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Study objectives: Hypercapnic ventilatory failure due to restrictive disorders may have a negative impact on sleep architecture. Non-invasive ventilation (NIV) may improve arterial blood gases but may adversely affect sleep. We assessed sleep structure and blood gases before and during NIV in patients with restrictive disorders in hypercapnic ventilatory failure. Design: Retrospective cohort study. Setting: Sleep laboratory of Saint-Luc University Hospital (Belgium). Patients: Chart review of all patients with predominantly restrictive disorders and respiratory failure seen between 1987 and 2008 and evaluated with a baseline polysomnography (PSG) and a PSG under NIV. Measurements and results: Sixty patients aged (mean±SD) 48±20years, with total lung capacity of 57±20% of predicted value, PaO 2 of 62±16mm Hg and PaCO 2 54±10mm Hg, were included. At baseline, total sleep time, sleep efficiency, slow wave and rapid-eye movement (REM) sleep were markedly decreased. Conversely, micro-arousals and stage I sleep (N1) were increased. NIV administered with volume-cycled (53%) or pressure-cycled (47%) ventilators improved daytime PaO 2, PaCO 2, pH and HCO 3 -. In addition, sleep efficiency, REM sleep, mean and lowest nocturnal SpO 2 increased while stage 1, sleep fragmentation, and oxygen desaturation index decreased significantly. Conclusion: Hypercapnic ventilatory failure in restrictive disorders profoundly affects sleep quality. NIV can improve not only blood gases, but also sleep architecture. © 2011 Elsevier B.V.

Psychogenic movement disorders remain a frequent and important clinical problem. First described in the Middle Ages, the dancing mania is considered to be one form of mass hysteria characterized by outbreaks of collective movement disorders. Patients may exhibit a wide variety of movement and gait disturbances, including tremulousness, jerks, or convulsions, usually with a sudden onset. Arthur Van Gehuchten (1861-1914), a distinguished Belgian neuroanatomist and neurologist, reported an outbreak of sudden involuntary movements in 13 adolescent girls residing in an orphanage. The description is to be found in his book Les Maladies nerveuses, completed before 1914 and published posthumously in 1920. The chapter is illustrated with sequential photographs of a girl exhibiting a peculiar gait, which is descriptively referred to as "choree salutatoire" (saluting chorea). The original film with these pictures has been retrieved and is presented here together with a very similar film excerpt also found in Van Gehuchten's film collection. Van Gehuchten's movie documentation of a psychogenic movement disorder-labeled chorea but which should probably be Considered as dystonia according to contemporary classification-appears to be unique. This report illustrates the tremendous value of moving pictures in recording and analyzing movement disorders. (c) 2007 Movement Disorder Society.

Continuous positive airway pressure (CPAP) remains the best treatment for sleep apnoea syndrome (SAS). In the 1990s, many authors reported on daily compliance, but all of the studies utilised relatively short periods of follow-up that did not exceed a few years. The mean annual rate of CPAP use in patients with SAS was prospectively recorded. In the current study, the results are presented along with compliance data from patients who started CPAP between 1991 and 1998 and were still using it by the end of 2003. The cohort was chosen in order to obtain >or=5 yrs of follow-up for each patient. In total, there were 204 patients. For the whole group, mean+/-sd compliance reached 321+/-90 and 393+/-84 min after 1 and 10 yrs, respectively. There was no significant change in the first 2 yrs, with a significant increase from the third year onwards. Compliance, or its evolution over time, was not correlated either to the baseline polysomnographical data (except slightly for the CPAP pressure), to the difference of these data before and under CPAP therapy, to the age of retirement or to changes in the marital status. In conclusion, very long-term compliance with continuous positive airway pressure increases by a mean of 8 min.day-1 per year of follow-up in patients with sleep apnoea syndrome.

Since Jean-Martin Charcot's time, Pieter Bruegel has been invoked as a famous contributor to the iconography of chorea. This is based not on a picture by Bruegel himself but on a 19th century engraving declared by Charcot to depict St Vitus' dance or chorea germanorum, a form of mass hysteria. A search through the art history literature did not find chorea or St Vitus' dance as a subject of any of Bruegel's works. However, the picture presented by Charcot appeared to be based on a composition that features a pilgrimage of patients suffering from St John's disease or falling sickness, one of the many names applied to epilepsy. This study traces the history of Charcot's allusions to Bruegel's picture and explores the little-known works--drawings, engravings, and paintings--based on Bruegel's composition in the context of chorea, epilepsy, and hysteria. The conclusion of this study is that while Charcot ignored the precise details of Bruegel's composition, his overall interpretation was correct. Beyond any specific diagnosis, Bruegel's work remains universal, giving a unique and compelling picture of human suffering and of the plight of devoted caregivers.

Upper airway patency is essential during sleep in order to avoid sleep-related breathing disorders (SRBD). Nasal obstruction may have a negative impact on sleep quality and must be considered to be a co-factor in the pathophysiology of SRBD. In this paper we will discuss the relation between nasal physiology at night and sleep quality and the possible mechanisms between nasal obstruction and obstructive sleep apnea-hypopnea syndrome (OSAS). We will review the effect of the relief of nasal obstruction (with nasal dilators, medication and/or surgery) on SRBD. Also an algorithm on the management of OSAS patients when nasal surgery is indicated will be proposed.