Chapter 21

Gallery of Sleep Laboratory Video Findings

Meir H. Kryger

This chapter contains examples of video findings obtained in a typical sleep medicine clinic polysomnography lab. They are grouped into categories. Most modern sleep lab acquisition systems allow the collection of synchronized digital videos. The videos can be played back in real time, or they can be sped up. Video clips referred to here were obtained during sleep studies of patients with sleep disorders and are available at the Atlas of Clinical Sleep Medicine collection at www.expertconsult.com.

Obstructive Sleep Apnea

Apnea, Restlessness in a Child

This 12-year-old boy came to medical attention with restless sleep, a common presentation of sleep apnea in children of all ages. The restlessness is often present the entire night (Video 21-1).

Nasal Obstruction and Apnea

This patient had been a boxer, had his nose fractured several times, and could not breathe through his nasal airway. During sleep he demonstrated periods of silence, noisy breathing, and restlessness (Video 21-2).

Arousal Threshold to Noise in Obstructive Sleep Apnea

This patient with sleep apnea is snoring loudly and sleeping on his side when a fire alarm goes off. The patient does not arouse or wake in response to the noise (Video 21-3).

Obstructive Sleep Apnea, Violent Body Movements

Excessive body movements linked to episodes of apnea are evident in this patient with obstructive sleep apnea (OSA) (Video 21-4).

Obstructive Sleep Apnea, Violent Body Movements (×10)

In the same patient as shown in Video 21-4, the video is sped up by a factor of 10 to better show the frequency and vigor of the movements (Video 21-5).

Atypical Snoring After Uvulopalatopharyngoplasty

This patient had undergone a uvulopalatopharyngoplasty, which removed part of the soft palate. The patient continued to have sleep apnea, but the snoring noises were atypical and were quite different than those observed preoperatively (Video 21-6).

Vigorous Movements in Obstructive Sleep Apnea (×10)

In many patients with sleep apnea, vigorous movements are often associated with the apnea. These sometimes result in the patient being diagnosed as having periodic limb movement disorder (PLMD) or periodic limb movements of sleep (PLMS). These movements often resolve with treatment. This clip has been sped up by a factor of 10 (Video 21-7).

Obstructive Sleep Apnea in Special Populations

Obesity Hypoventilation

This patient had obesity hypoventilation syndrome and evidence of both OSA and hypoventilation (Video 21-8).

Obesity Hypoventilation, Heart Failure

The patient shown in Video 21-8 also had the features of severe right-sided heart failure with massive peripheral edema. When he hypoventilated, he was relatively quiet. When obstructed, he demonstrated chest wall abdominal paradox and then loud snoring (Video 21-9).

Obesity Hypoventilation, Treated

The same patient shown in Videos 21-8 and 21-9 was treated with bilevel pressure and had an excellent response (Video 21-10).

Obstructive Sleep Apnea in Pregnancy

This pregnant woman had severe OSA related to obesity. She had a very high breathing frequency that was especially noticeable during unobstructed breathing (Video 21-11).

Postpartum Obstructive Sleep Apnea

This woman was 4 months postpartum and had difficulty caring for her new baby. She had had undiagnosed sleep apnea for years. A previous pregnancy ended with a miscarriage (Video 21-12).

Postpartum Obstructive Sleep Apnea, Treated

The same patient shown in Video 21-12 is on continuous positive airway pressure (CPAP) and sleeps with her mouth closed. The CPAP is much quieter than her snoring (Video 21-13).

Apnea in Acromegaly

This 71-year-old woman had acromegaly, with abnormalities in her jaw structure and an enlarged tongue. Stridor was noted (Video 21-14).

Apnea in Acromegaly (×10)

In the same patient shown in Video 21-14, the video has been sped up by a factor of 10 to show the marked movements of the jaw during sleep (Video 21-15).

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