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Semin Neurol 2017; 37(04): 471-480
DOI: 10.1055/s-0037-1605343
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Emergency Sleep Medicine

Christian S. Guay
1   Department of Clinical Medicine, Saba University School of Medicine, Devens, Massachusetts
,
Jeffrey M. Ellenbogen
2   Department of Neurology and Division of Sleep Medicine, Johns Hopkins University, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
24 August 2017 (online)

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Abstract

Sleep is a tranquil process that contributes substantially to our overall health and well-being. Yet sleep creates certain vulnerabilities. These sometimes require urgent management decisions for prehospital emergency medical services and on-call medical providers alike. Some of these emergencies may be directly due to sleep itself, whereas others may result from sleep disorders or a lack of sleep. And then some medical emergencies may occur during sleep by chance. Yet for some of these emergencies, sleep does not necessarily play a benign role. Sleep can mask the emergency—causing a delay in detection, confusion in the diagnosis, or even impede treatment. Finally, some disorders will mimic sleep and thus elude detection. Understanding these core principles will enable medical practitioners to optimize care for patients in emergency situations.

Keywords

sleep - emergency medicine - seizures - stroke - sleep–wake disorders
 

  • References

  • 1 Lozano R, Naghavi M, Foreman K. , et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859): 2095-2128
    CrossrefPubMedGoogle Scholar
  • 2 Manfredini R, Boari B, Smolensky MH. , et al. Circadian variation in stroke onset: identical temporal pattern in ischemic and hemorrhagic events. Chronobiol Int 2005; 22 (03) 417-453
    CrossrefPubMedGoogle Scholar
  • 3 Mackey J, Kleindorfer D, Sucharew H. , et al. Population-based study of wake-up strokes. Neurology 2011; 76 (19) 1662-1667
    CrossrefPubMedGoogle Scholar
  • 4 Chen JC, Brunner RL, Ren H. , et al. Sleep duration and risk of ischemic stroke in postmenopausal women. Stroke 2008; 39 (12) 3185-3192
    CrossrefPubMedGoogle Scholar
  • 5 Siengsukon CF, Boyd LA. Sleep to learn after stroke: implicit and explicit off-line motor learning. Neurosci Lett 2009; 451 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 6 Moradiya Y, Janjua N. Presentation and outcomes of “wake-up strokes” in a large randomized stroke trial: analysis of data from the International Stroke Trial. J Stroke Cerebrovasc Dis 2013; 22 (08) e286-e292
    CrossrefPubMedGoogle Scholar
  • 7 Jauch EC, Saver JL, Adams Jr HP. , et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44 (03) 870-947
    CrossrefPubMedGoogle Scholar
  • 8 Lorenzano S, Ahmed N, Tatlisumak T. , et al; SITS Investigators. Within-day and weekly variations of thrombolysis in acute ischemic stroke: results from safe implementation of treatments in stroke-international stroke thrombolysis register. Stroke 2014; 45 (01) 176-184
    CrossrefPubMedGoogle Scholar
  • 9 Kim BJ, Lee SH, Shin CW, Ryu WS, Kim CK, Yoon BW. Ischemic stroke during sleep: its association with worse early functional outcome. Stroke 2011; 42 (07) 1901-1906
    CrossrefPubMedGoogle Scholar
  • 10 Hu YZ, Xu ZQ, Lu XY, Chen J. Efficacy and safety of thrombolysis for stroke of unknown onset time: a meta-analysis. J Thromb Thrombolysis 2014; 38 (04) 528-539
    CrossrefPubMedGoogle Scholar
  • 11 Palaniswami M, Yan B. Mechanical thrombectomy is now the gold standard for acute ischemic stroke: implications for routine clinical practice. Interv Neurol 2015; 4 (1-2): 18-29
    PubMedGoogle Scholar
  • 12 Mokin M, Kan P, Sivakanthan S. , et al. Endovascular therapy of wake-up strokes in the modern era of stent retriever thrombectomy. J Neurointerv Surg 2016; 8 (03) 240-243
    CrossrefPubMedGoogle Scholar
  • 13 Thomalla G, Fiebach JB, Østergaard L. , et al; WAKE-UP investigators. A multicenter, randomized, double-blind, placebo-controlled trial to test efficacy and safety of magnetic resonance imaging-based thrombolysis in wake-up stroke (WAKE-UP). Int J Stroke 2014; 9 (06) 829-836
    CrossrefPubMedGoogle Scholar
  • 14 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353 (19) 2034-2041
    CrossrefPubMedGoogle Scholar
  • 15 Tsivgoulis G, Alexandrov AV. Cerebral autoregulation impairment during wakefulness in obstructive sleep apnea syndrome is a potential mechanism increasing stroke risk. Eur J Neurol 2009; 16 (03) 283-284
    CrossrefPubMedGoogle Scholar
  • 16 Kim Y, Koo YS, Lee HY, Lee SY. Can continuous positive airway pressure reduce the risk of stroke in obstructive sleep apnea patients? A systematic review and meta-analysis. PLoS One 2016; 11 (01) e0146317
    CrossrefPubMedGoogle Scholar
  • 17 Birkbak J, Clark AJ, Rod NH. The effect of sleep disordered breathing on the outcome of stroke and transient ischemic attack: a systematic review. J Clin Sleep Med 2014; 10 (01) 103-108
    PubMedGoogle Scholar
  • 18 Culebras A. Sleep and stroke. Semin Neurol 2009; 29 (04) 438-445
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Campbell IG. EEG recording and analysis for sleep research. Curr Protoc Neurosci 2009. ;Chapter 10:Unit10 12:13–14
    Google Scholar
  • 20 Frauscher B, von Ellenrieder N, Dubeau F, Gotman J. EEG desynchronization during phasic REM sleep suppresses interictal epileptic activity in humans. Epilepsia 2016; 57 (06) 879-888
    CrossrefPubMedGoogle Scholar
  • 21 Ng M, Pavlova M. Why are seizures rare in rapid eye movement sleep? Review of the frequency of seizures in different sleep stages. Epilepsy Res Treat 2013; 2013: 932790
    PubMedGoogle Scholar
  • 22 Spencer DC, Sun FT, Brown SN. , et al. Circadian and ultradian patterns of epileptiform discharges differ by seizure-onset location during long-term ambulatory intracranial monitoring. Epilepsia 2016; 57 (09) 1495-1502
    CrossrefPubMedGoogle Scholar
  • 23 Ferlisi M, Shorvon S. Seizure precipitants (triggering factors) in patients with epilepsy. Epilepsy Behav 2014; 33: 101-105
    CrossrefPubMedGoogle Scholar
  • 24 Shorvon SD. The etiologic classification of epilepsy. Epilepsia 2011; 52 (06) 1052-1057
    CrossrefPubMedGoogle Scholar
  • 25 Kreuzer P, Langguth B, Popp R. , et al. Reduced intra-cortical inhibition after sleep deprivation: a transcranial magnetic stimulation study. Neurosci Lett 2011; 493 (03) 63-66
    CrossrefPubMedGoogle Scholar
  • 26 Bhalla D, Godet B, Druet-Cabanac M, Preux PM. Etiologies of epilepsy: a comprehensive review. Expert Rev Neurother 2011; 11 (06) 861-876
    CrossrefPubMedGoogle Scholar
  • 27 Fountain NB, Kim JS, Lee SI. Sleep deprivation activates epileptiform discharges independent of the activating effects of sleep. J Clin Neurophysiol 1998; 15 (01) 69-75
    CrossrefPubMedGoogle Scholar
  • 28 Malow BA, Passaro E, Milling C, Minecan DN, Levy K. Sleep deprivation does not affect seizure frequency during inpatient video-EEG monitoring. Neurology 2002; 59 (09) 1371-1374
    CrossrefPubMedGoogle Scholar
  • 29 Lawn N, Lieblich S, Lee J, Dunne J. Are seizures in the setting of sleep deprivation provoked?. Epilepsy Behav 2014; 33: 122-125
    CrossrefPubMedGoogle Scholar
  • 30 Foldvary-Schaefer N, Andrews ND, Pornsriniyom D, Moul DE, Sun Z, Bena J. Sleep apnea and epilepsy: who's at risk?. Epilepsy Behav 2012; 25 (03) 363-367
    CrossrefPubMedGoogle Scholar
  • 31 Grigg-Damberger MM, Ralls F. Sleep disorders in adults with epilepsy: past, present, and future directions. Curr Opin Pulm Med 2014; 20 (06) 542-549
    PubMedGoogle Scholar
  • 32 Pornsriniyom D, Kim Hw, Bena J, Andrews ND, Moul D, Foldvary-Schaefer N. Effect of positive airway pressure therapy on seizure control in patients with epilepsy and obstructive sleep apnea. Epilepsy Behav 2014; 37: 270-275
    CrossrefPubMedGoogle Scholar
  • 33 Kuo J, Zhao W, Li CS, Kennedy JD, Seyal M. Postictal immobility and generalized EEG suppression are associated with the severity of respiratory dysfunction. Epilepsia 2016; 57 (03) 412-417
    CrossrefPubMedGoogle Scholar
  • 34 Kang JY, Mintzer S. Driving and epilepsy: a review of important issues. Curr Neurol Neurosci Rep 2016; 16 (09) 80
    CrossrefPubMedGoogle Scholar
  • 35 Epilepsy Foundation. State Driving Laws Database. Available at: https://www.epilepsy.com/driving-laws . Accessed January 19, 2017
    PubMedGoogle Scholar
  • 36 Takeda N, Maemura K. Circadian clock and cardiovascular disease. J Cardiol 2011; 57 (03) 249-256
    CrossrefPubMedGoogle Scholar
  • 37 Aizawa Y, Kohno T, Yuasa S, Fukuda K. The role of circadian rhythms in fatal arrhythmias and the potential impact of intervention for sleep-disordered breathing. Curr Pharm Des 2015; 21 (24) 3512-3522
    CrossrefPubMedGoogle Scholar
  • 38 Buxton OM, Ellenbogen JM, Wang W. , et al. Sleep disruption due to hospital noises: a prospective evaluation. Ann Intern Med 2012; 157 (03) 170-179
    CrossrefPubMedGoogle Scholar
  • 39 Chen WR, Shi XM, Yang TS, Zhao LC, Gao LG. Protective effect of metoprolol on arrhythmia and heart rate variability in healthy people with 24 hours of sleep deprivation. J Interv Card Electrophysiol 2013; 36 (03) 267-272 , discussion 272
    CrossrefPubMedGoogle Scholar
  • 40 Mehra R, Benjamin EJ, Shahar E. , et al; Sleep Heart Health Study. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173 (08) 910-916
    CrossrefPubMedGoogle Scholar
  • 41 Baranchuk A. Sleep apnea, cardiac arrhythmias, and conduction disorders. J Electrocardiol 2012; 45 (05) 508-512
    CrossrefPubMedGoogle Scholar
  • 42 Huikuri HV, Stein PK. Heart rate variability in risk stratification of cardiac patients. Prog Cardiovasc Dis 2013; 56 (02) 153-159
    CrossrefPubMedGoogle Scholar
  • 43 Avidan AY, Barkoukis TJ. Review of Sleep Medicine. Philadelphia, PA: Elsevier/Saunders; 2011
    Google Scholar
  • 44 Arzt M, Hetzenecker A, Steiner S, Buchner S. Sleep-disordered breathing and coronary artery disease. Can J Cardiol 2015; 31 (07) 909-917
    CrossrefPubMedGoogle Scholar
  • 45 Horner RL. Neural control of the upper airway: integrative physiological mechanisms and relevance for sleep disordered breathing. Compr Physiol 2012; 2 (01) 479-535
    PubMedGoogle Scholar
  • 46 Trachtenberg FL, Haas EA, Kinney HC, Stanley C, Krous HF. Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign. Pediatrics 2012; 129 (04) 630-638
    CrossrefPubMedGoogle Scholar
  • 47 Carberry JC, Jordan AS, White DP, Wellman A, Eckert DJ. Upper airway collapsibility (pcrit) and pharyngeal dilator muscle activity are sleep stage dependent. Sleep 2016; 39 (03) 511-521
    CrossrefPubMedGoogle Scholar
  • 48 Sato K, Nakashima T. Human adult deglutition during sleep. Ann Otol Rhinol Laryngol 2006; 115 (05) 334-339
    CrossrefPubMedGoogle Scholar
  • 49 Ellenbogen JM. Sleepiness. Semin Neurol 2016; 36 (05) 449-455
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep 1996; 19 (04) 318-326
    CrossrefPubMedGoogle Scholar
  • 51 Killgore WD. Effects of sleep deprivation on cognition. Prog Brain Res 2010; 185: 105-129
    PubMedGoogle Scholar
  • 52 Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003; 26 (02) 117-126
    CrossrefPubMedGoogle Scholar
  • 53 Weinhouse GL, Schwab RJ, Watson PL. , et al. Bench-to-bedside review: delirium in ICU patients - importance of sleep deprivation. Crit Care 2009; 13 (06) 234
    CrossrefPubMedGoogle Scholar
  • 54 Mirrakhimov AE, Brewbaker CL, Krystal AD, Kwatra MM. Obstructive sleep apnea and delirium: exploring possible mechanisms. Sleep Breath 2014; 18 (01) 19-29
    CrossrefPubMedGoogle Scholar
  • 55 Duffy JF, Zitting KM, Czeisler CA. The case for addressing operator fatigue. Rev Hum Factors Ergon 2015; 10 (01) 29-78
    PubMedGoogle Scholar
  • 56 Strohl KP. Drowsy Driving and Automobile Crashes. Available at: https://one.nhtsa.gov/people/injury/drowsy_driving1/Drowsy.html - NCSDR/NHTSA. Accessed January 29, 2017
    PubMedGoogle Scholar
  • 57 Tefft BC. Acute Sleep Deprivation and Risk of Motor Vehicle Crash Involvement. Washington, DC: AAA Foundation for Traffic Safety; 2016
    Google Scholar
  • 58 Arnedt JT, Wilde GJ, Munt PW, MacLean AW. How do prolonged wakefulness and alcohol compare in the decrements they produce on a simulated driving task?. Accid Anal Prev 2001; 33 (03) 337-344
    CrossrefPubMedGoogle Scholar
  • 59 Fairclough SH, Graham R. Impairment of driving performance caused by sleep deprivation or alcohol: a comparative study. Hum Factors 1999; 41 (01) 118-128
    CrossrefPubMedGoogle Scholar
  • 60 Hack MA, Choi SJ, Vijayapalan P, Davies RJ, Stradling JR. Comparison of the effects of sleep deprivation, alcohol and obstructive sleep apnoea (OSA) on simulated steering performance. Respir Med 2001; 95 (07) 594-601
    CrossrefPubMedGoogle Scholar
  • 61 Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature 1997; 388 (6639): 235
    CrossrefPubMedGoogle Scholar
  • 62 Mitler MM, Carskadon MA, Czeisler CA, Dement WC, Dinges DF, Graeber RC. Catastrophes, sleep, and public policy: consensus report. Sleep 1988; 11 (01) 100-109
    CrossrefPubMedGoogle Scholar
  • 63 Landrigan CP, Rothschild JM, Cronin JW. , et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med 2004; 351 (18) 1838-1848
    CrossrefPubMedGoogle Scholar
  • 64 McCarter SJ, Boswell CL, St Louis EK. , et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med 2013; 14 (03) 237-242
    CrossrefPubMedGoogle Scholar
  • 65 Kaye AD, David SF. Principles of Neurophysiological Assessment, Mapping and Monitoring. New York, NY: Springer; 2014
    Google Scholar
  • 66 Dato VM, Campagnolo ER, Long J, Rupprecht CE. A systematic review of human bat rabies virus variant cases: evaluating unprotected physical contact with claws and teeth in support of accurate risk assessments. PLoS One 2016; 11 (07) e0159443
    CrossrefPubMedGoogle Scholar
  • 67 Manning SE, Rupprecht CE, Fishbein D. , et al; Advisory Committee on Immunization Practices Centers for Disease Control and Prevention (CDC). Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2008; 57 (RR-3): 1-28
    PubMedGoogle Scholar