BackgroundPolysomnograms are not always feasible when sleep disordered breathing (SDB) is suspected in hospitalized patients. Portable monitoring is a practical alternative; however, it has not been recommended in patients with comorbidities.ObjectiveWe evaluated the accuracy of portable monitoring in hospitalized patients suspected of having SDB.DesignProspective observational study.SettingLarge, public, urban, teaching hospital in the United States.ParticipantsHospitalized patients suspected of having SDB.MethodsPatients underwent portable monitoring combined with actigraphy during the hospitalization and then polysomnography after discharge. We determined the accuracy of portable monitoring in predicting moderate to severe SDB and the agreement between the apnea hypopnea index measured by portable monitor (AHIPM) and by polysomnogram (AHIPSG).ResultsSeventy-one symptomatic patients completed both tests. The median time between the two tests was 97 days (IQR 25–75: 24–109). Forty-five percent were hospitalized for cardiovascular disease. Mean age was 52±10 years, 41% were women, and the majority had symptoms of SDB. Based on AHIPSG, SDB was moderate in 9 patients and severe in 39. The area under the receiver operator characteristics curve for AHIPM was 0.8, and increased to 0.86 in patients without central sleep apnea; it was 0.88 in the 31 patients with hypercapnia. For predicting moderate to severe SDB, an AHIPM of 14 had a sensitivity of 90%, and an AHIPM of 36 had a specificity of 87%. The mean±SD difference between AHIPM and AHIPSG was 2±29 event/hr.ConclusionIn hospitalized, symptomatic patients, portable monitoring is reasonably accurate in detecting moderate to severe SDB.

Key Clinical MessageCrazy paving pattern is the name given to characteristic polygonal pattern of interlobular thickening on computed tomography (CT scan) of the lung, which results from accumulation of collagen, interstitial fluid, cell, or other pathology and may be seen in multiple clinical conditions including metastatic cancer as described in this case.

Zonisamide is an anti-seizure medication that is indicated for adjunctive therapy in the treatment of partial seizures. This medication is rarely used in the United States. An infrequent adverse effect of psychosis occurs in about 2% of patients taking zonisamide. This is a case report of a 34-year-old male on phenytoin who presented with psychosis symptoms approximately 10 months after starting adjunctive zonisamide.

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