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| ==Different types of vasovagal syncope==
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| * [[Young patients]] | | * [[Young patients]] |
| * [[Old patients]] | | * [[Old patients]] |
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| * [[Blood phobia]] | | * [[Blood phobia]] |
| * [[Blood donation]] | | * [[Blood donation]] |
| * [[Vasovagal syncope during sleep]]
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| =Triggers for Vasovagal Syncope= | | =Triggers for Vasovagal Syncope= |
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| *Blood phobia: ''However, in a patient with blood phobia just thinking or talking about blood drawing may elicit a common faint <cite>Dijk01</cite>'' | | *Blood phobia: ''However, in a patient with blood phobia just thinking or talking about blood drawing may elicit a common faint <cite>Dijk01</cite>'' |
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| Especially during long flights (> 2 hours) they should perform in-chair [[Physical counterpressure manoeuvers|muscle tensing and relaxing exercise]] and have a regular walk through the isle. In recurrent cases '''midodrine''' prior to flying or '''supportive stockings''' can be considered. | | Especially during long flights (> 2 hours) they should perform in-chair [[Physical counterpressure manoeuvers|muscle tensing and relaxing exercise]] and have a regular walk through the isle. In recurrent cases '''midodrine''' prior to flying or '''supportive stockings''' can be considered. |
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| ==Sleep vasovagal syncope==
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| Sleep vasovagal syncope is defined as loss of consciousness in a non-intoxicated adult occurring during the night (e. g. 10:00 pm to 7:00 am), in which the patient wakes up with pre-syncopal and abdominal symptoms (i.e. an urge to defecate) and losses consciousness in bed or immediately upon standing.
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| There is no tongue biting or post-ictal confusion. There is usually a history of daytime vasovagal syncope and there seems to be a more pronounced fear of blood and medical procedures than in other syncope patients <cite>Jardine06b</cite>. Physical examination, ECG and EEG are within normal limits. The vasovagal reaction is thought to start while asleep <cite>Krediet04a</cite><cite>Jardine06a</cite>, and continuing after waking up, hence the name. During syncope there may be a profound sinus-bradycardia <cite>Krediet04a</cite>. Vasovagal sleep syncope occurs at all ages.
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| ===Differential Diagnosis===
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| Sleep vasovagal syncope is diagnosed by excluding beyond reasonable doubt the hereafter mentioned disorders <cite>Jardine06a</cite>.
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| Epilepsy is the foremost alternative diagnosis to consider, but can often easily be ruled out on clinical grounds. Complex partial, generalized tonic-clonic and myoclonic epilepsy may occur during sleep and can imitate syncope when causing cause sinus-bradycardia <cite>Tinuper</cite>.
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| There are a number of related conditions, including “'''abdominal epilepsy'''” and '''Panayiotopoulos syndrome''' (typically with vomiting) <cite>Covanis</cite>, in which the associated clinical features are abdominal pain and confusion.
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| Sleep paralysis and hypnogogic hallucinations occur in '''narcolepsy''' but also as isolated phenomena, mostly with other characteristic features in the history (e. g., daytime somnolence, in contrast to syncope there’s no amnesia.) and abnormal polysomnography, which can also be used to diagnose sleep apnoea and night terrors.
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| Occasionally cardiac disorders may cause cardiac arrhythmias during sleep. Most of these are unlikely if the 12-lead ECG is normal, and in some patients long-term ambulatory ECG monitoring is required <cite>Brierley</cite>.
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| Some patients with a diagnosis of defaecation syncope (see below) described abdominal and pre-syncopal symptoms that started simultaneously during sleep <cite>Pathy</cite><cite>Fisher</cite> there may be some overlap between this condition and sleep syncope <cite>Jardine06a</cite>.
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| ==References== | | ==References== |