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Locke BW, Brown JP, Sundar KM. The Role of Obstructive Sleep Apnea in Hypercapnic Respiratory Failure Identified in Critical Care, Inpatient, and Outpatient Settings. Sleep Med Clin 2024; 19:339-356. [PMID: 38692757 PMCID: PMC11068091 DOI: 10.1016/j.jsmc.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
An emerging body of literature describes the prevalence and consequences of hypercapnic respiratory failure. While device qualifications, documentation practices, and previously performed clinical studies often encourage conceptualizing patients as having a single "cause" of hypercapnia, many patients encountered in practice have several contributing conditions. Physiologic and epidemiologic data suggest that sleep-disordered breathing-particularly obstructive sleep apnea (OSA)-often contributes to the development of hypercapnia. In this review, the authors summarize the frequency of contributing conditions to hypercapnic respiratory failure among patients identified in critical care, emergency, and inpatient settings with an aim toward understanding the contribution of OSA to the development of hypercapnia.
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Affiliation(s)
- Brian W Locke
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jeanette P Brown
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Krishna M Sundar
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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2
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Spiesshoefer J, Herkenrath SD, Treml M, Pietzke-Calcagnile A, Hagmeyer L, Regmi B, Matthes S, Young P, Boentert M, Randerath WJ. Inspiratory Muscle Dysfunction Mediates and Predicts a Disease Continuum of Hypercapnic Failure in Chronic Obstructive Pulmonary Disease. Respiration 2024; 103:182-192. [PMID: 38325348 DOI: 10.1159/000536589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Advanced chronic obstructive pulmonary disease (COPD) is associated with chronic hypercapnic failure. The present work aimed to comprehensively investigate inspiratory muscle function as a potential key determinant of hypercapnic respiratory failure in patients with COPD. METHODS Prospective patient recruitment encompassed 61 stable subjects with COPD across different stages of respiratory failure, ranging from normocapnia to isolated nighttime hypercapnia and daytime hypercapnia. Arterialized blood gas analyses and overnight transcutaneous capnometry were used for patient stratification. Assessment of respiratory muscle function encompassed body plethysmography, maximum inspiratory pressure (MIP), diaphragm ultrasound, and transdiaphragmatic pressure recordings following cervical magnetic stimulation of the phrenic nerves (twPdi) and a maximum sniff manoeuvre (Sniff Pdi). RESULTS Twenty patients showed no hypercapnia, 10 had isolated nocturnal hypercapnia, and 31 had daytime hypercapnia. Body plethysmography clearly distinguished patients with and without hypercapnia but did not discriminate patients with isolated nocturnal hypercapnia from those with daytime hypercapnia. In contrast to ultrasound parameters and transdiaphragmatic pressures, only MIP reflected the extent of hypercapnia across all three stages. MIP values below -48 cmH2O predicted nocturnal hypercapnia (area under the curve = 0.733, p = 0.052). CONCLUSION In COPD, inspiratory muscle dysfunction contributes to progressive hypercapnic failure. In contrast to invasive tests of diaphragm strength only MIP fully reflects the pathophysiological continuum of hypercapnic failure and predicts isolated nocturnal hypercapnia.
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Affiliation(s)
- Jens Spiesshoefer
- Department of Pneumology and Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
- Interdisciplinary Health Science Center, Scuola Superiore Sant Anna Pisa, Pisa, Italy
| | - Simon D Herkenrath
- Institute for Pneumology at the University of Cologne, Solingen, Germany
- Bethanien Hospital gGmbH, Solingen, Germany
| | - Marcel Treml
- Institute for Pneumology at the University of Cologne, Solingen, Germany,
| | | | - Lars Hagmeyer
- Institute for Pneumology at the University of Cologne, Solingen, Germany
- Bethanien Hospital gGmbH, Solingen, Germany
| | - Binaya Regmi
- Department of Pneumology and Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Sandhya Matthes
- Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Peter Young
- Medical Park Klinik Reithofpark, Bad Feilnbach, Germany
| | - Matthias Boentert
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
- Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Winfried J Randerath
- Institute for Pneumology at the University of Cologne, Solingen, Germany
- Bethanien Hospital gGmbH, Solingen, Germany
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3
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Boentert M. [Sleep disorders in patients with neuromuscular diseases]. SOMNOLOGIE 2023; 27:64-73. [PMID: 36789371 PMCID: PMC9912238 DOI: 10.1007/s11818-023-00401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
Neuromuscular diseases (NMD) may affect skeletal muscles, peripheral nerves, or motor endplates. Clinical symptoms comprise muscle weakness, which is often progressive, but also sensory disturbances, and primary or secondary pain. Sleep disturbances in NMD may result from insomnia due to immobility, pain, or sleep-related leg muscle cramps, but also restless legs syndrome and sleep-disordered breathing. Many NMD predispose to obstructive sleep apnea or progressive respiratory muscle weakness, which first manifests as sleep-related hypoventilation and eventually leads to chronic hypercapnic respiratory failure. The latter is crucial for overall prognosis in muscular dystrophies and myopathies, but even more so in motor neuron diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy.
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Affiliation(s)
- Matthias Boentert
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Deutschland.,Klinik für Innere Medizin, Bereich Neurologie, UKM-Marienhospital, Steinfurt, Deutschland
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4
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Klein E, Dräger B, Boentert M. Validation of the Single Breath Count Test for Assessment of Inspiratory Muscle Strength in Healthy Subjects and People with Neuromuscular Disorders. J Neuromuscul Dis 2023; 10:251-261. [PMID: 36617788 DOI: 10.3233/jnd-221530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study aimed to validate the single breath count test (SBCT) against volitional measures of respiratory muscle function in healthy subjects and people with neuromuscular disorders (NMD; n = 100 per group). METHODS Testing comprised upright and supine SBCT, forced vital capacity (FVC), maximum inspiratory pressure (MIP), and sniff nasal inspiratory pressure (SNIP). Predictability of FVC by SBCT was assessed using logarithmic regression analysis. Receiver operating characteristics curves were used to identify SBCT thresholds for lung restriction (FVC < 80% predicted), inspiratory muscle weakness (MIP < 60 cmH2O), and indication for non-invasive ventilation (NIV) in NMD patients. RESULTS In both groups, SBCT showed moderate correlation with FVC. In patients, SBCT values were also correlated with MIP and SNIP. Strength of correlations was similar with supine and upright SBCT which accounted for 23.7% of FVC variance in healthy individuals (44.5% in patients). Predictive thresholds of upright SBCT were < 27 for MIP < 60 cmH2O (sensitivity 0.61/specificity 0.86), <39 for NIV indication (0.92/0.46), and <41 for FVC < 80% predicted (0.89/0.62). CONCLUSION The SBCT is positively correlated with spirometry. It predicts both lung restriction and NIV indication in NMD patients. The SBCT allows for remote monitoring and may substitute for spirometry/manometry if appropriate devices are unavailable.
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Affiliation(s)
- Eike Klein
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Bianca Dräger
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
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Eurich B, Nitsche C, Lau M, Hanker B, Spiegler J, Stichtenoth G. Progressive Respiratory Insufficiency in a Teenager with Diaphragmatic Hypomotility Due to a Novel Combination of Gliomedin Gene Variants. CHILDREN 2022; 9:children9060797. [PMID: 35740734 PMCID: PMC9221880 DOI: 10.3390/children9060797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
Abstract
Lethal congenital contracture syndrome 11 (LCCS11) is a form of arthrogryposis multiplex congenita (AMC) which is associated with mutations in the gliomedin gene (GLDN) and has been known to be severely life-shortening, mainly due to respiratory insufficiency. Patients with this condition have been predominantly treated by pediatricians as they usually do not survive beyond childhood. In this case report, we present a young adult who developed severe progressive respiratory insufficiency as a teenager due to diaphragmatic hypomotility and was diagnosed with LCCS11 following the discovery of compound heterozygous pathogenic variants in GLDN. This case demonstrates the importance of screening for neuromuscular diseases in well-child visits and follow-ups of patients at risk for gross and fine motor function developmental delay. It also underscores the significance of including LCCS11 and other axonopathies in the differential diagnosis of juvenile onset of respiratory insufficiency, highlights that patients with this condition may present to adult practitioners and questions whether the nomenclature of this condition with various phenotypes should be reconsidered due to the stigmatizing term ‘lethal’.
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Affiliation(s)
- Benjamin Eurich
- Department of Pediatrics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (C.N.); (M.L.); (G.S.)
- Correspondence:
| | - Catharina Nitsche
- Department of Pediatrics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (C.N.); (M.L.); (G.S.)
- Division of Pediatric Pneumology & Allergology, University Hospital Schleswig-Holstein Campus Lübeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Margot Lau
- Department of Pediatrics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (C.N.); (M.L.); (G.S.)
| | - Britta Hanker
- Institute of Human Genetics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany;
| | - Juliane Spiegler
- Department of Pediatrics, Julius Maximilian University of Würzburg, Sanderring 2, 97070 Würzburg, Germany;
| | - Guido Stichtenoth
- Department of Pediatrics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (C.N.); (M.L.); (G.S.)
- Division of Pediatric Pneumology & Allergology, University Hospital Schleswig-Holstein Campus Lübeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Ratzeburger Allee 160, 23538 Lübeck, Germany
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Spiesshoefer J, Lutter R, Kabitz HJ, Henke C, Herkenrath S, Randerath W, Young P, Dreher M, Görlich D, Boentert M. Respiratory Muscle Function Tests and Diaphragm Ultrasound Predict Nocturnal Hypoventilation in Slowly Progressive Myopathies. Front Neurol 2021; 12:731865. [PMID: 34721265 PMCID: PMC8551547 DOI: 10.3389/fneur.2021.731865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: In slowly progressive myopathies, diaphragm weakness early manifests through sleep-related hypoventilation as reflected by nocturnal hypercapnia. This study investigated whether daytime tests of respiratory muscle function and diaphragm ultrasound predict hypercapnia during sleep. Methods: Twenty-seven patients with genetic myopathies (myotonic dystrophy type 1 and 2, late-onset Pompe disease, facioscapulohumeral dystrophy; 48 ± 11 years) underwent overnight transcutaneous capnometry, spirometry, measurement of mouth occlusion pressures, and diaphragm ultrasound. Results: Sixteen out of 27 patients showed nocturnal hypercapnia (peak ptcCO2 ≥ 50 mmHg for ≥ 30 min or increase in ptcCO2 by 10 mmHg or more from the baseline value). In these patients, forced vital capacity (FVC; % predicted) and maximum inspiratory pressure (MIP; % of lower limit or normal or LLN) were significantly reduced compared to normocapnic individuals. Nocturnal hypercapnia was predicted by reduction in FVC of <60% [sensitivity, 1.0; area under the curve (AUC), 0.82] and MIP (%LLN) <120% (sensitivity, 0.83; AUC, 0.84), the latter reflecting that in patients with neuromuscular disease, pretest likelihood of abnormality is per se higher than in healthy subjects. Diaphragm excursion velocity during a sniff maneuver excluded nocturnal hypercapnia with high sensitivity (0.90) using a cutoff of 8.0 cm/s. Conclusion: In slowly progressive myopathies, nocturnal hypercapnia is predicted by FVC <60% or MIP <120% (LLN). As a novelty, nocturnal hypercapnia can be excluded with acceptable sensitivity by diaphragm excursion velocity >8.0 cm/s on diaphragm ultrasound.
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Affiliation(s)
- Jens Spiesshoefer
- Department of Neurology With Institute for Translational Neurology, Muenster University Hospital, Muenster, Germany.,Department of Pneumology and Intensive Care Medicine, Aachen University Hospital, Aachen, Germany
| | - Riccarda Lutter
- Department of Neurology With Institute for Translational Neurology, Muenster University Hospital, Muenster, Germany
| | - Hans-Joachim Kabitz
- Department of Pneumology, Cardiology, and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Carolin Henke
- Department of Neurology, Herz-Jesu-Krankenhaus Münster-Hiltrup, Münster, Germany
| | - Simon Herkenrath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany.,Institute for Pneumology, University of Cologne, Solingen, Germany
| | - Winfried Randerath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany.,Institute for Pneumology, University of Cologne, Solingen, Germany
| | - Peter Young
- Medical Park Klinik Reithofpark, Bad Feilnbach, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, Aachen University Hospital, Aachen, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Matthias Boentert
- Department of Neurology With Institute for Translational Neurology, Muenster University Hospital, Muenster, Germany.,Department of Medicine, Universitätsklinikum Münster (UKM) Marienhospital, Steinfurt, Germany
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7
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Engel M, Glatz C, Helmle C, Young P, Dräger B, Boentert M. Respiratory parameters on diagnostic sleep studies predict survival in patients with amyotrophic lateral sclerosis. J Neurol 2021; 268:4321-4331. [PMID: 33880611 PMCID: PMC8505303 DOI: 10.1007/s00415-021-10563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In amyotrophic lateral sclerosis (ALS), respiratory muscle involvement and sleep-disordered breathing relate to worse prognosis. The present study investigated whether respiratory outcomes on first-ever sleep studies predict survival in patients with ALS, specifically taking into account subsequent initiation of non-invasive ventilation (NIV). METHODS From patients with ALS, baseline sleep study records, transcutaneous capnometry, early morning blood gas analysis, survival data and clinical disease characteristics were retrospectively analyzed. Patients were stratified according to whether enduring NIV was consecutively established ("NIV(+)") or not ("NIV(-)"). RESULTS Among the study cohort (n = 158, 72 female, 51 with bulbar onset ALS, 105 deceased) sleep-disordered breathing was present at baseline evaluation in 97 patients. Early morning base excess (EMBE) > 2 mmol/l predicted nocturnal hypercapnia. Ninety-five patients were NIV(+) and 63 were NIV(-). Survival from baseline sleep studies was significantly reduced in NIV(-) but not in NIV(+) patients with nocturnal CO2 tension ≥ 50 mmHg, apnea hypopnea index ≥ 5/h, and EMBE > 2 mmol/l. Hazard ratio for EMBE > 2 mmol/l was increased in NIV(-) patients only, and EMBE independently predicted survival in both NIV(-) and NIV(+) patients. Furthermore, EMBE on baseline sleep studies was the only predictor for survival from symptom onset, and hazard ratio for shorter survival was markedly higher in the NIV(-) than the NIV(+) group (2.85, p = 0.005, vs. 1.71, p = 0.042). INTERPRETATION In patients with ALS, EMBE > 2 mmol/l predicts nocturnal hypercapnia and shorter survival. Negative effects of sleep-disordered breathing on survival are statistically abolished by sustained NIV.
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Affiliation(s)
- Markus Engel
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Christian Glatz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Cornelia Helmle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Peter Young
- Department of Neurology, Medical Park Reithofpark, Bad Feilnbach, Germany
| | - Bianca Dräger
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany. .,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany.
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8
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Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular disorders. Sleep Breath 2020; 25:1441-1451. [PMID: 33263819 PMCID: PMC7708892 DOI: 10.1007/s11325-020-02263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/24/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE In neuromuscular disorders (NMD), inspiratory muscle weakness may cause sleep-related hypoventilation requiring non-invasive ventilation (NIV). Alternatively, nasal high flow therapy (NHF) may ameliorate mild nocturnal hypercapnia (NH) through washout of anatomical dead space and generation of positive airway pressure. Ventilatory support by NIV or NHF might have favourable short-term effects on sympathovagal balance (SVB). This study comparatively investigated the effects of NHF and NIV on sleep-related breathing and SVB in NMD patients with evolving NH. METHODS Transcutaneous CO2 (ptcCO2), peripheral oxygen saturation (SpO2), sleep outcomes and SVB (spectral analysis of heart rate, diastolic blood pressure variability) along with haemodynamic measures (cardiac index, total peripheral resistance index) were evaluated overnight in 17 patients. Polysomnographies (PSG) were randomly split into equal parts with no treatment, NIV and NHF at different flow rates (20 l/min vs. 50 l/min). In-depth analysis of SVB and haemodynamics was performed on 10-min segments of stable N2 sleep taken from each intervention. RESULTS Compared with no treatment, NHF20 and NHF50 did not significantly change ptcCO2, SpO2 or the apnea hypopnea index (AHI). NHF50 was poorly tolerated. In contrast, NIV significantly improved both gas exchange and AHI without adversely affecting sleep. During daytime, NHF20 and NHF50 had neutral effects on ventilation and oxygenation whereas NIV improved ptcCO2 and SpO2. Effects of NIV and NHF on SVB and haemodynamics were neutral during both night and daytime. CONCLUSIONS NHF does not correct sleep-disordered breathing in NMD patients with NH. Both NHF and NIV exert no immediate effects on SVB.
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Abstract
PURPOSE OF REVIEW In amyotrophic lateral sclerosis (ALS), sleep disruption is frequently present and substantially adds to disease burden. This review aims to summarize current knowledge on causes, pathophysiology, and treatment of sleep disturbances in ALS. RECENT FINDINGS Motor neuron degeneration and muscle weakness may lead to muscle cramps, pain, spasticity, immobilization, restless legs, sleep-disordered breathing, and difficulties to clear secretions. Furthermore, existential fears and depression may promote insomnia. Sleep-disordered breathing, and nocturnal hypoventilation in particular, requires ventilatory support which meaningfully prolongs survival and improves health-related quality of life albeit respiratory failure is inevitable. Early indication for non-invasive ventilation can be achieved by inclusion of capnometry in diagnostic sleep studies. Sleep disruption is extremely common in ALS and may arise from different etiologies. The absence of causative therapeutic options for ALS underlines the importance of symptomatic and palliative treatment strategies that acknowledge sleep-related complaints.
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Affiliation(s)
- Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
- Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany.
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10
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Fleury Curado T, Pho H, Berger S, Caballero-Eraso C, Shin MK, Sennes LU, Pham L, Schwartz AR, Polotsky VY. Sleep-disordered breathing in C57BL/6J mice with diet-induced obesity. Sleep 2019; 41:4996050. [PMID: 29767787 DOI: 10.1093/sleep/zsy089] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 01/19/2023] Open
Abstract
Obesity leads to sleep-disordered breathing (SDB) manifested by recurrent upper airway obstructions termed obstructive sleep apnea (OSA) and carbon dioxide retention due to hypoventilation. The objective of this work was to characterize breathing during sleep in C57BL6/J mice with diet-induced obesity (DIO). Arterial blood gas was measured in nine obese and nine lean mice during wakefulness. Nine male mice with DIO and six lean male C57BL/6J mice were head mounted with electroencephalogram (EEG) and electromyogram (EMG) electrodes. Sleep recordings were performed in the whole body plethysmography chamber; upper airway obstruction was characterized by the presence of inspiratory flow limitation in which airflow plateaus with increases in inspiratory effort. Obese mice showed significantly lower pH and higher partial pressure of arterial CO2 (PaCO2) in arterial blood gas compared to lean mice, 7.35 ± 0.04 versus 7.46 ± 0.06 (p < 0.001) and 38 ± 8 mm Hg versus 30 ± 5 mm Hg (p < 0.001). Obese mice had similar levels of minute ventilation to lean mice during sleep and wakefulness, despite higher body weight and temperature, indicating an increase in the metabolic rate and hypoventilation. Obese mice also showed baseline hypoxemia with decreased mean oxyhemoglobin saturation across sleep/wake states. Obese mice had a higher prevalence of flow-limited breathing compared to lean mice during sleep. However, the oxygen desaturation index in lean and obese mice did not differ. We conclude that DIO in mice leads to hypoventilation. Obesity also increases the frequency of inspiratory limited breaths, but it does not translate into progression of OSA.
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Affiliation(s)
- Thomaz Fleury Curado
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Otolaryngology, University of Sao Paulo, Sao Paulo, Brazil
| | - Huy Pho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | - Slava Berger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | - Candela Caballero-Eraso
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
| | - Mi-Kyung Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Luu Pham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
PURPOSE OF REVIEW In numerous neuromuscular disorders (NMDs), respiratory muscle weakness is present, and acute or chronic respiratory failure may evolve. Very often, respiratory involvement substantially adds to the burden of disease, impairs quality of life, or reduces life expectancy. This article summarizes new aspects of both diagnosis and management of respiratory muscle weakness in patients with NMDs. RECENT FINDINGS Drugs like deflazacort, ataluren, eteplirsen, and nusinersen are now approved treatments for Duchenne Muscular Dystrophy and Spinal Muscular Atrophy, and others are on their way in NMDs. Although observing how innovative drugs will change the natural history of these diseases, including respiratory function over time, adequate symptomatic treatment remains meaningful and is strongly recommended. Physicians should systematically take respiratory involvement into account to improve patients' quality of life and prognosis. SUMMARY First, it is outlined in which subtypes of NMD respiratory muscle dysfunction is particularly relevant. Second, new developments regarding diagnostic procedures, including respiratory muscle strength testing, spirometry, and sleep studies, are covered. Third, this article gives an overview on current concepts of ventilatory support and management of secretions in patients with NMD.
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12
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Boentert M. Dissecting the benefits of long-term non-invasive ventilation in patients with distinct neuromuscular disorders. Respirology 2017. [DOI: 10.1111/resp.13103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Matthias Boentert
- Department of Sleep Medicine and Neuromuscular Disorders; University Hospital Münster; Münster Germany
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13
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Progression from respiratory dysfunction to failure in late-onset Pompe disease. Neuromuscul Disord 2016; 26:481-9. [PMID: 27297666 DOI: 10.1016/j.nmd.2016.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/12/2016] [Accepted: 05/26/2016] [Indexed: 11/23/2022]
Abstract
To identify determinants of respiratory disease progression in late-onset Pompe disease (LOPD), we studied relationships between pulmonary function, respiratory muscle strength, gas exchange, and respiratory control. Longitudinal evaluation of 22 LOPD patients (mean age 38 years) was performed at 6-month intervals for 6-24 months. Measurements included vital capacity (VC), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), tidal volume (VT), dead space (VD), and ventilatory response to CO2. Although reduction in VC correlated with MIP and MEP (p < 0.0001), some patients had normal VC despite reduced MIP and MEP (5 [23%] and 9 [41%] patients, respectively). Daytime hypercapnia was associated with reduced VC (<60% predicted) and MIP (<40% predicted). Moreover, chronic hypercapnia was associated with elevated VD/VT (≥0.44) due to falling VT (≈300 ml), compatible with reduced efficiency of CO2 clearance. The presence of hypercapnia and/or ventilatory support was associated with reduced ventilatory responsiveness to CO2 (≤0.7 l/min/mmHg). We conclude that daytime hypercapnia, an indicator of chronic respiratory failure, is tightly linked to the degree of respiratory muscle weakness and severity of pulmonary dysfunction in LOPD patients. Reductions in CO2 clearance efficiency and ventilatory responsiveness may contribute to the development of chronic daytime hypercapnia.
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Milioli G, Bosi M, Poletti V, Tomassetti S, Grassi A, Riccardi S, Terzano MG, Parrino L. Sleep and respiratory sleep disorders in idiopathic pulmonary fibrosis. Sleep Med Rev 2015; 26:57-63. [PMID: 26168886 DOI: 10.1016/j.smrv.2015.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 01/08/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease (ILD) characterized by inflammation and progressive scarring of the lung parenchyma. IPF profoundly affects the quality of life (QoL) and fatigue is a frequently disabling symptom. The cause of fatigue is not well understood but patients with IPF often report extremely poor sleep quality and sleep-related breathing disorders (SRBD) that correlate with QoL. IPF patients present alterations in sleep architecture, including decreased sleep efficiency, slow wave sleep and rapid eye movement (REM) sleep, and increased sleep fragmentation. Moreover, sleep related hypoventilation during the vulnerable REM sleep period and obstructive sleep apnea-hypopnea syndrome (OSAHS) are frequent, but remain usually underdiagnosed. These SRBD in IPF are associated with alterations of the sleep structure, reduction of QoL and increased risk of mortality. In the absence of an effective therapy for IPF, optimizing the QoL could become the primary therapeutic goal. In this perspective the diagnosis and treatment of SRBD could significantly improve the QoL of IPF patients.
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Affiliation(s)
- Giulia Milioli
- Sleep Disorders Center, Dept of Neurosciences, University of Parma, Italy.
| | - Marcello Bosi
- Pulmonary Operative Unit, Dept of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Venerino Poletti
- Pulmonary Operative Unit, Dept of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Sara Tomassetti
- Pulmonary Operative Unit, Dept of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Andrea Grassi
- Sleep Disorders Center, Dept of Neurosciences, University of Parma, Italy
| | - Silvia Riccardi
- Sleep Disorders Center, Dept of Neurosciences, University of Parma, Italy
| | | | - Liborio Parrino
- Sleep Disorders Center, Dept of Neurosciences, University of Parma, Italy
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