Anybody care to try to explain why sleep apnea is treated with the
high altitude drug .. ?
And also try to explain why they are all linked to migraine .. ?

Anybody with lupus get .. migraines .. ?

And again maybe explain why people with erythrocytosis get sleep
apnea .. ?

"Acetacolamide or oxygen"

Sanner B, Schäfer T
[Central sleep apnea syndrome] [English Abstract, Journal Article,
Review]
Dtsch Med Wochenschr 2008 Apr; 133(14):722-6.

Central sleep apnea (CSA) is characterized by a lack of drive to
inspire for at least 10 sec. In the CSA-syndrome accompanying arousals
and desaturations of the arterial blood cause sleep disturbances and
sympathetic nerve activations which lead to excessive daytime
sleepiness and increase the risk for cardiovascular morbidity. There
are six manifestations of CSA: a rare primary or idiopathic form,
often in hypocapnic patients with an increased hypercapnic ventilatory
drive; Cheyne-Stokes respiration, characterised by periodic CSA and a
crescendo/decrescendo breathing pattern, often in patients with severe
cardiac or neurological diseases; high altitude-induced periodic
breathing (above 4000 m), CSA due to medical or neurological
conditions; CSA due to drug or substance use; and primary sleep apnea
of infancy. Besides the consequent treatment of the underlying medical
conditions therapeutic options include the use of drugs, e. g.
acetacolamide or oxygen, as well as non-invasive ventilation, e. g.
continuous positive airway pressure (CPAP) or adaptive servo-
ventilation.

--------------------------------------------

Migraine Linked to Sleep Apnea in Children and Teens

Kathleen Louden
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April 22, 2008 (Chicago, Illinois) — In children and teenagers with
both headaches and sleep complaints, a new study using polysomnography
showed an association between migraine and sleep-disordered breathing
and between tension headache and bruxism.

Patients in this study were evaluated at St. Christopher Hospital for
Children, Drexel University, in Philadelphia, Pennsylvania. Ninety
patients with headache and sleep problems aged 5 to 19 years underwent
polysomnography, an electroencephalography-based sleep test. Migraine
was the most common type of headache, occurring in 60 of the 90
patients. Another 11 patients had chronic daily headache, 6 had
tension headache, and 13 had nonspecific headache, such as morning
headache. Sleep-disordered breathing, including obstructive sleep
apnea, was about twice as common in the migraineurs as in patients
with other types of headache (56% vs 30%, respectively), the authors
found.

"Parents and doctors need to be aware of the strong likelihood of
sleep disorders in children with migraine," said lead author Martina
Vendrame, MD, PhD, from the department of neurology at Temple
University, also in Philadelphia.

Dr. Vendrame presented the results at the American Academy of
Neurology (AAN) 60th Annual Meeting.

Ask About Sleep

A neurologist who did not participate in the study called it "a good
step in recognizing the broad reach of disordered sleep." Bradley V.
Vaughn, MD, professor of neurology at the University of North Carolina
at Chapel Hill, moderated the highlights session on sleep disorders at
the meeting.

"Children with headache should be questioned about symptoms of sleep
disorders because there's a high incidence of them in this group," Dr.
Vaughn told Medscape Neurology & Neurosurgery.

During a press briefing, Dr. Vendrame said physicians should ask
parents of children with migraine about snoring, frequent awakening
during sleep, and daytime sleepiness.

When asked whether the fact that all of their patients had reported
sleep problems could have biased the study results, Dr. Vendrame
agreed it was possible. She told Medscape Neurology & Neurosurgery,
"We want to repeat the study in a general population of children or in
children who have headache but do not report sleep complaints."

However, polysomnograms showed disturbed sleep architecture in the
study patients with severe migraine and with chronic daily headache
(occurring more than 15 days a month). These children and teens took a
longer time to fall asleep, had shorter rapid eye movement (REM)
sleep, and slept less total time than did those with milder or less
frequent migraine, she reported.

"Children with migraines take naps, and that can affect sleep
architecture," Dr. Vendrame said at the press conference. "But
headache may contribute to sleep disorders in children. We think they
share common mechanisms, which may be related to REM sleep."

The authors observed other sleep disturbances. Three (50%) of the
patients with tension headache had bruxism, whereas only 2.4% of the
patients with other types of headache ground their teeth during sleep,
according to the abstract.

Referral

"Teeth grinding is related to dysfunction of the temporomandibular
joint, and these children need to be referred to a dental specialist,"
Dr. Vendrame said.

Most of the children with sleep apnea needed referral to an ear-nose-
throat (ENT) specialist, and about 50% of those children underwent
tonsillectomy, the author said. "After surgery, about 80% had less
severe and less frequent migraine," she said. "This needs more follow-
up."

American Academy of Pediatrics guidelines for children with symptoms
of sleep disorders are to refer them for a sleep study, according to
Dr. Vaughn. "However, there are not as many sleep centers that do
sleep studies in children as there are for adults," he said. "As a
backup plan, have an ENT evaluate the child."

Polysomnography is not part of the usual migraine workup in children.
The sleep test monitors the brain, eye movements, breathing, cardiac
rhythm, and muscle activity.

Drs. Vendrame and Vaughn report no relevant financial disclosures.

American Academy of Neurology 60th Annual Meeting: Abstract S49.008.
Presented April 17, 2008
--------------------------------------------------------------------------------

Kathleen Louden is a freelance writer for Medscape.

Medscape Medical News 2008. © 2008 Medscape

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