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"detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0275" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Polysomnography. Top image: pre-treatment with CPAP showing apnoeas, hypoapnoeas and oxygen desaturation up to 52% (*) in some moments of sleep. Bottom image: post-treatment improvement.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CPAP: continuous positive airway pressure.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hypnopompic hallucinations are experiences that occur in the transition from the dream state to waking, where the phenomenon is perceived as if it were real. The prevalence is thought to vary between 7–70%, although it is estimated that it may be under-diagnosed due to patients’ fear of being labelled as psychiatrically ill.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They tend to occur more frequently in young people, especially women, and can be visual, tactile or auditory.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They are classified as simple or complex according to the degree of elaboration, this classification being useful to guide the possible aetiology, since complex hallucinations, for example, are usually related to narcolepsy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Hypnagogic hallucinations, on the other hand, occur during the transition from wakefulness to sleep.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It has been observed in different descriptive observational studies that hypnopompic hallucinations can be influenced by different factors and, moreover, are more common in certain pathologies: presence of sleep disorders, insomnia, narcolepsy, sleep paralysis, anxiety or depression and stress.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Among sleep disorders, the role of obstructive sleep apnoea-hypopnoea syndrome (OSAHS) stands out, as this is one of the main causes of sleep disturbances today, although there are no reported cases of a link between this syndrome and hallucinations.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of a 50-year-old female patient who presented with visual hallucinations on waking, which had been present for five years and had increased considerably in recent months. She reported seeing moving hearts, like an emoticon, and unspecific musical sounds interspersed with periods of total deafness that disappeared when she woke up completely. She was self-critical at all times. History-taking highlighted daytime hypersomnia, fatigue and increased total sleep time. She had no personal, ophthalmological or family history of interest, and no known allergies. Physical examination revealed a weight of 95<span class="elsevierStyleHsp" style=""></span>kg and a height of 1.70<span class="elsevierStyleHsp" style=""></span>m (body mass index [BMI]<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>32.87, corresponding to obesity). The ophthalmological examination was normal, with no abnormalities that could explain the clinical manifestations. On suspicion of OSAHS, a polysomnography was performed, showing severe OSAHS with more than 50 apnoeas/hypopnoeas per hour and an arterial oxygen saturation of 52% at some time during the night (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient was treated with a continuous positive airway pressure (CPAP) device at 8<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O with improvement of systemic symptoms and disappearance of hallucinations within 24<span class="elsevierStyleHsp" style=""></span>h. Finally, she was diagnosed with hypnopompic hallucinations secondary to OSAHS once other causes were ruled out.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The etiopathogenesis of hypnopompic hallucinations is still under study, it is postulated to be a fugue from the <span class="elsevierStyleItalic">rapid eye movement</span> (REM) stage, in which dreams occur, to the awakening stage, which is considered the non-REM stage.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, more recent research is not entirely clear on this hypothesis and concludes that more research is needed.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Waters et al. believe that the cortical response to external stimuli during the non-REM stage may be increased in patients who commonly experience these hallucinations.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are clinical cases in the literature linking hypnopompic hallucinations to other diseases such as Lewy body dementia<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> or narcolepsy,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> however, we did not find any cases related to OSAHS. In this syndrome, hallucinations could be related to hypoxia and especially hypercapnia, in the same way that hallucinations can occur in carbon monoxide poisoning.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">With this clinical case, we would like to highlight hypnopompic hallucinations as another manifestation of OSAHS, as this is now one of the main causes of daytime hypersomnia and a major social and health problem because of all the consequences that can be associated with it, such as cardiovascular pathology or road accidents. Therefore, in order to avoid under-diagnosis, it is important to be aware of the most atypical clinical features. On the other hand, it is important to emphasise the importance of differentiating them from sleep and to conduct a multidisciplinary study in neuro-ophthalmology departments in order to reach a correct diagnosis, avoiding diagnostic errors and unnecessary treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study was conducted in accordance with the recommendations of good clinical practice guidelines. The patient was informed orally and in writing and gave written consent for the publication of this case report anonymously. Only the researchers have had access to patient data to ensure confidentiality. They have kept the necessary measures so that patients are not identified, in compliance with the General Data Protection Regulation (GDPR) 2016/679, in force since 25 May 2018 and the Organic Law 3/2018, on Personal Data Protection and Guarantee of Digital Rights, in force since 7 December 2018.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This work has not received any funding.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1582 "Ancho" => 2458 "Tamanyo" => 387379 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0275" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Polysomnography. Top image: pre-treatment with CPAP showing apnoeas, hypoapnoeas and oxygen desaturation up to 52% (*) in some moments of sleep. Bottom image: post-treatment improvement.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CPAP: continuous positive airway pressure.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The hypnagogic state: A brief update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Ghibellini" 1 => "B. Meier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jsr.13719" "Revista" => array:3 [ "tituloSerie" => "J Sleep Res" "fecha" => "2023" "volumen" => "32" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Night-time hypnopompic visual hallucinations related to REM sleep disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Takata" 1 => "Y. Inoue" 2 => "H. Hazama" 3 => "E. Fukuma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1819.1998.tb01034.x" "Revista" => array:6 [ "tituloSerie" => "Psychiatry Clin Neurosci" "fecha" => "1998" "volumen" => "52" "paginaInicial" => "207" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9628155" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What Is the Link Between Hallucinations, Dreams, and Hypnagogic-Hypnopompic Experiences?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Waters" 1 => "J.D. Blom" 2 => "T.T. Dang-Vu" 3 => "A.J. Cheyne" 4 => "B. Alderson-Day" 5 => "P. 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Vol. 162. Issue 6.
Pages 305-306 (March 2024)
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Vol. 162. Issue 6.
Pages 305-306 (March 2024)
Letter to the Editor
Hypnopompic hallucinations and the sleep apnea–hypopnea syndrome
Alucinaciones hipnopómpicas y el síndrome de apnea-hipoapnea del sueño
Mireia García-Bermúdez
, Maria Pampillón-Albert, Enrique Santos-Bueso
Corresponding author
Servicio de Oftalmología, Hospital Universitario Clínico San Carlos, Madrid, Spain
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