The document discusses the case of a 20-year-old patient with Prader-Willi syndrome who was referred for sleep apnea. A polysomnography showed central apneas, desaturations, and low respiratory flow. The patient was diagnosed with obstructive sleep apnea predominantly with hypopneas and had an apnea-hypopnea index of 54.8/hour and desaturation index of 27/hour. Treatment with CPAP titration during sleep was recommended.

1. MANAGEMENTUL SAS IN PRADER - WILLI Stefan Mihaicuta UMF V. Babes Clinica de Pneumologie

5. PSG – traseu normal

6. PSG cu apnee centrala

7. Polisomnografie Durations Patient name : SERESAN Acq : 707 First name : MARIA Type : Adult Sex : F Started : 11/4/2008 at 10:18:13 PM Birth date : 9/20/1988 Stopped : 11/5/2008 at 7:01:13 AM Patient age : 20 years Duration : 8:43:00 (523.0 min) Recording duration : 523.0 min Recording start -> end TIB : 523.0 min Light off -> Light on SPT : 488.5 min Sleep Onset -> Last Sleep Page TST : 469.0 min REM + NREM + MVT (during SPT) WK before sleep : 32.0 min WK from Light off to Sleep onset WK during sleep : 19.5 min SPT - TST WK after sleep : 0.0 min WK from Last sleep page to Light on TWK duration (tot) : 51.5 min All WK summed REM duration : 55.0 min REM (during TIB) NREM duration : 416.0 min S1 + S2 + S3 + S4 (during TIB) SWS duration : 78.5 min S3 + S4 (during TIB) Movement : 0.5 min MVT (during TIB)

8. Caracteristicile somnului Latencies From Light off (min) From Sleep onset (min) Sleep onset 34.5 - S1 32.0 12.5 S2 34.5 0.0 S3 144.5 110.0 S4 REM 253.5 219.0 Sleep efficiency 1 : 89.7% 100 x TST/TIB Sleep efficiency 2 : 96.0% 100 x TST/SPT Sleep efficiency 3 : 28.5% 100 x (N3+REM)/TST Inter-sleep WK : 4.0% WK in sleep / SPT

9. Evenimente respiratorii CA OA MA Sum Ap HYP Events Settings (sec) 10.0 10.0 10.0 - 10.0 - Number 4 47 1 52 376 428 Max (sec) 15.5 22.5 12.0 22.5 53.0 53.0 Mean (sec) 13.4 12.0 12.0 12.1 16.0 15.5 Tot duration (min) 0.9 9.4 0.2 10.5 100.0 110.5 TST (469.0 min) % of TST 0.2 2.0 0.0 2.2 21.3 23.6 Index [#/h TST] 0.5 6.0 0.1 6.7 48.1 54.8

10. PSG – hipopnee cu desaturari

11. PSG

12. REM #/h (REM) NREM #/h(NREM) TST #/h (sleep) RDI 31.6 57.8 54.8 Central apnea total duration : 1.68 minutes (0.3% of sleep) Total number of central apnea : 12 ( 1.5 CA/h (sleep)) Sigh rate : 8% Periodic breathing total duration : 1.57 minutes (0.3% of sleep)

13. PSG – apnei centrale, desaturari, flux respirator scazut

14. Cardio-vascular Statistics WK REM NREM S1 S2 S3 MVT Duration (min) 51.5 55.0 416.0 86.0 251.5 78.5 0.5 Mean HR (BPM) 90.5 88.8 88.6 94.2 87.3 86.4 113.0 Stand. dev. 8.356 6.891 8.777 8.908 8.232 7.718 2.000 Coef. var. 0.092 0.078 0.099 0.095 0.094 0.089 0.018 Median (BPM) 89.000 87.000 87.000 94.500 86.000 85.000 112.000 IQ 8.000 4.000 10.000 12.000 8.000 5.000 2.000 # of LHR 0 0 16 0 11 5 0 LHR min (BPM) 57 57 58 # of HHR 0 7 34 9 18 7 0 HHR max (BPM) 124 186 135 186 130 Mean RR (BPM) 92.4 89.7 89.7 95.4 88.4 87.3 112.9 Stand. dev. 20.215 12.928 12.548 13.067 12.521 9.677 2.641 Coef. var. 0.219 0.144 0.140 0.137 0.142 0.111 0.023 Mean RR (msec) 663.0 676.0 677.6 636.9 687.4 694.6 531.7 Stand. dev. 130.181 56.643 72.330 65.540 70.506 67.921 12.488 Coef. var. 0.196 0.084 0.107 0.103 0.103 0.098 0.023 ECG fail (min) 0.0 0.0 0.0 0.0 0.0 0.0 0.0

15. Saturatia in O2 WK REM NREM TOTAL Fail duration (min) 0.2 0.0 0.0 0.2 Average (%) 98 97 96 96 Desat Index (#/hour) 8.7 29.7 27.2 Duration desat/hour 1.8 6.3 5.8 Desat max (%) 0 5 19 19 Desat max dur (sec) 0.0 20.0 45.0 45.0

16. Desaturari Longest continuous duration spent below 0%: 0.0 minute(s) Lowest SpO 2 (>= 2 seconds) [%]: 79 # Episodes (>= 5.0 minutes) SpO 2 < 88 %: 0 Longest duration SpO 2 < 88 % 0.0 minute(s) Mean of the resp. event SpO 2 min levels [%] : 93 Mean of the resp. event SpO 2 min levels with desat [%] : 92 Minimum of the resp. event SpO 2 min levels [%] 79

17. Total number of WK or MVT episodes : 3 Arousal index : 5.8/h(sleep) % of pages with arousal during sleep : 4.8 Number of arousals associated with leg movements : 0 Number of arousals NOT associated with leg movements : 45

18. Hipnograma completa

20. Hipnograma

23. PSG

24. Dispozitive

25. CPAP 80% din pacienţi acceptă CPAP ca terapie de lungă durată la domiciliu W. T. McNicholas, M. R. Bonsignore, Eur Respir J , January 2007; 29:156-178

27. CPAP: impact ul asupra activităţii din timpul zilei Engleman HM et al, Lancet 1994;343:572–575 Engleman HM et al, Thorax 1998;53:341–345 Redline S et al, AJRCCM 1998;57:858–865 Jenkinson C et al, Lancet 1999;353:2100–2105 Ballester E et al, AJRCCM 1999;159:495–501 Montserrat et al, AJRCCM, 2001, 164:608-13 nCPAP aduce îmbunătăţiri semnificative pe somnolenţă şi calitatea vieţii la pacienţii cu simptome de SAS moderată sau severă R Davies and J Stradling, AJRCCM, 2000, 161:1775-8

28. Morbiditate c ardiovascular ă

30. Moarte subită Somers et al, NEJM 2005

31. Mortalit atea crescută la pacienţii care nu primesc CPAP Doherty LS Chest. 2005;127:2076-2084 Long-term Effects of Nasal Continuous Positive Airway Pressure Therapy on Cardiovascular Outcomes in Sleep Apnea Syndrome* Chest. 2005;128:624-633. Mortality in Obstructive Sleep Apnea-Hypopnea Patients Treated With Positive Airway Pressure* Francisco Campos-Rodriguez, Marti, S, Sampol, G, Muñoz, X, et al Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment. Eur Respir J 2002;20 ,1511-1518

35. Circumferinţa abdominală medie 120,06 cm Obezitatea abdominală (plus ≥2 elemente) - element obligatoriu în noua definiţie a sindromului metabolic: peste 80 cm la femei şi peste 94 la bărbaţi la europeni Lancet 2007; 369:2059-2061