80 Patients with OSAS on CPAP or BIPAP should

be reevaluated at regular intervals to assess compliance, address problems, and reinforce the importance of continued treatment. Surgery is indicated for OSAS patients who have an underlying specific surgically correctable abnormality that is causing sleep apnea and may be indicated in patients who are not candidates for or have failed other noninvasive treatments, desire surgery, and are medically stable.90 Identification of the site(s) of obstruction is necessary in choosing the appropriate surgical intervention. Inhibitors,research,lifescience,medical Methods of localizing the site of obstruction include endoscopy, pressure catheters, fluoroscopy, computed tomography Inhibitors,research,lifescience,medical (CT) scan, or magnetic resonance imaging (MRI).91 Surgical procedures can be divided into phase I and phase II surgical procedures.92-96 Phase I involves palatal and lingual surgery: tonsillectomy, uvulopalatopharyngoplasty (LJPPP),uvulopalatal flap (UPF), modified UPPP, palatal advancement, genioglossus advancement, hyoid suspension, laser midline glossectomy, lingualoplasty, and radiofrequency of the soft

palate Inhibitors,research,lifescience,medical and tongue base. Phase II procedures either advance the jaws (maxillomandibular osteotomy) or widen the jaws using distraction procedures. Central sleep apnea is characterized by either shallow or absent breathing during sleep associated with one of the Afatinib in vivo following features: gasping, grunting, choking movements, frequent body movement, and cyanosis. The PSG shows central apneic pauses >10 s (20 s in infancy) in duration, with one or more of the following: bradytachycardia; frequent arousals from sleep; or oxygen desaturation associated with apneas4. MSLT may or may not demonstrate a mean sleep latency <10 Inhibitors,research,lifescience,medical min. Treatment of central sleep apnea involves treatment

of comorbid Inhibitors,research,lifescience,medical medical conditions (congestive heart failure, nasal congestion, OSAS), consideration of supplemental oxygen (1-2 L/min via nasal cannula), or use of acetazolamide (125-250 mg, two to three times per day).7 Patients with central apneas before and after an arousal, without evidence of desaturation, Tryptophan synthase may benefit from a trial of a hypnotic agent (Zolpidem, 5-10 mg at night).7 RLS and PLMD RLS has a prevalence of 10% to 15% among patients between the ages of 27 to 41 years.97 It consists of unpleasant creeping or crawling sensations inside the calves and generalized aches and pains in the legs associated with a desire to move the extremities, motor restlessness, worsening of symptoms at rest with at least temporary relief by activity, nocturnal worsening of symptoms (circadian pattern), and difficulty initiating sleep in the absence of any medical, mental, or other sleep disorder that would account for the symptoms.97-99 RLS can be idiopathic or secondary to iron deficiency, peripheral neuropathies, or uremia.