Images in Sleep Medicine

Can nocturnal groaning be suspected by cardiorespiratory polygraphy?

Introduction to the case

A 15-year-old girl was brought by her parents to the sleep clinic to undergo ambulatory nocturnal cardiorespiratory polygraphy for ‘suspected snoring and sleep apnea’ as requested by an otorhinolaryngologist, albeit the actual reason for consult was the social and family problem due to loud ‘snoring’. Her parents witnessed recurrent episodes of unusual nocturnal sounds occurring in clusters every night. The patient had a regular sleep schedule; she did not complain of daytime sleepiness or of

Image analysis

Fig. 1. Two-minute segment obtained from a nocturnal sleep cardiorespiratory monitoring showed eupneic breathing switching to bradypneic breathing associated with cluster of expiratory noises.

Fig. 2. Two-minute segment of nocturnal full PSG performed one month later at home. Expiratory groaning emerged from stage N2 during laboratory full PSG recording. Eupneic breathing switched to catathrenic breathing. The cycle length is mainly engaged by expiratory phase during groaning. Inspiration is

Discussion

Full PSG is considered the investigation of choice to diagnose nocturnal groaning in order to distinguish it from other sleep-related breathing phenomena [1]. This approach is essential to assess this rare and scarcely characterized parasomnia. Comprehensive standard PSG is expensive and problematic for patients who need to travel to a centre and spend a night away from home. Home sleep monitoring is closer to ‘real life’ and is less expensive [2]. In addition, there is growing evidence that

Conflict of interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2014.03.013.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.