Sleep state misperception Other names Paradoxical insomnia, pseudo-insomnia, subjective insomnia, subjective sleepiness, sleep hypochondriasis [1] Specialty Sleep medicine Sleep state misperception ( SSM ) is a term in the International Classification of Sleep Disorders (ICSD) most commonly used for people who mistakenly perceive their sleep as wakefulness, [1] [2] though it has been proposed that it be applied to those who severely overestimate their sleep time as well [3] ("positive" sleep state misperception). [4] While most sleepers with this condition will report not having slept in the previous night at all or having slept very little, [5] clinical recordings generally show normal sleep patterns. ... Philadelphia: WB Saunders, 1994. [ page needed ] External links [ edit ] Classification D ICD - 10 : F51.0 , G47.0 ICD - 9-CM : 307.42 , 307.49 , 780.52 MeSH : D020919 DiseasesDB : 26877 SNOMED CT : 427745001 External resources eMedicine : med/2698 v t e Sleep and sleep disorders Stages of sleep cycles Rapid eye movement (REM) Non-rapid eye movement Slow-wave Brain waves Alpha wave Beta wave Delta wave Gamma wave K-complex Mu rhythm PGO waves Sensorimotor rhythm Sleep spindle Theta wave Sleep disorders Dyssomnia Excessive daytime sleepiness Hypersomnia Insomnia Kleine–Levin syndrome Narcolepsy Night eating syndrome Nocturia Sleep apnea Catathrenia Central hypoventilation syndrome Obesity hypoventilation syndrome Obstructive sleep apnea Periodic breathing Sleep state misperception Circadian rhythm disorders Advanced sleep phase disorder Cyclic alternating pattern Delayed sleep phase disorder Irregular sleep–wake rhythm Jet lag Non-24-hour sleep–wake disorder Shift work sleep disorder Parasomnia Bruxism Nightmare disorder Night terror Periodic limb movement disorder Rapid eye movement sleep behavior disorder Sleepwalking Somniloquy Benign phenomena Dreams Exploding head syndrome Hypnic jerk Hypnagogia / Sleep onset Hypnopompic state Sleep paralysis Sleep inertia Somnolence Nocturnal clitoral tumescence Nocturnal penile tumescence Nocturnal emission Treatment Sleep diary Sleep hygiene Sleep induction Hypnosis Lullaby Somnology Polysomnography Other Sleep medicine Behavioral sleep medicine Sleep study Daily life Bed Bunk bed Daybed Four-poster bed Futon Hammock Mattress Sleeping bag Bed bug Bedding Bedroom Bedtime Bedtime story Bedtime toy Biphasic and polyphasic sleep Chronotype Dream diary Microsleep Mouth breathing Nap Nightwear Power nap Second wind Siesta Sleep and creativity Sleep and learning Sleep deprivation / Sleep debt Sleeping while on duty Sleepover Snoring

This may be due to RMD’s comorbidity with sleep apnea, which has been observed in some patients [6] . ... Other sleep related disorders like sleep apnea are ruled out by examining the patients’ respiratory effort, air flow, and oxygen saturation. ... In some patients who also experience sleep apnea, episodes of apnea can be followed immediately by RMD-like symptoms, suggesting that the apnea episodes may trigger an RMD episode. ... Infantile and adolescent RMD respond well to low doses of clonazepam . [19] Prescription medications such as ropinirole or pramipexole given to restless legs syndrome patients do not show any clinical improvement in many patients with RMD. [6] Non-medication [ edit ] Treatment of sleep apnea via a continuous positive airway pressure ( CPAP ) device has shown dramatic improvement in apnea and nearly complete resolution of RMD symptoms. [7] Behavioral interventions may alleviate some RMD symptoms and movements. ... "Rhythmic movement disorder associated with respiratory arousals and improved by CPAP titration in a patient with restless legs syndrome and sleep apnea". Sleep Med . 10 (4): 501–3. doi : 10.1016/j.sleep.2009.03.003 .

Excess weight increases the chances of high blood pressure, atherosclerosis and diabetes. Sleep apnea. Spells of stopping breathing at night might increase the risk of stroke. ... Being overweight increases other risk factors, such as high blood pressure, cardiovascular disease, diabetes and sleep apnea. Eat a healthy diet. Focus on fruits and vegetables, whole grains and fish, nuts and legumes. ... What do you eat in a typical day? Do you have symptoms of sleep apnea?

External links [ edit ] Classification D ICD - 10 : G47.59 v t e Sleep and sleep disorders Stages of sleep cycles Rapid eye movement (REM) Non-rapid eye movement Slow-wave Brain waves Alpha wave Beta wave Delta wave Gamma wave K-complex Mu rhythm PGO waves Sensorimotor rhythm Sleep spindle Theta wave Sleep disorders Dyssomnia Excessive daytime sleepiness Hypersomnia Insomnia Kleine–Levin syndrome Narcolepsy Night eating syndrome Nocturia Sleep apnea Catathrenia Central hypoventilation syndrome Obesity hypoventilation syndrome Obstructive sleep apnea Periodic breathing Sleep state misperception Circadian rhythm disorders Advanced sleep phase disorder Cyclic alternating pattern Delayed sleep phase disorder Irregular sleep–wake rhythm Jet lag Non-24-hour sleep–wake disorder Shift work sleep disorder Parasomnia Bruxism Nightmare disorder Night terror Periodic limb movement disorder Rapid eye movement sleep behavior disorder Sleepwalking Somniloquy Benign phenomena Dreams Exploding head syndrome Hypnic jerk Hypnagogia / Sleep onset Hypnopompic state Sleep paralysis Sleep inertia Somnolence Nocturnal clitoral tumescence Nocturnal penile tumescence Nocturnal emission Treatment Sleep diary Sleep hygiene Sleep induction Hypnosis Lullaby Somnology Polysomnography Other Sleep medicine Behavioral sleep medicine Sleep study Daily life Bed Bunk bed Daybed Four-poster bed Futon Hammock Mattress Sleeping bag Bed bug Bedding Bedroom Bedtime Bedtime story Bedtime toy Biphasic and polyphasic sleep Chronotype Dream diary Microsleep Mouth breathing Nap Nightwear Power nap Second wind Siesta Sleep and creativity Sleep and learning Sleep deprivation / Sleep debt Sleeping while on duty Sleepover Snoring

More pervasive autonomic dysfunction involving any of the following: night sweats or abnormal lack of sweating, urogenital problems (frequent UTIs, incontinence, frequency, urgency), gastrointestinal problems (chronic constipation, chronic constipation alternating with diarrhea, poor gastric motility), or esophageal/respiratory problems ( sleep apnea , abnormal breath sounds during sleep or while awake) indicate possible autoimmune autonomic ganglionopathy or multiple system atrophy .

Additional studies may include: sleep study for obstructive apnea; nerve conduction velocity to assess for carpal tunnel syndrome; head/neck MRI to document ventricular size and cervicomedullary narrowing; opening pressure on lumbar puncture; and orthopedic evaluation to monitor hip disease. ... Retinal degeneration leads to poor peripheral vision and night blindness, which occur frequently in individuals with MPS II, while central visual impairment due to retinal degeneration is rare [Suppiej et al 2013]. ... Ear, Nose, Throat Common oral findings in boys with MPS II include macroglossia, hypertrophic adenoids and tonsils, and ankylosis of the temporomandibular joint, which limits opening of the mouth. ... The progression of airway obstruction is relentless and usually results in sleep apnea and the need for positive pressure assistance and eventually tracheostomy. ... Visualization of the vocal cords is compromised by the large tongue, GAG-infiltrated soft tissues, and large tonsils and adenoids. Care must be taken to avoid hyperextension of the neck secondary to atlantoaxial instability and cervicomedullary compression that may be present.

., "Laryngospam -The Best Treatment", Anesthesiology , 11 1998, Vol.89, 1293–1294 v t e Diseases of the respiratory system Upper RT (including URTIs , common cold ) Head sinuses Sinusitis nose Rhinitis Vasomotor rhinitis Atrophic rhinitis Hay fever Nasal polyp Rhinorrhea nasal septum Nasal septum deviation Nasal septum perforation Nasal septal hematoma tonsil Tonsillitis Adenoid hypertrophy Peritonsillar abscess Neck pharynx Pharyngitis Strep throat Laryngopharyngeal reflux (LPR) Retropharyngeal abscess larynx Croup Laryngomalacia Laryngeal cyst Laryngitis Laryngopharyngeal reflux (LPR) Laryngospasm vocal cords Laryngopharyngeal reflux (LPR) Vocal fold nodule Vocal fold paresis Vocal cord dysfunction epiglottis Epiglottitis trachea Tracheitis Laryngotracheal stenosis Lower RT / lung disease (including LRTIs ) Bronchial / obstructive acute Acute bronchitis chronic COPD Chronic bronchitis Acute exacerbation of COPD ) Asthma ( Status asthmaticus Aspirin-induced Exercise-induced 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Worsening of symptoms in the evening. Symptoms occur mainly at night. Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep, which causes the legs to twitch and kick, possibly throughout the night, while you sleep. ... Your symptoms are partially or temporarily relieved by activity, such as walking or stretching. Your symptoms are worse at night. Symptoms can't be explained solely by another medical or behavioral condition. ... This may involve an overnight stay and a study at a sleep clinic if another sleep disorder such as sleep apnea is suspected. However, a diagnosis of RLS usually doesn't require a sleep study. ... These drugs help you sleep better at night, but they don't eliminate the leg sensations, and they may cause daytime drowsiness. ... Do your symptoms start while you're sitting or lying down? Are your symptoms worse at night? Does movement make you feel better?

"Circulating phospholipase-A2 activity in obstructive sleep apnea and recurrent tonsillitis". Int J Pediatr Otorhinolaryngol . 76 (4): 471–4. doi : 10.1016/j.ijporl.2011.12.026 . PMID 22297210 . ^ van Kempen MJ, Rijkers GT, Van Cauwenberge PB (May 2000). "The immune response in adenoids and tonsils". Int. Arch. Allergy Immunol. ... "Tissue fatty acid composition in obstructive sleep apnea and recurrent tonsillitis". Int J Pediatr Otorhinolaryngol . 77 (6): 1008–12. doi : 10.1016/j.ijporl.2013.03.033 . ... Wetmore RF (2007). "Tonsils and adenoids". In Kliegman RM, Behrman RE, Jenson HB, Stanton BF (eds.). ... Classification D ICD - 10 : J03 , J35.0 ICD - 9-CM : 463 MeSH : D014069 DiseasesDB : 13165 External resources MedlinePlus : 001043 eMedicine : article/871977 Patient UK : Tonsillitis v t e Diseases of the respiratory system Upper RT (including URTIs , common cold ) Head sinuses Sinusitis nose Rhinitis Vasomotor rhinitis Atrophic rhinitis Hay fever Nasal polyp Rhinorrhea nasal septum Nasal septum deviation Nasal septum perforation Nasal septal hematoma tonsil Tonsillitis Adenoid hypertrophy Peritonsillar abscess Neck pharynx Pharyngitis Strep throat Laryngopharyngeal reflux (LPR) Retropharyngeal abscess larynx Croup Laryngomalacia Laryngeal cyst Laryngitis Laryngopharyngeal reflux (LPR) Laryngospasm vocal cords Laryngopharyngeal reflux (LPR) Vocal fold nodule Vocal fold paresis Vocal cord dysfunction epiglottis Epiglottitis trachea Tracheitis Laryngotracheal stenosis Lower RT / lung disease (including LRTIs ) Bronchial / obstructive acute Acute bronchitis chronic COPD Chronic bronchitis Acute exacerbation of COPD ) Asthma ( Status asthmaticus Aspirin-induced Exercise-induced Bronchiectasis Cystic fibrosis unspecified Bronchitis Bronchiolitis Bronchiolitis obliterans Diffuse panbronchiolitis Interstitial / restrictive ( fibrosis ) External agents/ occupational lung disease Pneumoconiosis Aluminosis Asbestosis Baritosis Bauxite fibrosis Berylliosis Caplan's syndrome Chalicosis Coalworker's pneumoconiosis Siderosis Silicosis Talcosis Byssinosis Hypersensitivity pneumonitis Bagassosis Bird fancier's lung Farmer's lung Lycoperdonosis Other ARDS Combined pulmonary fibrosis and emphysema Pulmonary edema Löffler's syndrome / Eosinophilic pneumonia Respiratory hypersensitivity Allergic bronchopulmonary aspergillosis Hamman-Rich syndrome Idiopathic pulmonary fibrosis Sarcoidosis Vaping-associated pulmonary injury Obstructive / Restrictive Pneumonia / pneumonitis By pathogen Viral Bacterial Pneumococcal Klebsiella Atypical bacterial Mycoplasma Legionnaires' disease Chlamydiae Fungal Pneumocystis Parasitic noninfectious Chemical / Mendelson's syndrome Aspiration / Lipid By vector/route Community-acquired Healthcare-associated Hospital-acquired By distribution Broncho- Lobar IIP UIP DIP BOOP-COP NSIP RB Other Atelectasis circulatory Pulmonary hypertension Pulmonary embolism Lung abscess Pleural cavity / mediastinum Pleural disease Pleuritis/pleurisy Pneumothorax / Hemopneumothorax Pleural effusion Hemothorax Hydrothorax Chylothorax Empyema/pyothorax Malignant Fibrothorax Mediastinal disease Mediastinitis Mediastinal emphysema Other/general Respiratory failure Influenza Common cold SARS Coronavirus disease 2019 Idiopathic pulmonary haemosiderosis Pulmonary alveolar proteinosis Authority control NDL : 00563120

If airway obstruction is present, temporizing measures may be required. Treatment of sleep apnea by surgical intervention and/or supplemental oxygen via nasal cannula may be required. ... Agents/circumstances to avoid: Contact sports and activities that involve neck hyperflexion or extension for those with cervical spine anomalies; factors that potentiate hearing loss; use of CPAP/BiPAP for long-term treatment of sleep apnea. Pregnancy management: For affected pregnant women: monitoring for signs and symptoms of worsening obstructive sleep apnea and anethesia evaluation prior to initiation of labor to identify any multilevel airway anomalies or vertebral anomalies that would result in additional risk with certain types of anesthesia; fiberoptic intubation could be required. ... Avoid use of CPAP/BiPAP for long-term treatment of sleep apnea when possible because pressure on midface exacerbates midfacial retrusion. Supplemental oxygen via nasal cannula is sometimes beneficial. Reducing sleep apnea & improving sleep quality has the potential to improve learning, cognition, & behavior. ... Use of CPAP/BiPAP for long-term treatment of sleep apnea should be avoided when possible because pressure on the midface will exacerbate midfacial retrusion.

It may be necessary to remove the tonsils and/or adenoids. Severe tracheomalacia may require surgery. ... Aggressive management of airway secretions is necessary as well. Sleep apnea may be treated with a CPAP or BPAP device. [5] Prognosis [ edit ] A slowly-progressing female patient in her 20s, showing few physical abnormalities The life expectancy of individuals with MPS VI varies depending on the severity of symptoms.

The altered state of consciousness may be explained by a hypersynchronous delta activity (see delta wave ) in network involving the frontoparietal cortices (suggesting to be "asleep"), and higher frequency activities in sensorimotor, orbitofrontal, and temporal lateral cortices (suggesting an "awakening"). [6] [7] Sleep-related violence and abnormal sexual behaviours [ edit ] Confusional arousals have often been linked to sleep-related violence (self-injury or injury to the bed partner). [8] [9] [10] [11] The latter highlights important medical and legal issues when such behaviours are suspected and purported to have caused a criminal offense. [12] The first documented case of homicide as a result of confusional arousal was reported in medieval times by the case of the Silesian woodcutter Bernard Schedmaizig. [13] Sleep-related abnormal sexual behaviours (also called sexsomnia or sleep sex ) are mainly classified as confusional arousals and more rarely associated to sleepwalking (also known as somnambulism). [12] Even if sleep-related violence may occur during an episode of confusional arousal, it remains extremely rare and there are no specific predisposition to aggression during these episodes. [8] Distinction between sleepwalking and night terrors [ edit ] Violent behaviours in confusional arousals slightly differ from those in sleepwalking or night terrors. [8] Above all, during an episode of confusional arousal the patient never leaves the bed unlike sleepwalking. ... Unlike confusional arousals and sleep walking, patients experiencing night terrors seem to react to some type of frightening image. ... NREM parasomnias (or disorders of arousal) also include sleep terrors (see night terror ) and sleepwalking . Confusional arousals are characterised by more or less complex movements without leaving bed with whimpering, sitting up in bed and some articulation without walking or terror. [14] [15] In comparison of other arousal parasomnias the age onset of sleep walking is generally between 5 and 10 years whereas confusional arousals and sleep terror may occur 3 years earlier. ... According to studies, [2] [21] [22] they are shift work, hypnagogic hallucinations (also known as hypnagogia ), excessive daytime sleepiness, insomnia and hypersomnia disorder, circadian rhythm sleep disorder , restless legs syndrome , obstructive sleep apnea syndrome (OSAS), bipolar disorder , daily smoking, and age of 15–24 years. ... G.; Guilleminault, C.; Ohayon, M. M. (April 1999). "Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders".

Glaucoma-sleep apnea syndrome is characterized by sleep apnoea associated with glaucoma.

Sleep disturbance in childhood is reported in fewer than half of affected individuals [Whalen et al 2012] and includes difficulty falling asleep, problems sleeping through the night, and night terrors [de Winter et al 2016]. ... Episodic hyperventilation often followed by breath-holding/apnea while awake are reported in 40%-60% of individuals [Whalen et al 2012, de Winter et al 2016, Goodspeed et al 2018]. ... However, in most affected individuals breathing abnormalities persist to some degree, though too few adults have been described to make conclusive statements about frequency or severity. Breath-holding/apnea episodes are not typically related to seizure activity [Maini et al 2012]. ... The breathing abnormality in PTHS does not appear to be a manifestation of seizure activity [Maini et al 2012], though in this study, 7/38 individuals with seizures had apnea or hyperventilation shortly before their seizures. ... Polysomnography may be indicated if there is a history of episodic apnea, especially when associated with cyanosis (typically alternating with episodes of hyperventilation).

It is believed that the reduction in firing in the SCN stimulates sleep. [30] While day-active individuals produce melatonin at night, night shift workers' production of melatonin is suppressed at night due to light exposure. [31] Circadian misalignment [ edit ] Circadian misalignment plays a major role in shift work sleep disorder. ... A nap before starting a night shift is a logical prophylactic measure. ... "Dark goggles and bright light improve circadian rhythm adaptation to night-shift work" . Sleep . 17 (6): 535–43. doi : 10.1093/sleep/17.6.535 . ... "The effects of caffeine on simulated night-shift work and subsequent daytime sleep" . ... "Sleepiness/alertness on a simulated night shift following sleep at home with triazolam" .

He also had frequent attacks of cyanosis and apnea. At age 8 weeks, he showed general retardation and atrophy of the optic nerve. ... He had no signs of infection, but had been very active the night before. Lactate, pyruvate, and ammonia were normal, free fatty acids were elevated, and GPT was slightly elevated. ... INHERITANCE - Autosomal recessive HEAD & NECK Eyes - Optic nerve atrophy RESPIRATORY - Apnea, episodic ABDOMEN Liver - Enlarged liver - Fatty infiltration - Portal inflammation, mild to moderate Portal fibrosis, mild - Patchy to diffuse macrovesicular steatosis - Acute liver failure, transient (in 1 patient) SKIN, NAILS, & HAIR Skin - Cyanosis NEUROLOGIC Central Nervous System - Seizures (in some patients) - Hepatic encephalopathy (in 1 patient) METABOLIC FEATURES - Cytosolic phosphoenolpyruvate carboxykinase deficiency - Impaired gluconeogenesis - Fasting hypoglycemia - Lactic acidemia - Normal to elevated blood ammonia - Elevated blood alanine aminotransferase - Normal to high plasma glutamine - Normal to low plasma citrulline - Normal to low plasma arginine - Ketonuria - Elevated urine lactate - Prominent tricarboxylic acid cycle metabolites in urine (particularly fumarate) MISCELLANEOUS - Onset in infancy ▲ Close

Cognitive effects include poorer performance on mental tasks and concentration ; dizziness, nausea , insomnia , confusion, anxiety , increased fatigue , headaches , and irritability ; and problems with digestion, including indigestion , changes in the frequency of defecation and consistency of faeces , and reduced interest in and enjoyment of food. [2] The symptoms are caused by a circadian rhythm that is out of sync with the day-night cycle of the destination, [3] as well as the possibility of internal desynchronisation. ... Travel fatigue can occur without crossing time zones, and it often disappears after one day accompanied by a night of good quality sleep. [3] Cause [ edit ] Jet lag is a chronobiological problem, [6] similar to issues often induced by shift work and the circadian rhythm sleep disorders. ... Equally important, the necessary exposure to light to realign the body clock does not tie in with the day/night cycle at the destination. [3] Travelling east by six to nine time zones causes the biggest problems, as it is desirable to avoid light in the mornings. ... Management when travelling west [ edit ] Travelling west causes fewer problems than travelling east, and it is usually sufficient to seek exposure to light during the day and avoid it at night. [3] The advice is to prepare by having late sleep times the days before, and to travel daytime (not so early that early wakeup is needed) and to sleep some on board in order to be less tired at arrival and during ground transfer. ... External links [ edit ] Classification D ICD - 10 : G47.25 ICD - 9-CM : 307.45 , 780.50 327.35 MeSH : D021081 DiseasesDB : 7045 v t e Sleep and sleep disorders Stages of sleep cycles Rapid eye movement (REM) Non-rapid eye movement Slow-wave Brain waves Alpha wave Beta wave Delta wave Gamma wave K-complex Mu rhythm PGO waves Sensorimotor rhythm Sleep spindle Theta wave Sleep disorders Dyssomnia Excessive daytime sleepiness Hypersomnia Insomnia Kleine–Levin syndrome Narcolepsy Night eating syndrome Nocturia Sleep apnea Catathrenia Central hypoventilation syndrome Obesity hypoventilation syndrome Obstructive sleep apnea Periodic breathing Sleep state misperception Circadian rhythm disorders Advanced sleep phase disorder Cyclic alternating pattern Delayed sleep phase disorder Irregular sleep–wake rhythm Jet lag Non-24-hour sleep–wake disorder Shift work sleep disorder Parasomnia Bruxism Nightmare disorder Night terror Periodic limb movement disorder Rapid eye movement sleep behavior disorder Sleepwalking Somniloquy Benign phenomena Dreams Exploding head syndrome Hypnic jerk Hypnagogia / Sleep onset Hypnopompic state Sleep paralysis Sleep inertia Somnolence Nocturnal clitoral tumescence Nocturnal penile tumescence Nocturnal emission Treatment Sleep diary Sleep hygiene Sleep induction Hypnosis Lullaby Somnology Polysomnography Other Sleep medicine Behavioral sleep medicine Sleep study Daily life Bed Bunk bed Daybed Four-poster bed Futon Hammock Mattress Sleeping bag Bed bug Bedding Bedroom Bedtime Bedtime story Bedtime toy Biphasic and polyphasic sleep Chronotype Dream diary Microsleep Mouth breathing Nap Nightwear Power nap Second wind Siesta Sleep and creativity Sleep and learning Sleep deprivation / Sleep debt Sleeping while on duty Sleepover Snoring

With obesity comes a myriad of health complications: sleep apnea , cancer , heart disease , high blood pressure , type 2 diabetes , arthritis . [6] Effects [ edit ] Typically the eating is done rapidly and a person will feel emotionally numb and unable to stop eating. [7] Most people who have eating binges try to hide this behavior from others, and often feel ashamed about being overweight or depressed about their overeating. ... He also reported that some of these cases unhealthy eating habits were seen during a time period he called “night eating”. After this report, the terminology of “Binge Eating” caught on for diagnosing the episodes of infrequent eating of large amounts of food, whether or not the episode is connected with night eating. [11] 1987: The APA's DSM [ edit ] The American Psychiatric Association (APA) mentioned and listed Binge Eating under the listed criteria and features of Bulimia in the Diagnostic and Statistical Manual of Mental Disorders (DSM) - 3 in 1987.

People with muscular dystrophy might eventually need to use a breathing assistance device (ventilator), initially at night but possibly also during the day. ... As respiratory muscles weaken, a sleep apnea device might help improve oxygen delivery during the night.

Treatment of manifestations: Standard treatment for obesity, obstructive sleep apnea, cleft palate, congenital heart defects, hypercholesterolemia, renal anomalies, immunodeficiency, and developmental delay / intellectual disability. Surveillance : Measurement of growth parameters (particularly weight); assessment of developmental progress, mobility, self-help skills, and educational needs; and monitoring for symptoms of obstructive sleep apnea at each visit; ophthalmology evaluation annually or as clinically indicated; measurement of lipid profile periodically starting in childhood. ... In those w/obesity who have symptoms of sleep apnea Craniofacial Clinical assessment for cleft palate &/or micrognathia Consider referral to craniofacial clinic. ... Treatment of Manifestations in Individuals with Ritscher-Schinzel Syndrome View in own window Manifestation/Concern Treatment Considerations/Other Obesity Standard treatment Incl referral to nutritional specialists to monitor food intake & weight Obstructive sleep apnea Standard treatment May incl weight control, removal of tonsils/adenoids, &/or CPAP Cleft palate Standard surgical treatment, ideally by a specialized craniofacial team Congenital heart defects Standard treatment Hypercholesterolemia Standard treatment incl consideration of oral HMG-CoA reductase inhibitors (statins) 1 Other considerations incl optimizing weight, ↑ physical activity, & optimizing dietary fiber intake Renal anomalies Standard treatment per urologist &/or nephrologist Immunodeficiency Standard treatment per immunologist Family/Community Ensure appropriate social work involvement to connect families w/local resources, respite, & support. ... Recommended Surveillance for Individuals with Ritscher-Schinzel Syndrome View in own window System/Concern Evaluation Frequency Eyes Ophthalmology evaluation Annually or as clinically indicated Cardiovascular Lipid profile 1 Periodically 2 Constitutional Measurement of growth parameters, particularly weight Each visit Respiratory Monitor for symptoms of obstructive sleep apnea. Musculoskeletal Physical medicine, OT/PT assessment of mobility, self-help skills Development Monitor developmental progress & educational needs.