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This chapter describes a case of alternating leg muscle activation (ALMA) followed by discussion of this condition and the related hypnagogic foot tremor (HFT). HFT and ALMA are benign sleep-related movements of unknown etiology, typically found incidentally on polysomnography. Both HFT and ALMA are characterized by bursts of tibialis anterior activity occurring in sequences with an inter-burst interval shorter than found in periodic limb movements in sleep. There is no specific treatment for HFT and ALMA. Rather, treatment should focus on the other comorbid sleep disorders such as obstructive sleep apnea, as HFT and ALMA motor activity associated with respiratory events may be responsive to positive airway pressure therapy. In this chapter the diagnostic criteria and clinical features are summarized, and polysomnographic tracings and video samples are provided.

This chapter illustrates the impact of sleep disorders in pregnancy by demonstrating a case of obstructive sleep apnea (OSA) associated with preeclampsia. Maternal-fetal health complications are well documented in association with maternal OSA. OSA in pregnancy is a risk for preeclampsia, eclampsia, gestational hypertension, and gestational diabetes mellitus. A growing body of literature supports the importance of detection and diagnosis of OSA in pregnant women. Pregnancy-related complications may be mitigated by OSA treatment. Treatment with continuous PAP therapy is well tolerated in pregnancy and can be offered during pregnancy. Further investigation is needed to understand the effects of treatment on outcomes in pregnancy.

The patient presented in this chapter had uncontrolled obstructive sleep apnea (OSA) and was intolerant of positive airway pressure (PAP). Previous conservative and surgical interventions failed. The patient was successfully treated with maxillomandibular advancement (MMA) surgery. Although many patients benefit from first-line therapy with PAP for OSA, some are intolerant of PAP and require discussion of alternative treatments. Maxillofacial surgical approaches are an option for the treatment of OSA in patients whose craniofacial anatomy is anatomically appropriate. With MMA, patients can achieve significant improvement and in many cases can achieve cure of OSA. Multiple studies support the benefits of MMA in those who are candidates for this treatment.