Studies that controlled for environmental factors and sleep/wake schedule reported no significant disturbances in sleep architecture. Nevertheless, several studies have consistently reported that the main change in sleep architecture during fasting is a reduction in the proportion of REM sleep.
Central alveolar hypoventilation is rarely encountered. This case report describes a young woman who was recently diagnosed with hypertension and ischemic heart disease. She presented to the emergency room with hypercapnic respiratory failure, for which she was mechanically ventilated. This was preceded by an acute upper respiratory tract infection. She was initially suspected to have Guillain-Barré syndrome, but further investigations ruled out neuromuscular or autoimmune disorders. Sleep-related hypoventilation was suspected after she experienced recurrent apneas at night that resulted in re-intubation. Polysomnographic studies confirmed episodes of central apnea and hypopnea during sleep, with significant carbon dioxide retention and oxygen desaturations. She required nocturnal ventilation via a tracheostomy tube until a diaphragmatic pacer could be placed. Using bi-level positive airway pressure and average volume-assured pressure support together with the diaphragmatic pacer, adequate ventilation during sleep was achieved.
Sleep medicine as an independent medical specialty is relatively new in Saudi Arabia. Since its foundation, there has been significant growth and an increase in the number of sleep medicine physicians and technologists to meet the continuous increase in demand among the Saudi population. In response to the expansion of sleep medicine in Saudi Arabia, the Saudi Commission for Health Specialties (SCHS) established clear guidelines for the accreditation of sleep medicine physicians and technologists in 2012. Currently, there are two training programs providing structured training and certification in sleep medicine in Saudi Arabia. Despite this progress, there are still many difficulties hindering sleep medicine growth in Saudi Arabia, including the shortage of trained technicians, and specialists, the lack of financial support, and awareness of sleep disorders and their profound effects on healthcare workers and healthcare authorities. In the future, it is essential to introduce sleep medicine in the medical educational system at all levels to show the importance of early recognition and management of sleep disorders, in addition to developing research that is necessary to build knowledge about the prevalence of many sleep disorders in order to help to plan the number of sleep specialists and sleep facilities needed to meet the increasing demands. This chapter discusses the current practice of sleep medicine, and the challenges it faces in Saudi Arabia, in addition to the available data and research about common sleep disorders among the Saudi population.
Purpose of Review Kleine – Levin syndrome (KLS) is a rare relapsing–remitting sleep disorder distinguished by recurrent periods of severe hypersomnia accompanied by cognitive, mood, and behavioral changes. This review focuses mainly on the most recent developments and articles concerning this illness in the preceding five years while attempting to provide a basic overview of KLS. Recent Findings Genetic links were reported in some patients with KLS, like variation in TRANK1 in a worldwide case – control genome-wide association in patients with KLS, in addition to several uncommon variations in the LMOD3 gene, some of which are likely to be pathogenic, discovered by linkage analysis and exome sequencing in a sizable Saudi Arabian family with KLS and a European cohort of KLS patients. Additionally, recent data indicate that the amplitude of the circadian active/rest cycles significantly decreased during hypersomnia attacks, but during asymptomatic periods, it did not differ significantly from the controls. Moreover, patients with KLS are at a higher risk of developing emerging psychiatric disorders during follow-up. Recent data also points to possible discoveries of diagnostic-potential dysregulated proteomic patterns in KLS. Finally, new data suggest that functional imaging studies are often abnormal in KLS both during and between episodes. Summary KLS is an uncommon, severe, and uniform illness. When it comes to the diagnosis and treatment of KLS, these characteristics offer both opportunities and challenges. Over the past five years, some promising work has appeared in genetics, functional imaging, and biomarker identification; nevertheless, these areas still need more focus to advance the detection and treatment of patients suffering from KLS.
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