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Sleep, Stroke and Cardiovascular Disease
  • Edited by Antonio Culebras
  • Published online:
    05 January 2013
    Print publication:
    06 December 2012
  • The relationship between sleep disorders – in particular sleep apnea, a highly prevalent condition – and common vascular disturbances such as stroke and hypertension is an area of active research. Summarizing the clinical evidence to date between sleep disorders and vascular pathology, this is the first time a comprehensive overview of this relationship has been covered in a single volume. Bringing together some of the world's most renowned authors in the field, Sleep, Stroke and Cardiovascular Disease contains recommended treatment plans – allowing for rapid and accurate diagnosis and management of patients – enabling learning from real experience. Of interest, not only, to specialists who intervene in diagnosis and management of sleep and stroke disorders such as neurologists, cardiologists and pulmonologists, the book will also be of value to primary-care practitioners, allowing them to arrive at better diagnoses and management of sleep and vascular disorders.

  • Chapter 1 - Overview of sleep and stroke

  • Edited by Antonio Culebras
  • Book:
    Sleep, Stroke and Cardiovascular Disease
    Published online:
    05 January 2013
    Print publication:
    06 December 2012, pp 1-10

  • Summary

    The sleep apnea syndrome occurs in 4% of adult men and 2% of adult women. Inflammation and hypoxia are intertwined at the molecular, cellular, and clinical levels. Sleep apnea influences heart rate variability, during sleep and during wakefulness. It is also an independent risk factor for stroke. Sleep apnea may also lead to cognitive dysfunction from the effects of chronic hypoxia and sympathetic stress associated with small-vessel disease in the brain, white matter ischemia, and lacunar strokes. This syndrome is a modifiable risk factor and therefore efforts to control this condition in patients at risk of vascular disease is a clinical endeavor that should be pursued vigorously, even though clinical research needs to persist in its quest to answer pressing pathophysiological questions. Emerging evidence suggests that restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) represent risk factors for cardio- and cerebrovascular disease, even leading to stroke.

Case Studies in Sleep Neurology
  • Common and Uncommon Presentations
  • Edited by Antonio Culebras
  • Published online:
    10 November 2010
    Print publication:
    23 September 2010
  • Sleep disorders are increasingly recognized as a major clinical problem, with significant morbidity and considerable economic importance. This compendium of case studies presents a diverse range of situations which challenge the problem-solving abilities of all those interested in sleep disorders, covering both common and unusual cases. Each case begins with a clinical history, followed by examination findings and special investigations and culminating in diagnosis, treatment and management, with discussion of differential diagnosis where appropriate. Focusing attention on the major categories of sleep medicine, including insomnia, hypersomnias, sleep-breathing disorders, parasomnias, movement disorders, circadian dysrhythmias and the neurology of sleep, this clinical guide promotes integrative thinking and diagnostic skill. Historical and review citations, illustrations and concise real-life stories stimulate memory and facilitate learning. Written and edited by an international cadre of sleep professionals, this book will inform and challenge established specialists and provide a stimulating teaching tool for those in training.

  • Case 6 - A sleepy-head

  • from Part II - Hypersomnias of central origin
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 39-42

  • Summary

    This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 25-year old patient who was admitted for the evaluation of insomnia. The specialist made a diagnosis of narcolepsy with possible cataplexy and decided not to pursue a CSF hypocretin analysis in light of the diagnostic certainty of the polysomnography (PSG) results. The multiple sleep latency test (MSLT) showed the presence of REM sleep in all four naps with a latency of 5 minutes. He prescribed modafinil 200 mg to be taken in the morning, a dose that could be increased to 400 mg if necessary. Narcolepsy is a life-long disorder presenting with excessive daytime sleepiness (EDS) and, ironically, with fragmented sleep that may lead to an erroneous diagnosis of insomnia. In addition to modafinil, patients may respond favorably to the administration of methylphenidate and dexedrine.

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