Lunding McCullough (driverdoubt6)

Sleep disorders are prevalent in patients with multiple sclerosis. In contrast, a frank increase of rapid eye movement (REM) sleep time is a rare phenomenon, mostly described in the context of REM sleep rebound (after sleep deprivation, abrupt withdrawal of antidepressants or neuroleptics, and during the first night of ventilation for severe sleep apnea), but not in link with specific brain lesions. We incidentally found an isolated, marked increase in REM sleep time (200 min, 40% of total sleep time, normative values 18.2-20.3%) and in rapid eye movements density during REM sleep in a patient with a secondary progressive multiple sclerosis, associated with an anterior pontine demyelinating lesion on magnetic resonance imaging. This result suggests that a network blocking REM sleep in the pons has been damaged. Sleep disorders are prevalent in patients with multiple sclerosis. In contrast, a frank increase of rapid eye movement (REM) sleep time is a rare phenomenon, mostly described in the context of REM sleep rebound (after sleep deprivation, abrupt withdrawal of antidepressants or neuroleptics, and during the first night of ventilation for severe sleep apnea), but not in link with specific brain lesions. FHT-1015 cell line We incidentally found an isolated, marked increase in REM sleep time (200 min, 40% of total sleep time, normative values 18.2-20.3%) and in rapid eye movements density during REM sleep in a patient with a secondary progressive multiple sclerosis, associated with an anterior pontine demyelinating lesion on magnetic resonance imaging. This result suggests that a network blocking REM sleep in the pons has been damaged. The recognition of specific endotypes as drivers of sleep apnea suggests the need of therapies targeting individual mechanisms. Acetazolamide is known to stabilize respiration at high-altitude but benefits at sea-level is less well understood. All controlled studies of acetazolamide in obstructive sleep apnea (OSA) and/or central sleep apnea (CSA) were evaluated. The primary outcome was the apnea-hypopnea index (AHI). Fifteen trials with a total of 256 patients were pooled in our systematic review. Acetazolamide reduced the overall AHI (mean difference [MD] -15.82, 95% CI -21.91 ∼ -9.74, p < 0.00001) in CSA (MD -22.60, 95% CI -29.11 ∼ -16.09, p < 0.00001), but not in OSA (MD -10.29, 95% CI -33.34 ∼ 12.77, p = 0.38). Acetazolamide reduced the respiratory related arousal index (MD -0.82, 95% CI -1.56 ∼ -0.08, p = 0.03), improved partial arterial of oxygen (MD 11.62, 95% CI 9.13 ∼ 14.11, p < 0.00001), mean oxygen saturation (MD 1.78, 95% CI 0.53 ∼ 3.04, p = 0.005), total sleep time (MD 25.74, 95% CI 4.10 ∼ 47.38, p = 0.02), N2 sleep (MD 3.34, 95% CI 0.12 ∼ 6.56, p = 0.04) and sleep efficiency (MD 4.83, 95% CI 0.53 ∼ 9.13, p = 0.03). Acetazolamide improves the AHI and several sleep metrics in CSA. The drug may be of clinical benefit in patients with high loop gain apnea of various etiologies and patterns. The existence of high heterogeneity is an important limitation in applicability of our analysis. Registry PROSPERO, Identifier CRD42020163316, URL https//. Registry PROSPERO, Identifier CRD42020163316, URL https//. Acute respiratory failure is a life-threatening emergency. Standard prehospital management involves controlled oxygen therapy. Continuous positive airway pressure is a potentially beneficial alternative treatment; however, it is uncertain whether or not this treatment could improve outcomes in NHS ambulance services. To assess the feasibility of a large-scale pragmatic trial and to update an existing economic model to determine cost-effectiveness and the value of further research. (1) An open-label, individual patient randomised controlled external pilot t