The sleep apnea syndrome occurs in 4% of adult men and 2% of adult women. Inflammation and hypoxia are intertwined at the molecular, cellular, and clinical levels. Sleep apnea influences heart rate variability, during sleep and during wakefulness. It is also an independent risk factor for stroke. Sleep apnea may also lead to cognitive dysfunction from the effects of chronic hypoxia and sympathetic stress associated with small-vessel disease in the brain, white matter ischemia, and lacunar strokes. This syndrome is a modifiable risk factor and therefore efforts to control this condition in patients at risk of vascular disease is a clinical endeavor that should be pursued vigorously, even though clinical research needs to persist in its quest to answer pressing pathophysiological questions. Emerging evidence suggests that restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) represent risk factors for cardio- and cerebrovascular disease, even leading to stroke.

This chapter discusses the case of an 11-year-old Asian-American girl who was admitted for treating sleep disturbances, excessive daytime sleepiness (EDS) and paroxysmal weakness in the sleep center. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. Nocturnal video-polysomnography (PSG) followed by a multiple sleep latency test (MSLT) were ordered. She went into REM sleep, without going into any other sleep stages at the beginning of the MSLT in three of the five naps. The diagnosis was narcolepsy with cataplexy. Sodium oxybate was administered and titrated twice nightly, which helped further decrease her cataplexy to once or twice daily. Cataplexy may take the form of prolonged waxing and waning, with partial or complete muscle atonia, called status cataplecticus. Schizophreniamay be co-morbid or an intrinsicmanifestation of narcolepsy. Obesity is frequently observed in association with narcolepsy, contributing to sleepiness.