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Pasquale Montagna - One of the best experts on this subject based on the ideXlab platform.
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Catathrenia sleep related groaning
Reference Module in Neuroscience and Biobehavioral Psychology#R##N#Encyclopedia of Sleep, 2010Co-Authors: Roberto Vetrugno, Giuseppe Plazzi, Pasquale MontagnaAbstract:Catathrenia, from the Greek κατά θρήνος (like a groan), is a rare condition characterized by monotonous, irregular groans which occur during prolonged expiration in sleep (sleep-related groaning). The hallmark of Catathrenia is that inspiration is followed by protracted expiration during which a sound is produced. Oxygen desaturation does not occur in Catathrenia.
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Catathrenia nocturnal groaning what is it
Sleep, 2008Co-Authors: Roberto Vetrugno, E Lugaresi, Luigi Ferinistrambi, Pasquale MontagnaAbstract:GUILLEMINAULT ET AL RECENTLY REPORTED IN SLEEP A SERIES OF SEVEN NON OBESE YOUNG WOMEN AFFECTED WITH SLEEP-RELATED RESPIRATORY noises that they diagnosed as cases of Catathrenia (sleep-related groaning).1 In their patients sleep-related respiratory noises occurred mainly during light NREM sleep and diminished during REM sleep. Respiratory noise in these patients was expiratory. In view of the presence of a significant, mainly inspiratory flow limitation, with anatomic evidence of a small upper airway and small jaws, the authors put their patients on nasal CPAP treatment, plus successive surgical intervention or oral device appliance in four of them, that abolished/reduced sleep-related hypopnoeas and inspiratory flow limitation with resolution of the respiratory noise. They argued therefore that Catathrenia may have different subtypes related to sleep stage specificity or to the presence of sleep disordered breathing. Together with a recent report of continuous airway pressure benefit in a case of nocturnal groaning associated with mild obstructive sleep apnoea, oxygen desaturation and irregular abdominal wall movements,2 Guilleminault et al. raise the question regarding the definition, the heterogeneity and the pathophysiology of Catathrenia.1 Catathrenia was first reported as sleep-related expiratory groaning during REM sleep in abstract form.3 Pevernagie et al. described apparently the same phenomenon as “vocalization during prolonged expiration during REM sleep”,4 and, in our description of nocturnal groaning, we proposed the term of Catathrenia (meaning “groaning”) in 4 cases in which the groaning sounds, though sometimes present also during NREM, were prevalent during REM sleep.5 The same prevalence, or even the recurrence solely during REM sleep, was emphasized by Oldani et al. in their report of 21 patients, 16 examined by polysomnography (PSG).6 In all of the PSG performed in Catathrenia, the features were quite similar and stereotyped: a deep inspiration without sound production was followed by a prolonged expiration with groaning, usually lasting from at least 2 s to 20 seconds; there was bradypnea during Catathrenia, no evidence of respiratory muscular effort and no oxygen desaturation.5,6 Thus, the hallmark of Catathrenia is that inspiration is followed by protracted expiration during which a prolonged or fragmented sound is produced, and this recurs especially during REM sleep. Vetrugno et al. recently reported ten patients with Catathrenia and without any evidence of other facial, airway or lung disease in whom intrathoracic pressure recordings was performed.7 During the expiratory groaning sounds, neither the diaphragm nor the intercostalis EMG were active and endoesophageal pressure, monitored in all patients, showed a slight initial positive rise subsequently returning to values around 0 cm H2O. Strikingly, during the groaning, the respiratory pattern was distinctly abnormal, with a substantial slowing of the respiratory rate (breathing rate was actually decreased by 2/3) and a disproportionate increase in the length of expiration. Remarkably again, nocturnal groaning alternated with normal breathing in the same night, sometimes in the same sleep state.7 This respiratory pattern, that we consider as typical for Catathrenia, is clearly different from what reported by Guilleminault et al.1 In their seven patients, the produced sound was expiratory but short lasting (about 1 s in their figure 1, and again 1–1.5 s in figure 2, compared to 2–20 s in our patients) and occurred at the peak of expiration; in particular, expiration was not prolonged, and there was no bradypnea during the “groaning” (see Figures 1 and 2 in Guilleminault et al.);1 sometimes, a noise could be detected also at the peak of inspiration (see Figure 1 in Guilleminault et al);1 finally, the sounds were not produced during REM sleep.1 All of these differences are substantial, and indicate that the case of Guilleminault et al1 are not Catathrenia, but rather instances of expiratory snoring. Figure 1 Catathrenia (A) compared to expiratory snoring in a snorer patient (B). The recordings are shown at the same time scale. Please note: 1) the different duration of the groaning sounds (microph.), 2) the prolonged expiration (oral, thoracic and abdominal ... In order to show that these two phenomena are quite distinct, we provide a picture comparing the polysomnographic features of a catathrenic patient of ours versus expiratory snoring, both displayed at the same time scale. The differences are readily evident (Figure 1). Narrowing of the upper airway and flow limitation is not solely an inspiratory phenomenon but may also occur with expiration in healthy subjects, in snorers, in patients with upper airway resistance syndrome (UARS) and in patients with obstructive sleep apnoea syndrome (OSAS) (Stanescu et al, 1993).8 Observations of expiratory obstruction during sleep are not new. Weitzman et al. first postulated expiratory obstruction9 and Lugaresi et al. provided an illustration of expiratory flow limitation in a snorer.10 Gravity (mainly during the supine body position) together with relaxation of pharingeal dilator muscles, such as the tensor palatini and genioglossus, have been considered to promote local upper airway narrowing during expiration more frequently at the supraglottic/retroglossal level. Isolated expiratory flow limitation has been reported to recur in breaths and to be coupled with inspiratory flow limitation in sleep.8 Whether Catathrenia is an abnormal, possibly vestigial, central respiratory pattern during sleep, due to abnormality in brainstem respiratory centers, as we proposed,7 and whether narrowing of the airways occurs during Catathrenia, must be left to further studies. We also consider that whether Catathrenia is a parasomnia rather than a sleep-related breathing disorder is just a matter of definition. In the previous ICSD-1 classification indeed, at the time of most reports of Catathrenia, snoring too, itself a respiratory phenomenon, was classified as a parasomnia. What we are really concerned about and wish to emphasize with this letter is that Catathrenia presents with a distinctive pattern on the PSG, and should be clearly differentiated from other respiratory disturbances during sleep. This has clear and important consequences on prognosis and treatment.
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Catathrenia nocturnal groaning an abnormal respiratory pattern during sleep
European Journal of Neurology, 2007Co-Authors: Roberto Vetrugno, E Lugaresi, Giuseppe Plazzi, Federica Provini, Roberto Dangelo, Pasquale MontagnaAbstract:Catathrenia (nocturnal groaning) is a rare condition characterized by monotonous irregular groans occurring during sleep. Ten patients (five women; mean age: 27 +/- 7.4 years, range: 15-41) with sleep-related groaning persisting for years or decades and normal daytime fibreoptic laryngoscopy and respiratory function tests underwent videopolysomnographic recording (VPSG) analysing their respiratory patterns during sleep. After the VPSG, all patients were clinically followed up for a mean period of 4.9 +/- 3.5 years. On VPSG, all patients showed nocturnal groaning during NREM sleep and particularly during REM sleep stages. Groaning was associated with disproportionate prolonged expiration causing reduced breathing rate without oxygen desaturation. The breathing pattern with prolonged expiration and sound production alternated with a normal respiratory pattern without groaning. Endoesophageal pressure during groaning showed mildly positive swings at the initial phase of expiration suggesting a partial mild expiratory upper airway obstruction. At the end of the follow-up period, all patients reported persistent nocturnal groaning but no other clinical manifestations. Groaning confined to sleep alternating with normal breathing and the absence of long-term clinical consequences suggest that Catathrenia is because of an abnormality of the internal respiratory drive system, possibly related to persistence of a neonatal (vestigial) type of breathing pattern.
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Catathrenia nocturnal groaning a new type of parasomnia
Neurology, 2001Co-Authors: Roberto Vetrugno, E Lugaresi, Giuseppe Plazzi, Federica Provini, Luca Vignatelli, Pasquale MontagnaAbstract:Four patients between 15 and 25 years of age presented with exclusively expiratory groaning during sleep. Groaning usually occurred during the second part of the night, beginning at age 5 to 16 years. Patients were unaware of the nocturnal noise, but it alarmed others. Results of otorhinolaryngologic and neurologic examinations were normal. Expiratory groaning arose during REM and non-REM sleep stage 2, and was repeated in clusters. Nocturnal groaning, which the authors term Catathrenia, represents a distinctive parasomnia.
Roberto Vetrugno - One of the best experts on this subject based on the ideXlab platform.
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Catathrenia under sodium oxybate in narcolepsy with cataplexy
Sleep and Breathing, 2012Co-Authors: Francesca Poli, Christian Franceschini, Fabio Pizza, Lara Ricotta, Stefano Vandi, Vincenzo Palaia, Keivan Kaveh Moghadam, Donatella Banal, Roberto Vetrugno, Michael J. ThorpyAbstract:Purpose This study aims to report on Catathrenia occurring in narcolepsy with cataplexy (NC) patients under sodium oxybate (SO) treatment. Catathrenia is a parasomnia characterized by groaning and an abnormal respiratory pattern during sleep.
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Catathrenia sleep related groaning
Reference Module in Neuroscience and Biobehavioral Psychology#R##N#Encyclopedia of Sleep, 2010Co-Authors: Roberto Vetrugno, Giuseppe Plazzi, Pasquale MontagnaAbstract:Catathrenia, from the Greek κατά θρήνος (like a groan), is a rare condition characterized by monotonous, irregular groans which occur during prolonged expiration in sleep (sleep-related groaning). The hallmark of Catathrenia is that inspiration is followed by protracted expiration during which a sound is produced. Oxygen desaturation does not occur in Catathrenia.
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Catathrenia nocturnal groaning what is it
Sleep, 2008Co-Authors: Roberto Vetrugno, E Lugaresi, Luigi Ferinistrambi, Pasquale MontagnaAbstract:GUILLEMINAULT ET AL RECENTLY REPORTED IN SLEEP A SERIES OF SEVEN NON OBESE YOUNG WOMEN AFFECTED WITH SLEEP-RELATED RESPIRATORY noises that they diagnosed as cases of Catathrenia (sleep-related groaning).1 In their patients sleep-related respiratory noises occurred mainly during light NREM sleep and diminished during REM sleep. Respiratory noise in these patients was expiratory. In view of the presence of a significant, mainly inspiratory flow limitation, with anatomic evidence of a small upper airway and small jaws, the authors put their patients on nasal CPAP treatment, plus successive surgical intervention or oral device appliance in four of them, that abolished/reduced sleep-related hypopnoeas and inspiratory flow limitation with resolution of the respiratory noise. They argued therefore that Catathrenia may have different subtypes related to sleep stage specificity or to the presence of sleep disordered breathing. Together with a recent report of continuous airway pressure benefit in a case of nocturnal groaning associated with mild obstructive sleep apnoea, oxygen desaturation and irregular abdominal wall movements,2 Guilleminault et al. raise the question regarding the definition, the heterogeneity and the pathophysiology of Catathrenia.1 Catathrenia was first reported as sleep-related expiratory groaning during REM sleep in abstract form.3 Pevernagie et al. described apparently the same phenomenon as “vocalization during prolonged expiration during REM sleep”,4 and, in our description of nocturnal groaning, we proposed the term of Catathrenia (meaning “groaning”) in 4 cases in which the groaning sounds, though sometimes present also during NREM, were prevalent during REM sleep.5 The same prevalence, or even the recurrence solely during REM sleep, was emphasized by Oldani et al. in their report of 21 patients, 16 examined by polysomnography (PSG).6 In all of the PSG performed in Catathrenia, the features were quite similar and stereotyped: a deep inspiration without sound production was followed by a prolonged expiration with groaning, usually lasting from at least 2 s to 20 seconds; there was bradypnea during Catathrenia, no evidence of respiratory muscular effort and no oxygen desaturation.5,6 Thus, the hallmark of Catathrenia is that inspiration is followed by protracted expiration during which a prolonged or fragmented sound is produced, and this recurs especially during REM sleep. Vetrugno et al. recently reported ten patients with Catathrenia and without any evidence of other facial, airway or lung disease in whom intrathoracic pressure recordings was performed.7 During the expiratory groaning sounds, neither the diaphragm nor the intercostalis EMG were active and endoesophageal pressure, monitored in all patients, showed a slight initial positive rise subsequently returning to values around 0 cm H2O. Strikingly, during the groaning, the respiratory pattern was distinctly abnormal, with a substantial slowing of the respiratory rate (breathing rate was actually decreased by 2/3) and a disproportionate increase in the length of expiration. Remarkably again, nocturnal groaning alternated with normal breathing in the same night, sometimes in the same sleep state.7 This respiratory pattern, that we consider as typical for Catathrenia, is clearly different from what reported by Guilleminault et al.1 In their seven patients, the produced sound was expiratory but short lasting (about 1 s in their figure 1, and again 1–1.5 s in figure 2, compared to 2–20 s in our patients) and occurred at the peak of expiration; in particular, expiration was not prolonged, and there was no bradypnea during the “groaning” (see Figures 1 and 2 in Guilleminault et al.);1 sometimes, a noise could be detected also at the peak of inspiration (see Figure 1 in Guilleminault et al);1 finally, the sounds were not produced during REM sleep.1 All of these differences are substantial, and indicate that the case of Guilleminault et al1 are not Catathrenia, but rather instances of expiratory snoring. Figure 1 Catathrenia (A) compared to expiratory snoring in a snorer patient (B). The recordings are shown at the same time scale. Please note: 1) the different duration of the groaning sounds (microph.), 2) the prolonged expiration (oral, thoracic and abdominal ... In order to show that these two phenomena are quite distinct, we provide a picture comparing the polysomnographic features of a catathrenic patient of ours versus expiratory snoring, both displayed at the same time scale. The differences are readily evident (Figure 1). Narrowing of the upper airway and flow limitation is not solely an inspiratory phenomenon but may also occur with expiration in healthy subjects, in snorers, in patients with upper airway resistance syndrome (UARS) and in patients with obstructive sleep apnoea syndrome (OSAS) (Stanescu et al, 1993).8 Observations of expiratory obstruction during sleep are not new. Weitzman et al. first postulated expiratory obstruction9 and Lugaresi et al. provided an illustration of expiratory flow limitation in a snorer.10 Gravity (mainly during the supine body position) together with relaxation of pharingeal dilator muscles, such as the tensor palatini and genioglossus, have been considered to promote local upper airway narrowing during expiration more frequently at the supraglottic/retroglossal level. Isolated expiratory flow limitation has been reported to recur in breaths and to be coupled with inspiratory flow limitation in sleep.8 Whether Catathrenia is an abnormal, possibly vestigial, central respiratory pattern during sleep, due to abnormality in brainstem respiratory centers, as we proposed,7 and whether narrowing of the airways occurs during Catathrenia, must be left to further studies. We also consider that whether Catathrenia is a parasomnia rather than a sleep-related breathing disorder is just a matter of definition. In the previous ICSD-1 classification indeed, at the time of most reports of Catathrenia, snoring too, itself a respiratory phenomenon, was classified as a parasomnia. What we are really concerned about and wish to emphasize with this letter is that Catathrenia presents with a distinctive pattern on the PSG, and should be clearly differentiated from other respiratory disturbances during sleep. This has clear and important consequences on prognosis and treatment.
-
Catathrenia nocturnal groaning an abnormal respiratory pattern during sleep
European Journal of Neurology, 2007Co-Authors: Roberto Vetrugno, E Lugaresi, Giuseppe Plazzi, Federica Provini, Roberto Dangelo, Pasquale MontagnaAbstract:Catathrenia (nocturnal groaning) is a rare condition characterized by monotonous irregular groans occurring during sleep. Ten patients (five women; mean age: 27 +/- 7.4 years, range: 15-41) with sleep-related groaning persisting for years or decades and normal daytime fibreoptic laryngoscopy and respiratory function tests underwent videopolysomnographic recording (VPSG) analysing their respiratory patterns during sleep. After the VPSG, all patients were clinically followed up for a mean period of 4.9 +/- 3.5 years. On VPSG, all patients showed nocturnal groaning during NREM sleep and particularly during REM sleep stages. Groaning was associated with disproportionate prolonged expiration causing reduced breathing rate without oxygen desaturation. The breathing pattern with prolonged expiration and sound production alternated with a normal respiratory pattern without groaning. Endoesophageal pressure during groaning showed mildly positive swings at the initial phase of expiration suggesting a partial mild expiratory upper airway obstruction. At the end of the follow-up period, all patients reported persistent nocturnal groaning but no other clinical manifestations. Groaning confined to sleep alternating with normal breathing and the absence of long-term clinical consequences suggest that Catathrenia is because of an abnormality of the internal respiratory drive system, possibly related to persistence of a neonatal (vestigial) type of breathing pattern.
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Catathrenia nocturnal groaning a new type of parasomnia
Neurology, 2001Co-Authors: Roberto Vetrugno, E Lugaresi, Giuseppe Plazzi, Federica Provini, Luca Vignatelli, Pasquale MontagnaAbstract:Four patients between 15 and 25 years of age presented with exclusively expiratory groaning during sleep. Groaning usually occurred during the second part of the night, beginning at age 5 to 16 years. Patients were unaware of the nocturnal noise, but it alarmed others. Results of otorhinolaryngologic and neurologic examinations were normal. Expiratory groaning arose during REM and non-REM sleep stage 2, and was repeated in clusters. Nocturnal groaning, which the authors term Catathrenia, represents a distinctive parasomnia.
Elena Urrestarazu - One of the best experts on this subject based on the ideXlab platform.
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Catathrenia parasomnia respiratory disorder or something else
Clinical Neurophysiology, 2017Co-Authors: Elena UrrestarazuAbstract:Catathrenia is a peculiar sleep-related phenomenon that is associated with the production of loud groaning sounds during episodes of prolonged expiration. The first case was reported in 1983 by De Roeck et al. It has a typical respiratory pattern of bradypnoea consisting of a deep inspiration followed by a long expiration and noiseresembling central apnoeas. The analysis of the harmonics and formants showed that Catathrenia has a vocal origin with a predominant frequency. Although there is consensus about the above mentioned characteristics, there are controversies about the classification among the sleep disorders. In fact, there is no full agreement about its nature, origin, meaning, and treatment. The International Classification of Sleep Disorders-Second Edition (ICSD-2) classified Catathrenia among parasomnias; however, the ICSD-3 includes it among the respiratory disorders (isolated symptom or normal variant inside the respiratory disorders of sleep). Supporting its classification within the parasomnias, it can be considered a complex respiratory motor behavior consisting of a deep inspiration, followed by breath holding and slow release of air through a closed glottis, during which the groaning sound is produced. Furthermore, it is often associated with spontaneous arousals that may precede or coincide with the vocalization. On the other hand, it can be considered a breathing related disorder because, as stated in the ICSD-3, it also has a respiratory pattern of bradypnoea consisting of a deep inspiration followed by a long expiration and noiseresembling central apnoeas, although is not usually accompanied by evident oxygen desaturation. The heterogeneity in the published cases could be the origin of the discrepancies. According to the duration of the sound there may be at least two different types of patients: in some of them the duration is short (0.5–1.5 s) and in others it is longer (2–50 s); although long and more pronounced bradypnoeic events seem to occur exclusively during REM sleep and the index of bradypnoeic events increase with consecutive REM cycles, some reports have indicated that the sound could appear at any time during the night, or even with some predominance during non-REM stages. The intensity of the sound also has a great variability between 40 and 120 dB. Globally, patients with the long sound and with respiratory dysrhythmia might be different from patients with the short and very intense sound. In conclusion, the questions about the nature of Catathrenia, its classification and the decision if it is a single phenomenon or if it comprises two or more variants or disorders are still opened.
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Catathrenia respiratory disorder or parasomnia
Sleep Medicine, 2015Co-Authors: J Iriarte, Secundino Fernandez, Manuel Alegre, Arantza Campo, Elena UrrestarazuAbstract:Abstract Background The International Classification of Sleep Disorders – Third Edition (ICSD-3) classifies Catathrenia among the respiratory disorders and not as a parasomnia as in ICSD-2. Few patients have been reported during these years, and the clinical description of the sound is different from group to group. In fact, there is no full agreement about its nature, origin, meaning, and treatment. Methods and results In this paper we review the literature on Catathrenia focusing on the characteristics of the sound, demographics of the patients, aetiology, response to treatment, etc., in order to support its classification as a respiratory disorder or a parasomnia. We also discuss the possibility of Catathrenia being not one disorder but two variants or two different disorders.
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sound analysis of Catathrenia a vocal expiratory sound
Sleep and Breathing, 2011Co-Authors: J Iriarte, Secundino Fernandez, Natalia Fernandezarrechea, Elena Urrestarazu, I Pagola, Manuel Alegre, J ArtiedaAbstract:Catathrenia (nocturnal groaning) is a rare and relatively little-understood parasomnia. The characteristics of the sound and the recordings are not similar in all the relevant research papers. Indeed, there is currently some discussion regarding whether or not this is a single entity. For some authors, Catathrenia is a particular form of parasomnia; for others, it may be a variant of snoring or a respiratory problem. The goal is to establish whether or not Catathrenia may be regarded as an expiratory vocal sound. An attempt was made to classify the origin of this sound according to its sound structure. We present the sound analysis of two patients, a man and a woman, with clinically diagnosed Catathrenia and we compared them with the analysis of snoring. We use the spectrogram and the oscillogram. We classified the sounds according to the Yanagihara criteria. The vocal nature of the sound was confirmed, and several significant differences to some snoring sounds were discovered. The analysis of the Catathrenia samples demonstrated that these signals are type II according to Yanagihara classification; these signals had a very short jitter, and had formants and harmonics. However, snoring is a type III, very irregular and had formants but not harmonics. The oscillogram and the spectrogram in these patients show that the origins of the sounds are clearly different: Catathrenia is laryngeal, while snoring is guttural. Catathrenia cannot be considered as expiratory snoring.
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continuous positive airway pressure as treatment for Catathrenia nocturnal groaning
Neurology, 2006Co-Authors: J Iriarte, Elena Urrestarazu, Manuel Alegre, C Viteri, J Arcocha, J ArtiedaAbstract:Iriarte et al. report a patient with Catathrenia and mild obstructive sleep apnea whose polysomnographic recording showed a respiratory dysrhythmia during all sleep stages that caused secondary oxygen desaturations and irregular movements of the abdominal wall. A trial with continuous positive airway pressure (CPAP) improved this condition.1 These features are somehow atypical for Catathrenia.2,3 Over 90% of the reported bradypneic events in Catathrenia occur only, or predominantly, during REM sleep.2 There is an internal, brainstem-based, excitatory drive to the respiratory system during REM sleep possibly independent of chemical stimuli.4 The hallmark of Catathrenia is a deep inspiration followed by a short expiratory phase and a long expiratory period with sound production. The output signal of the respiratory thoracoabdominal bands is flat or very low during these expiratory …
Aliuddin M Khaja - One of the best experts on this subject based on the ideXlab platform.
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Catathrenia is not expiratory snoring
Sleep, 2008Co-Authors: Christian Guilleminault, Chad C Hagen, Aliuddin M KhajaAbstract:WE THANK VETRUGNO ET AL1 FOR THEIR COMMENTS IN RESPONSE TO OUR MANUSCRIPT. WE AGREE THAT Catathrenia SHOULD NOT BE CONFUSED WITH expiratory snoring. However, we strongly disagree with their erroneous presumption that our findings represent snoring—an argument which they have based entirely on differences in microphone display collected by two different methods. Our two groups share a similar lapse in that neither was precise about how this sound was truly monitored, processed, or displayed in the respective figures. Catathrenia is not common and prior to our manuscript we accumulated only 6 cases over the previous five years.2 Our Catathrenia patients had home recordings of their conspicuous and “bizarre” sounds convincing us of the originality of their problem during their initial clinic consultation. These sounds were distinctly different expiratory sounds that could not be confused with expiratory snoring. Once in the laboratory our patients were monitored by audio speaker in real time providing observers undeniable confirmation of the distinct quality of their groaning sounds. This was neither recorded nor displayed in our montage. We did present a microphone signal in our published report. This signal was digitized and presented as a visual display in our routine clinical fashion. This microphone is placed for the detection of routine snoring and not for the purpose of complex acoustic analysis nor with the intent of providing a signal that clearly discriminates snoring from expiratory groaning. Due to variability in placement and equipment, even duration of the sound may not be comparable; and as our colleagues know, duration is variable throughout the night. We have been involved in acoustic analysis previously. We know that these analyses require a more sophisticated and well-defined technique. The “microphone,” its properties, its specific and reproducible location on the subject, recording, processing, and displaying technique all need to be defined.3 As acoustic analysis of this signal was not intended at the time of collection or reporting in our Catathrenia manuscript, we neglected these details. Our Italian colleagues subsequently repeated this error. Such analysis was not within the scope of our investigation and had not been done in any prior article on Catathrenia. Both our groups presented figures obtained during the monitoring of subjects that undeniable displayed nocturnal groaning distinct from expiratory snoring. Both groups however only indicated the variable monitored. If we look at the presented figures placed in the commentary by Vetrugno et al., a recording is presented with an undefined microphone, without description of its sound characteristics, placed in an undefined position compared to the sleeping subject, with a presentation of a signal recorded with an undefined unit on an undefined system, without any of the necessary information to perform a critical acoustic analysis. Many technical details are omitted in articles presenting segments of polysomnographic recordings, and this is the case in both ours and our Italian colleagues' figures. Our study was performed using two different means for the investigation of the subject behavior and presence of sound during sleep. For determination of the timing of the sound compared to respiratory cycle, we used a piezo sensor located on the lateral side of the neck roughly in a similar location between patients, but without a defined relationship to anatomical landmarks. This sensor gives a signal with a known power. It is calibrated in an artificial unit on a computerized system (Sandman, Ontario, Canada) before any recording and bio-calibration are obtained by having subjects perform specific, standardized sounds, which are not measured for volume or pitch. It is called a “neck microphone,” but this equipment does not generate the more complex shape of a sound, as would a directional microphone placed perpendicular to the nose of the subject at a 60-cm distance, monitored with a signal calibrated in decibel on a specific recorder for that purpose. In our study, we also used a multi-directional microphone, placed on the night stand of the patient, which means a variable lateral distance depending of the subject position that may vary from 1 to 2 meters during the night, with sounds transmitted through an interphone to a recording room without direct recording on polysomnography but with human monitoring in association with continuous videotaping. Home investigations used commercially available tape recorders with a standard decibel range (usually 40-120 dB) placed in the subject bedroom. These systems allow discrimination of snoring from other types of sound, identification of respiratory phase of the sound, and the relationship to sleep stages. None of these techniques are appropriate for a more sophisticated physical analysis of the sound or comparison between varied methodologies. If a special effort is not made to monitor the obtained signal specifically for such analysis, it will be difficult to draw conclusions or compare between studies.3 We did not attempt to make such conclusions or comparisons, but Vetrugno et al have. Additional reports are forthcoming from the Mayo clinic with a case-report recently published in Sleep Medicine4 and an abstract in press5 presenting 11 cases to be presented at the 2008 SLEEP meeting. These present Catathrenia similar to ours with sounds observed during both NREM and REM sleep and associated with sleep disordered breathing. They also used nasal CPAP in patients with OSA and report similar improvement as we observed in our own cases.
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Catathrenia parasomnia or uncommon feature of sleep disordered breathing
Sleep, 2008Co-Authors: Christian Guilleminault, Chad C Hagen, Aliuddin M KhajaAbstract:Objective: We report a series of seven consecutive cases of Catathrenia (sleep related groaning) that differ from limited previous reports in the literature with regard to sleep stage and response to treatment.
J Artieda - One of the best experts on this subject based on the ideXlab platform.
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sound analysis of Catathrenia a vocal expiratory sound
Sleep and Breathing, 2011Co-Authors: J Iriarte, Secundino Fernandez, Natalia Fernandezarrechea, Elena Urrestarazu, I Pagola, Manuel Alegre, J ArtiedaAbstract:Catathrenia (nocturnal groaning) is a rare and relatively little-understood parasomnia. The characteristics of the sound and the recordings are not similar in all the relevant research papers. Indeed, there is currently some discussion regarding whether or not this is a single entity. For some authors, Catathrenia is a particular form of parasomnia; for others, it may be a variant of snoring or a respiratory problem. The goal is to establish whether or not Catathrenia may be regarded as an expiratory vocal sound. An attempt was made to classify the origin of this sound according to its sound structure. We present the sound analysis of two patients, a man and a woman, with clinically diagnosed Catathrenia and we compared them with the analysis of snoring. We use the spectrogram and the oscillogram. We classified the sounds according to the Yanagihara criteria. The vocal nature of the sound was confirmed, and several significant differences to some snoring sounds were discovered. The analysis of the Catathrenia samples demonstrated that these signals are type II according to Yanagihara classification; these signals had a very short jitter, and had formants and harmonics. However, snoring is a type III, very irregular and had formants but not harmonics. The oscillogram and the spectrogram in these patients show that the origins of the sounds are clearly different: Catathrenia is laryngeal, while snoring is guttural. Catathrenia cannot be considered as expiratory snoring.
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continuous positive airway pressure as treatment for Catathrenia nocturnal groaning
Neurology, 2006Co-Authors: J Iriarte, Elena Urrestarazu, Manuel Alegre, C Viteri, J Arcocha, J ArtiedaAbstract:Iriarte et al. report a patient with Catathrenia and mild obstructive sleep apnea whose polysomnographic recording showed a respiratory dysrhythmia during all sleep stages that caused secondary oxygen desaturations and irregular movements of the abdominal wall. A trial with continuous positive airway pressure (CPAP) improved this condition.1 These features are somehow atypical for Catathrenia.2,3 Over 90% of the reported bradypneic events in Catathrenia occur only, or predominantly, during REM sleep.2 There is an internal, brainstem-based, excitatory drive to the respiratory system during REM sleep possibly independent of chemical stimuli.4 The hallmark of Catathrenia is a deep inspiration followed by a short expiratory phase and a long expiratory period with sound production. The output signal of the respiratory thoracoabdominal bands is flat or very low during these expiratory …