Patients with neurological disease have an increased risk of a variety of sleep-related breathing disturbances that include OSA, periodic breathing, hypoventilation, and hypoxemia. These disturbances, in turn may have a negative impact on the patients' neurological state. Clinicians must therefore be cognizant of subtle sleep-related breathing issues that afflict each neurological disease and proceed with an appropriate evaluation and treatment tailored to the individual disease state.
Extremity weakness, decreased cognitive function, restricted movements during sleep and pain or spasticity are all issues that demand the physicians and polysomnographic technologists to come up with creative solutions for optimal use of CPAP/BPAP devices. Safety issues for patients with epilepsy, or those with limited sensory, motor or cognitive abilities should be outlined prior to patients' arrival to the sleep lab and considered in the choice of therapy. For all these patients, involvement of a caregiver is paramount to optimize adherence to the treatment plan. Yet, our real challenge is for clinicians to recognize SRBDs in these complex patients as opportunities to improve the quality of life and to have a potentially positive impact on their neurological state. Through this recognition, decisive investigation of the sleep related issues and customized effective therapies can make significant gains for these patients.
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