Periodic Limb Movement Disorder Ebook
Loud snoring with gasping or choking sounds, witnessed apneas, restless sleep, hypertension, and neck circumference greater than 16.5 inches are useful predictors of OSA, but a definitive diagnosis usually requires polysomnography. Among children, snoring or noisy breathing, daytime mouth breathing, and parental observation of apneas and struggles to breathe are suggestive symptoms. The absence of snoring and obesity does not rule out OSA in either adults or children. In patients with excessive daytime sleepiness, other diagnostic considerations include narcolepsy, idiopathic hypersomnia, periodic limb movement disorder (PLM), central sleep apnea, and the insufficient sleep syndrome. The differential diagnosis of nocturnal choking and gasping includes gastroesophageal reflux, nocturnal asthma, congestive heart failure, nocturnal panic attacks, and sleep-related laryngospasm.
Obtaining a detailed clinical history is especially important when diagnosing a sleep disturbance because routine physical examination is often not revealing during the waking hours. From the history, age of onset, duration and progression of the sleep complaint, and the general classification of the type of sleep disturbance is usually obtained. The International Classification of Sleep Disorders categorizes sleep disturbances as (1) dyssomnias or disorders that result in insomnia or excessive sleepiness (2) parasomnias or disorders of arousal, partial arousal, or sleep stage transition and (3) sleep disorders associated with medical or psychiatric disorders. The dyssomnias include the intrinsic sleep disorders arising from bodily malfunctions such as psychophysiological insomnia, obstructive and central sleep apnea, restless legs syndrome (RLS), and periodic limb movement disorder (PLMD). Examples of parasomnias include sleep walking, sleep terrors, sleep talking, nightmares, REM...
Restless Leg Syndrome
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