (SRBD) have shown to cause worsened cognitive impairment among people with dementia. Therefore, we conducted the first meta-analysis to estimate the prevalence of SRBD among people with dementia. MethodsComprehensive searches were conducted in Embase, Ovid-MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, and CINAHL. The generalized linear mixed model (GLMM) was used for the pooled prevalence analysis and heterogeneity using I2 test and Cochran's Q-statistic in R-software. Study quality was assessed by Hoy's risk of bias assessment tool. Overall, 20 studies from 1282 studies were included with 1461 participants. ResultsThe pooled prevalence of SRBD among dementia was 59% (95%CI: 44%–73%) with 55% (95%CI: 34%–74%) for obstructive sleep apnea (OSA), 49% (95%CI: 25%–73%) for unspecified SRBD, and 11% (95%CI: 5%–21%) for central sleep apnea (CSA). Regarding dementia subtypes, the prevalence of SRBD was 89% (95%CI: 61%–97%) for Alzheimer's dementia, 56% (95%CI: 48%–63%) for Parkinson's and Idiopathic Parkinson's dementia, and 16% (95%CI: 8%–30%) for Huntington's dementia. Significant moderator variables were male, body mass index, larger waist and hip circumference, waist-hip ratio, and comorbidities including hypertension, dyslipidemia, renal disease, diabetes, heart disease, and stroke. ConclusionsThere is considerable high prevalence of SRBD among dementia people, with OSA and unspecified SRBD being fivefold higher than CSA. Regarding dementia subtypes, Parkinson's and Idiopathic Parkinson's, and Alzheimer's dementia had four to sixfold increased risk of presenting with SRBD than Huntington's dementia. Therefore, assessment and management of SRBD in Alzheimer's, and Parkinson's and Idiopathic Parkinson's dementia deserves more attention in future research.

Sleep-related breathing disorders in patients with heart failure with reduced and mildly reduced ejection fraction: main types and their dependence on heart failure etiology

Aim. To identify and study the nature of sleep-related breathing disorders (SBDs) in a cohort of hospitalized patients with heart failure (HF) with reduced and mildly reduced ejection fraction (EF), as well as to clarify the relationship between SBD type, etiology and severity of HF.Material and methods. The study included 117 patients with HF with reduced and mildly reduced ejection fraction hospitalized at the National Medical Research Center for Therapy and Preventive Medicine from 2019 to 2021. All patients underwent clinical and paraclinical examination, including cardiorespiratory sleep study. Patients were divided into three groups according to the type and severity of SBD: no or mild SBD, predominantly with obstructive sleep apnea (OSA) and predominantly with central sleep apnea (CSA). Severity of SBD and clinical data were compared between these groups.Results. A total of 5 patients (4,27%) did not have any SBDs, while 47 (40,17%) were diagnosed with CSA, and 65 (55,56%) — OSA of varying severity. The proportions of patients with moderate and severe CSA and OSA differed insignificantly and amounted to 35,9% (n=42) and 44,4% (n=52), respectively. There were following proportions of diseases related to HF: coronary artery disease (41,88%), nonischemic cardiomyopathy (26,5%), arrhythmogenic cardiomyopathy (15,38%) and other causes (16,24%) (hypertension, myocarditis, heart defects). We found that reduced EF <40%, end-diastolic volume >210 ml, and ventricular ectopy (>300 extrasystoles/day) were associated with CSA, and body mass index >30 kg/m2 was traditionally associated with OSA.Conclusion. More than half of HF patients with reduced and mildly reduced EF have SBDs. Decreased LVEF and ventricular ectopic activity are associated with CSA, while increased body mass index is associated with OSA. Consideration of SBD risk factors may improve patient phenotyping for individualized therapy.

Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea-A Narrative Review.

Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA.

Impact of Spina Bifida on Sleep Quality: Current Insights.

Spina bifida (SB) is one of the most common birth defects in children. The care for patients with SB continues to evolve, and there has been notable improvement in survival outcomes, degree of disability and quality of life for these children. However, patients with SB continue to remain at higher risk for sleep-related breathing disorders (SRBD), unexplained sudden death, and potential alterations in their sleep chronotype. Previous studies report on abnormalities in the spinal cord, brainstem function, and dysfunction of upper airway maintenance as the likely mechanisms behind SRBD that is commonly seen in SB. Most studies looking at prevalence of SRBD in SB have been retrospective studies. A recent prospective study identified a prevalence as high as 42% when a polysomnography (PSG) was completed on all patients regardless of symptomatology. Treatment options vary depending on the type and severity of SRBD and can range widely. Despite advances in care for patients with SB and SRBD, a subset of these patients with myelomeningocele (MMC) continue to experience sudden unexplained death. Studies continue to evaluate ways to stratify which of these patients may be at higher risk of this devastating outcome. Given that SRBD is potentially treatable, early assessment and intervention could become an integral part of a multidisciplinary treatment strategy to optimize long-term medical and neurodevelopmental outcomes for this patient population. By understanding the impact that SB may have on a patient's sleep quality, their biological chronotype and their potential of developing SRBD, a provider may help to optimize the care a patient with SB receives from birth into adulthood.

Monitoring of Sleep Breathing States Based on Audio Sensor Utilizing Mel-Scale Features in Home Healthcare.

Sleep-related breathing disorders (SBDs) will lead to poor sleep quality and increase the risk of cardiovascular and cerebrovascular diseases which may cause death in serious cases. This paper aims to detect breathing states related to SBDs by breathing sound signals. A moment waveform analysis is applied to locate and segment the breathing cycles. As the core of our study, a set of useful features of breathing signal is proposed based on Mel frequency cepstrum analysis. Finally, the normal and abnormal sleep breathing states can be distinguished by the extracted Mel-scale indexes. Young healthy testers and patients who suffered from obstructive sleep apnea are tested utilizing the proposed method. The average accuracy for detecting abnormal breathing states can reach 93.1%. It will be helpful to prevent SBDs and improve the sleep quality of home healthcare.

Sleep-related breathing disorders in patients with implanted cardioverter-defibrillators

Sleep-related breathing disorders in patients with implanted cardioverter-defibrillators

The Role of Orthodontic Treatment in the Management of Sleep Apnea and Other Sleep-Related Breathing Disorders

Sleep-disordered breathing encompasses conditions ranging from primary snoring to the more serious obstructive sleep apnea (OSA), caused by upper airway obstructions during sleep. OSA disrupts sleep patterns, leading to health issues like hypertension and cardiovascular problems. Although adults with sleep-disordered breathing typically face issues with upper airway instability or complete pharyngeal obstruction, the root cause often lies in structural blockages in the nasal passage. The gold standard for OSA treatment is continuous positive air pressure. However, orthodontic treatments also play a crucial role, though they are often overlooked. Orthodontics is not limited to tooth alignment; when integrated with medical approaches, it provides alternative OSA treatments. While orthodontics typically focuses on tooth positioning, collaboration with oral and maxillofacial surgeons is frequent, especially for orthognathic surgery. For pediatric patients, growth modification treatments are also viable. Some treatments, especially for adolescents, have shown significant promise in managing OSA.

Smart Mattress Based on Multipoint Fiber Bragg Gratings for Respiratory Rate Monitoring

Long-term monitoring of respiratory rate (RR) is of great importance in people suffering from sleep-related breathing disorders (SBDs). Instrumented mattresses are gaining the attention of several research groups to monitor this vital sign. Among the existing sensing techniques, fiber Bragg grating sensors (FBGs) show promise in this arena. In this article, we presented a novel FBG-based smart mattress to monitor RR over time. The proposed measuring system consisted of 13 sensing elements (SEs) based on FBGs encapsulated in soft biocompatible rubber, totally embedded in multiple silicone layers. Compactness, robustness, and user comfort are the main advantages of our solution. The mattress size and the arrangement of the 13 SEs were chosen to allow monitoring subjects with different anthropometric parameters and taking up different sleeping postures. Before the overall system integration, each SE was subjected to static and dynamic metrological characterization, a process often overlooked in fiber-optic-based mattresses. Results showed a mean sensitivity to force equal to 14 pm <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\cdot \,\,\text{N}^{-1}$ </tex-math></inline-formula> and a mean percentage hysteresis error always lower than 18%. The feasibility assessment of the system in RR monitoring was carried out on five healthy volunteers taking up common sleeping postures (i.e., supine -S-, right side -RS-, left side -LS-, and prone -P-) under two breathing conditions (i.e., quiet breathing -QB-, and tachypnea -T-). RR estimation showed a mean absolute error (MAE) always lower than 0.65 breaths/min. The promising findings proved the capability of our smart mattress in monitoring RR over time, encouraging the investigation of its performance in real-world scenarios.

Decreased Peripapillary and Macular Vascular Densities in Patients with Moderate/Severe Obstructive Sleep Apnea/Hypopnea Syndrome.

To compare peripapillary and macular vascular densities (PVDs and MVDs) between patients with obstructive sleep apnea/hypopnea syndrome (OSA) and control subjects with symptoms of sleep-related breathing disorders only by swept-source optical coherence tomography angiography (OCTA). In this prospective study, 192 participants underwent a full-night polysomnography to determine OSA severity and subsequently received OCTA measurements as well as AngioTool software analysis. A total of 146 patients with OSA (51 mild, 43 moderate, 52 severe) and 24 control subjects (apnea/hypopnea index, AHI <5) were enrolled. PVDs and MVDs in the superficial and choroidal layers were significantly different among the four groups. When participants with simple snoring/mild OSA (AHI <15) were grouped together and compared with moderate/severe OSA (AHI ≥15), PVDs were significantly lower for the latter group in the superficial layer (p = 0.0003), deep layer (p = 0.004), and choroidal layer (p = 0.003). MVDs were also lower for the moderate/severe OSA group in the superficial (p = 0.012) and choroidal layer (p = 0.004). Negative correlations were identified between AHI and PVDs in the superficial layer (ρ = -0.257, p = 0.0007), deep layer (ρ = -0.197, p = 0.0102) and choroidal layer (ρ = -0.220, p = 0.0039) and between AHI and MVDs in the superficial layer (ρ = -0.199, p = 0.0094) and choroid layer (ρ = -0.186, p = 0.0152). PVDs and MVDs were significantly lower in patients with moderate/severe OSA as compared to subjects with simple snoring/mild OSA. Furthermore, decreased PVDs and MVDs significantly correlated with OSA severity.

The combination of nasal steroids and anti-leukotriene to reduce adenectomy in children with OSA and adenoid hypertrophy.

Obstructive sleep apnea (OSA) affects 1% to 5% of all children, with the most significant prevalence between ages 2 and 8. Correlations between OSA and Adenoid hypertrophy (AH) have been well-demonstrated in children. If untreated, OSA can cause growth impairment, neuro-cognitive and behavioral problems, and cardiovascular complications. Allergy was reported to be a vital risk factor for AH, among other inflammatory processes mentioned. To demonstrate that the combination of nasal steroids and ani leukotriene reduces the number of adenectomies in children with OSA and adenoid hypertrophy in Saudi children.To demonstrate the positive Correlation between allergic sensitization and OSA caused by adenoid hypertrophy Methods: This retrospective study included 60 children with moderate/severe OSA attending a Pediatric Allergy Clinic in Saudi Arabia diagnosed using Sleep-Related Breathing Disorder Scale (pediatrics-related items). We had children with adenoid hypertrophy confirmed by soft neck tissue x-ray or both; children who suffer from obesity were excluded. Sensitization was defined as positive specific IgE and/or skin prick for food and/or inhaled allergens; allergic comorbidities were enumerated. Combination of nasal steroid and anti-leukotriene reduces adenectomy by 58.3 % in children with OSA caused by AH. 71.7% of Them were sensitized to inhaled food or both allergens. Anti-inflammatory treatment with a combination of nasal steroids and anti-leukotriene remarkably reduces the adenectomy rate in children with OSA caused by AH. Our findings suggest that allergic sensitization, regardless of the allergen, increases children's susceptibility to AH through the inflammatory process. This may be why nasonex and montelukast are effective treatments for OSA in children with AH.

A Wearable Functional Near-Infrared Spectroscopy (fNIRS) System for Obstructive Sleep Apnea Assessment.

Obstructive sleep apnea (OSA), one of the most common sleep-related breathing disorders, contributes as a potentially life-threatening disease. In this paper, a wearable functional near-infrared spectroscopy (fNIRS) system for OSA monitoring is proposed. As a non-invasive system that can monitor oxygenation and cerebral hemodynamics, the proposed system is dedicated to mapping the pathogenic characteristics of OSA to dynamic changes in blood oxygen concentration and to constructing an automatic approach for assessing OSA. An algorithm including feature extraction, feature selection, and classification is proposed to signals. Permutation entropy(PE), for quantitative measuring the complexity of time series, is firstly involved to characterize the features of the physiological signals. Subsequently, the principal component analysis (PCA) for feature dimensionality reduction and support vector machine (SVM) algorithm for OSA classification are applied. The proposed method has been validated on a dataset that collected by the wearable system. It includes 40 subjects and composes of normal, and various severity cessation of breathing (e.g., mild, moderate, and severe). Experimental results exhibit that the proposed system can effectively distinguish OSA and non-OSA subjects, with an accuracy of 91.89%. The proposed system is expected to pave the novel perspective for OSA assessment in terms of cerebral hemodynamics.

The role of metalloproteinases in the pathogenesis of Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep-related breathing disorder. Untreated OSAS leads to significant health consequences, disturbed functioning in society, decreased efficiency in a workplace and increased risk of accidents at work and while driving. The main patomechanisms of OSAS development are hypoxia, oxidative stress and inflammatory process. Intermittent hypoxia in OSAS patients is associated with subsequent episodes of reoxygenation with simultaneous increase of reactive oxygen species and reactive nitrogen species that stimulate secretion of extracellular metalloproteinases (MMPs). These compounds belong to a group of endogenous proteolytic enzymes produced by structural cells of extracellular matrix (ECM) and by cells of inflammatory response as well. ECMs are made of collagen proteins and glycoproteins. They form a scaffold for tissues of the soft palate. MMPs break down collagen molecules, which results in flaccidity of tissues, including tissues of the soft palate. The results of scientific studies have shown that expression, secretion, and activeness of MMPs increase during hypoxia. Thus metalloproteinases may be involved in the process of upper airway tissue damage during the intermittent hypoxia in OSAS.

Sleep related breathing disorders in the spina bifida population ages 1-20 years: A retrospective study in Arkansas.

Sleep related breathing disorders (SRBD) are seen at disproportionately higher rates in children with spina bifida compared with their same aged peers. SRBD such as obstructive sleep apnea (OSA) or central apnea are associated with developmental and cognitive consequences, and sudden death. Participants aged 1 to 20 years with a diagnosis of spina bifida were recruited from a pediatric academic hospital spinal cord specialty clinic to evaluate the prevalence and impact of sleep disorders in the spina bifida population; 76 polysomnogram (PSG) reports spanning a 3-year period were reviewed in this retrospective cohort study. Of the PSGs reviewed, 37 (49%) indicated the presence of SRBD, and 28 (76%) of those children required an escalation of management (surgical intervention or additional respiratory support). These results are consistent with previous studies and further emphasize the clinical impact of SRBD on children with spina bifida by describing the interventions that followed an abnormal PSG. The high prevalence of SRBD in the spina bifida population supports the need for additional research to develop sleep questionnaires specific to spina bifida that can predict abnormal PSG clinically and to determine the standard of care following an abnormal PSG, chiefly in OSA and central apnea.

The Oxygen Desaturation Index for Severity Assessment of Obstructive Sleep Apnea Associated With Cigarette Smoking

Objectives: Nicotine stimulates release of neurotransmitters that regulate the sleep-wake cycle and thereby leads to insomnia. Smoking is associated with upper airway distress; however, its role in severe sleep-related breathing disorders remains controversial. In this study, we investigated the effects of smoking on obstructive sleep apnea (OSA).Methods: We investigated 1,163 patients diagnosed with OSA who underwent polysomnography between March 2020 and July 2022. We recorded details including smoking status (current, former, and non-smoker), demographics, questionnaire-related data, and polysomnography findings and performed univariate analysis to compare these variables between smokers and non-smokers. We also analyzed the correlation between smoking status and OSA severity. The risk of smoking on the severity of OSA was determined using logistic regression analysis.Results: Current and former smokers included 461 male (49.1%) and 10 female (4.4%) (&lt;i&gt;p&lt;/i&gt;=0.001). Smokers had a high apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) (&lt;i&gt;p&lt;/i&gt;&lt;0.001), high arousal index (&lt;i&gt;p&lt;/i&gt;=0.001), and severe daytime sleepiness (indicated by the Epworth Sleepiness Scale, &lt;i&gt;p&lt;/i&gt;&lt;0.001). We observed no correlation between the AHI and the number of cigarettes smoked per day and the duration of smoking. Logistic regression analysis after adjustment for age, sex, body mass index, and alcohol consumption showed that smoking was a risk factor for ODI (ODI &gt;15, odds ratio 1.33, &lt;i&gt;p&lt;/i&gt;=0.04), and AHI was independent of smoking.Conclusions: Controversy regarding the severity of OSA with smoking has currently not been definitively determined. However, our results provide new evidence to support the association between smoking and the ODI, which few studies have investigated to date.

Rehabilitation for atrial fibrillation : Impact on arrhythmia and cumulative risk factors

Atrial fibrillation (AF) occurs in cardiovascular diseases but also in hyperthyroidism. The independent risk factors (RF) that are cumulatively the cause of AF include arterial hypertension, obesity, malnutrition, alcohol and tobacco consumption, lack of exercise, diabetes mellitus, and sleep-related breathing disorders. These cause and reinforce each other and are amplified by psychosocial RF. This also leads to morphological consequences such as atrial cardiomyopathy or diastolic heart failure (HFpEF). Therapy focuses on stroke prophylaxis through anticoagulation and rhythm or frequency control of the AF. The risk factors of AF are presented here in detail. RF control must be included in the management of AF. Effective risk management should definitely include the patient's lifestyle. Although RF management can be integrated into the acute medical and outpatient treatment of AF, there is little scope to deal with the individual risk profile of individual patients. With the bio-psycho-social treatment approach, cardiological rehabilitation offers the opportunity to establish individual, lifestyle-oriented risk management and to achieve symptomatic improvement, decreased AF burden, better performance, and abetter quality of life through correctly dosed training. Further studies to clarify the question of whether clinical endpoints such as hospitalization or morbidity and mortality are reduced by cardiac rehabilitation in AF are desirable.

Practical approach to sleep disordered breathing

It is not uncommon to have occasional difficulty in falling asleep or have fatigue and day time sleepiness. However, when sleep disturbances persist for over a month and are associated with significant daytime dysfunction for at least two weeks, it may be a warning of an underlying sleep disorder requiring further evaluation and treatment. The combination of snoring, nonrefreshing sleep and daytime sleepiness is usually a hallmark of Obstructive Sleep Apnea (OSA) which is the most common sleep related breathing disorder. This review article aims to provide a practical and comprehensive approach to the diagnosis and management of sleep related breathing disorders with a focus on OSA.

Screening for Obstructive Sleep Apnea using Epworth Sleepiness Score and Berlin Questionnaire: Which is Better?

Background: Obstructive sleep apnea (OSA) is a highly prevalent, but underdiagnosed and undertreated disorder. There is a need for simple but accurate tool for early detection of patients based on their clinical symptoms and physical findings into high- or low-risk group and give information for urgent polysomnography (PSG) and further treatment to prevent serious consequences. Epworth Sleepiness Score (ESS) and Berlin Questionnaire (BQ) are the most popular and widely acceptable instruments for identification of high-risk patients of OSA. The aim of our study was to compare these two established and well-known sleep questionnaires regarding their ability to find out the probable cases of OSA in Indian scenario. Methods: This cross-sectional study was conducted at a tertiary care center on 72 adult patients with symptoms of sleep-related breathing disorders. All patients were asked to fill both ESS and BQ questionnaires. Subsequently, all patients were subjected to level-1 PSG. For each patient, the Apnea–hypopnoea index was calculated to assess the diagnosis and severity of OSA and to further compare the ESS and BQ questionnaires for their sensitivity (SN) in OSA patients. Results: A total of 14 (19.4%) patients were diagnosed as OSA by ESS while by BQ, 32 (44.4%) patients were diagnosed as having OSA with SN of 31% and 71.11%, respectively (P = 0.00004). The positive predictive value was 82.3% and 88.8% for ESS and BQ, respectively, with a negative predictive value of 43.6% by ESS and 63.8% by BQ questionnaires. Conclusion: ESS is a less sensitive diagnostic tool for early detection of high-risk patients of OSA in general population. BQ is a valid, reliable, and more sensitive parameter to screen patients for OSA and may help in improving the quality of life in such patients with proper OSA management.

Sleep disorders and polysomnography findings in patients with autoimmune encephalitis.

Sleep disorders in patients with autoimmune encephalitis (AE) are increasingly reported. Early recognition and treatment have significant importance regarding the potential of sleep disorders' effect on morbidity and even mortality. There are a limited number of studies related to polysomnography (PSG) in these patients. Here, we report the clinical and PSG data of patients with AE and sleep disorders, with a particular interest in sleep-related breathing disorders (SRBD). Seventeen patients with diagnosed AE and acute or subacute onset sleep complaints who underwent video-electroencephalography-PSG recordings in our tertiary center were investigated. The mean age was 50, with eight females and nine males. The detected antibodies were against leucine-rich glioma-inactivated 1(LGI-1) in 6, anti-contactin-associated protein-2(CASPR2) in 3, voltage-gated potassium channel complex antigens(VGKC) in 1, anti-glycine in 1, dipeptidyl-peptidase-like protein-6(DPPX) in 1, anti-Hu in 1, and anti-amphiphysin in 1. All commercially available and known autoimmune encephalitis-related antibodies were negative in 3 of the patients. Final diagnosis after PSG was circadian rhythm sleep disorder (n = 3), periodic limb movement disorder (n = 3), insomnia (n = 5), central apnea with or without Cheyne-Stokes breathing (CSB) (n = 4), obstructive sleep apnea (OSA) (n = 4), non-rapid eye movement (NREM) and REM parasomnia (n = 8), faciobrachial dystonic seizures (n = 2), and subclinical seizures (n = 1). Sleep microstructure was disrupted in 9, REM periods without atonia occurred in 4, and brief sleep fragments consisting of theta activity interspersed with faster rhythms existed in 7 patients. Nearly half of our patients (47%) had SRBD, and the mean apnea-hypopnea index (AHI) was 14. Sleep disorders are frequent and essential components of AEs. Systematic clinical questionnaires and routine PSG assessments would significantly impact the correct diagnosis and proper treatment of SRBD and the overall prognosis of AE.