From burlesque to horror: a century of sleepwalking on the silver screen.

BACKGROUND: Long before being described as a disorder, sleepwalking was considered as a mysterious phenomenon inspiring artwork. From the early beginning of cinema, sleepwalkers were shown to populations, playing a crucial role in storytelling and collective knowledge. OBJECTIVE: We characterized how sleepwalking has been portrayed in a large number of movies from the origins of cinema to recent years. METHODS: Movies containing the words "sleepwalking" or "somnambulism" were searched for in International Movie Databases. Types of movies, sleepwalking characters, postures and behaviors during episodes, triggers, and suggested treatments were collected. RESULTS: Production of 87 movies and 22 cartoons portraying sleepwalkers was clustered around two peaks, in the 1910s and 2010s. Comedies predominated before 1960, and thriller/horror movies as a dominant genre after 1960. In contrast with real-life sleepwalking epidemiology, sleepwalkers are more often portrayed as women than men (and often wearing a transparent white nightgown), as adults more than children on-screen, and 23% suffered psychiatric comorbidities. The unrealistic posture of outstretched arms and eyes closed was found in 20% of movies and 79% of cartoons. Night terrors, sexsomnias (kissing, having sex, initiated pregnancy), sleep-related eating and sleep driving were also featured. Homicides and falls while sleepwalking were recurrent fear-inducing topics. The first sleep EEG was featured in a sleepwalking movie in 1985, and a sleep specialist gave his first advice in 1997. DISCUSSION: The representation of sleepwalking on the screen seems to have evolved from popular, unrealistic stereotypes of somnambulism towards a medical condition, paralleling the development of sleep medicine.

Automatic Sleep Stages Classification Combining Semantic Representation and Dynamic Expert System.

Interest in sleep has been growing in the last decades, considering its benefits for well-being, but also to diagnose sleep troubles. The gold standard to monitor sleep consists of recording the course of many physiological parameters during a whole night. The human interpretation of resulting curves is time consuming. We propose an automatic knowledge-based decision system to support sleep staging. This system handles temporal data, such as events, to combine and aggregate atomic data, so as to obtain high-abstraction-levels contextual decisions. The proposed system relies on a semantic reprentation of observations, and on contextual knowledge base obtained by formalizing clinical practice guidelines. Evaluated on a dataset composed of 131 full night polysomnographies, results are encouraging, but point out that further knowledge need to be integrated.

OSA treatment with CPAP: Randomized crossover study comparing tolerance and efficacy with and without humidification by ThermoSmart.

OBJECTIVES: Adherence to continuous positive airway pressure (CPAP) remains an issue, as adverse effects (AE) such as rhinitis, dry/congested nose, dry mouth or throat are commonly experienced. The aim of the study was to compare CPAP efficacy and tolerance in severe obstructive sleep apnea (OSA) patients with or without (w/o) heated humidification using the ThermoSmart system. METHODS: Multicenter RCT study in which CPAP-naive patients with severe OSA and meeting one or more of the following criteria: >65 years, using >1 drying medication, previous nasal symptoms or nasal surgery, were included. Patients were randomized to CPAP w/o heated humidification for 1 month and then crossed-over to the other treatment arm for another month. Naso-pharyngeal symptoms, Quality of life (FOSQ-10), sleepiness (ESS) and CPAP compliance and efficacy data were collected. RESULTS: Forty patients were enrolled: age 62 ± 9 years, diagnostic AHI 46.7 ± 15.3/hour. About 70% were using >1 drying medication, mainly antihypertensives. Both treatment modalities were found to normalize AHI and decrease sleepiness with no differences between 2 modes, compliance (4.63 ± 0.39 vs 4.70 ± 0.36 h/night) or leaks (32.4 ± 2.0 versus 31.1 ± 1.7l/min). With heated humidification, there was a significant decrease in nasal symptoms such as dry/congested nose. At the study end, 26 patients preferred ThermoSmart ON, 3 did not have preference and 11 preferred ThermoSmart OFF. CONCLUSION: ThermoSmart helps to decrease nose and throat discomfort because of CPAP therapy, these effects did not translate to better compliance but patients had a preference for ThermoSmart.

Early Electroencephalography Findings in Cardiogenic Shock Patients Treated by Venoarterial Extracorporeal Membrane Oxygenation.

OBJECTIVES: We aimed to assess early electroencephalography findings in patients treated by venoarterial extracorporeal membrane oxygenation and their association with neurologic outcome. DESIGN: Single-center observational study. SETTING: Medical ICU of a university hospital. PATIENTS: An early standardized electroencephalography assessment, that is, standard electroencephalography followed by continuous electroencephalography, was performed in consecutive cardiogenic shock patients requiring venoarterial extracorporeal membrane oxygenation. Associations between electroencephalography findings and outcome, defined as a composite of acute brain injury or death at 14 days, were investigated. MEASUREMENTS AND MAIN RESULTS: Twenty-two patients with a median Full Outline of Unresponsiveness score of 4 (interquartile range, 3-6) were studied. Pupillary light reflex, corneal reflex, and cough reflex were preserved in 20 (90%), 17 (77%), and 17 (77%) patients, respectively. Overall, standard electroencephalography findings consisted of diffuse slowing in 21 patients (95%) and severe background abnormalities in 13 patients (59%) (i.e., a discontinuous [n = 5; 23%] and/or an unreactive background [n = 9; 41%]). Severe background abnormalities on standard electroencephalography (poor outcome rate: 69% vs 22%; p = 0.03) and absence of sleep transients on continuous electroencephalography (poor outcome rate: 67% vs 14%; p = 0.02) were associated with a poor outcome, whereas neurologic findings and doses of sedation were not. Patients without sleep transients on continuous electroencephalography tended to have lower Full Outline of Unresponsiveness scores than patients with preserved sleep transients-appearing patterns. CONCLUSIONS: In patients treated by venoarterial extracorporeal membrane oxygenation, early severe background abnormalities on standard electroencephalography provide important information on neurologic outcome. The lack of sleep transients on continuous electroencephalography reflects the severity of brain dysfunction and might represent an additional prognostic marker.

A novel hereditary extensive vascular leukoencephalopathy mapping to chromosome 20q13.

OBJECTIVE: The detection of a leukoencephalopathy is a frequent situation in neurologic practice. In a number of cases, the etiology remains obscure despite extensive investigations. We characterized the clinical, pathologic, and genetic features of a novel hereditary vascular leukoencephalopathy. METHODS: After the observation of a similar leukoencephalopathy in 2 sisters, clinical, neuroimaging, and molecular genetics investigations were conducted in 21 of their consenting relatives. Pathologic data were obtained in one patient. RESULTS: Fourteen members presented with significant white matter lesions at MRI examination, among whom only 5 individuals were symptomatic. The main clinical manifestations included gait disturbances, transient movement disorders, stroke, and cognitive dysfunction. The 9 remaining members aged from 26 to 60 years were asymptomatic. The MRI pattern was highly stereotyped with symmetric white matter hyperintensities worsening with patient's age. We mapped the gene involved in this condition on chromosome 20q13. Neuropathologic examination suggested that this leukoencephalopathy is underlaid by a cerebral arteriolopathy affecting small preterminal arterioles, clearly distinct from amyloid angiopathy and hypertension-related small-vessel disease. CONCLUSIONS: These data establish that this family is affected by a novel autosomal dominant vascular leukoencephalopathy mapping to chromosome 20q13. This disease is characterized by a progressive and age-related hemispheric and brainstem leukoencephalopathy contrasting with the paucity and late onset of clinical symptoms in most of the cases.

Plasmapheresis for the treatment of acute pancreatitis induced by hemophagocytic syndrome related to hypertriglyceridemia.

Histiocytic cytophagic panniculitis is an unusual form of hemophagocytic syndrome related to T-cell lymphoma that can be responsible for hypertriglyceridemia. The elevation of serum triglycerides, usually in the setting of familial lipidemia or during uncontrolled diabetes mellitus, is a well-recognized cause of pancreatitis. We report here on the treatment by plasmapheresis of a patient suffering from a T-cell lymphoma-related panniculitis who presented with an acute pancreatitis induced by hypertriglyceridemia. The Ranson scoring system at day 2 was increased and predicted a poor course while clinical features worsened. The patient was treated with one plasmapheresis that allowed a dramatic (89%) decrease in the triglycerides level. The acute pancreatitis resolved and the patient was discharged from the intensive care unit at day 5 with lipids and pancreatic enzyme levels within normal range. To our knowledge, this is the first case of acute pancreatitis induced by hypertriglyceridemia in the setting of an uncontrolled cytophagic histiocytic panniculitis successfully treated by plasmapheresis.