Neural derived exosomes can be used as a diagnostic marker to screen various psychiatric conditions. These intravenously injected exosomes carry the potential to cross the blood brain barrier and deliver miRNA specifically to neurons, microglia, and oligodendrocytes in the brain, resulting in a specific gene knockdown. MicroRNAs have been identified as markers in depression where miR-16 has been found to be a negative regulator of the serotonin transporter (SERT) through computer analysis. Futhermore, where miR 134 levels in bipolar disorder have been discovered to be inversely correlated with severity of manic symptoms; manipulating expression or activity of miR-219 can prove as a therapeutic tool for schizophrenia. Despite these studies, the exact nature and extent of dysregulation of microRNAs in psychiatric disorders is yet to be determined. To realize the therapeutic potential of MiRNAs in greater depth; efficient, tissue-specific and nonimmunogenic delivery of exosomes must be developed.

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INTRODUCTION: PAP therapy in children may interfere with mid-face development presumably due to pressure of head gear and mask in the opposite direction of sutural growth. Some children may require protraction therapy to correct midface hypoplasia and improve midface aesthetics. Such changes do not occur in adult population. However, full face mask can cause retroclination of mandible, which may interfere with PAP effectiveness. CASE PRESENTATION:We present a 71-year-old Caucasian gentleman, with medical history of atrial fibrillation, hypertension and dyslipidemia, was evaluated for snoring, non-restorative sleep and abnormal overnight oximetry, suggestive of moderate sleep disordered breathing. Physical examination was significant for a crowded oropharynx with Friedman class 3 tongue position and mild overbite. We proceeded with in-lab attended polysomnography (PSG) in a split night fashion. PSG revealed moderate obstructive sleep apnea with an Apnea Hypopnea Index (AHI) of 28. His mean oxygen saturation was 92.5 %. The therapeutic portion of the study employed a CPAP and BiPAP titration, using a medium-sized ResMed Air-Touch F20 mask. CPAP pressures were titrated from 5 to 10 cm of water with persistence of obstructive events and some treatment emergent central events. Due to patient intolerance to higher pressures, he was transitioned to BiPAP-S, which was titrated from IPAP/EPAP of 12/9 to 16/11 cmH20. He continued to show residual obstructive and treatment emergent central events at highest tested BiPAP pressure. The mean saturation during PAP therapy was 93.4%.Patient returned for repeat PAP titration study. We requested that BiPAP-S be initiated at IPAP/EPAP of 16/11 cmH20 and titrate up. Patient advised the technician of his intolerance to PAP, he experienced during his prior study. BiPAP-S was started at a lower pressure; IPAP/EPAP of 10/5 and titrated up to 12/7cmH20. The final pressure was effective in controlling obstructive events without emergence of central events. A N30 nasal mask was used during this titration. DISCUSSION: Our patient required lower PAP pressures, when a nasal mask was used in place of a full-face mask. There was no leak with either interface. We postulate that a full-face mask or an oronasal mask may have caused some worsening of the sleep disordered breathing due to downward and backward pressure on the mandible. Previous literature has documented effect on the tongue with an oronasal mask (Andrade, 2014), as well as the need for higher pressures with full face mask (Dibra, 2020). CONCLUSIONS: Our case highlights the importance of effective communication between the patient and technician and initiative taking by sleep technician to find the optimal interface and pressure, essential for an effective study.

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Sleep and eating behavior are complimentary homeostatic functions and adequate sleep is fundamental for the nutritional balance of the body. Short sleep duration has been linked to development of obesity and abnormal eating patterns in children and adults. Individuals with eating disorders report significantly higher sleep disturbances of sleep apnea, insomnia, circadian rhythm disorders, and impairment of daytime functioning, as compared to controls. Sleep disturbances have been implicated in suicidal behaviors in patients with eating disorders. This chapters outline the current evidence examining the pathophysiology and comorbidity of sleep disturbance in daytime eating disorders and focus on clinical assessment and management of nocturnal eating disorders including night eating syndrome and particularly sleep-related eating disorder, which is a combination of parasomnia and eating disorder. There is an imminent need to develop evidence-based pharmacological and psychological treatments for management of nocturnal eating disorders and the sleep disturbances associated with daytime eating disorders.