Sleep Disorders in Neuromuscular Diseases

Obstructive Sleep Apnea Treatment with Oral Appliance in a Myotonic Dystrophy Type I Subject: A Case Report

Objective  to report a myotonic dystrophy type 1 (MD1) subject with obstructive sleep apnea syndrome treated with oral appliance. Methods  A review of individual's history and records, associated with a photographic register of all diagnostic methods and literature research about the topic were done. Final Statements  This case depicts the therapeutical choices disposable to treat subjects with obstructive sleep apnea and DM1. Although considered an uncommon treatment, the oral appliances, if well indicated in adequately selected cases, can satisfactorily improve respiratory parameters, symptoms and quality of life.

Does Scoliosis Affect Sleep Breathing?

OBJECTIVE

Scoliosis, especially thoracic curves, causes poor pulmonary function. As a result, scoliosis may impair sleep breathing. The literature regarding the relationship between scoliosis and sleep breathing is sparse.

METHODS

Fifty-seven patients with adolescent idiopathic scoliosis or congenital scoliosis and 25 healthy control subjects were included. The wrist sleep monitors was used. Sleep breathing was evaluated with the following parameters: 1) Respiratory Disorders Index (pRDI), indicating mean respiratory events per hour of sleep including apnea, hypoxia, and respiratory effort-related arousal; 2) Apnea and Hypopnea Index (pAHI), expressing the number of apnea and hypopnea events per hour of sleep; and 3) mean and minimal oxygen saturation (Sao₂) during sleep.

RESULTS

No differences in age, sex distribution, and body mass index were found between the two groups. Patients with scoliosis had statistically significant higher pRDI (median, 10.10 vs. 8.65; P = 0.039) and pAHI (median, 1.60 vs. 0.72; P = 0.029) scores than the control group. The minimal SaO₂ value in patients with scoliosis was lower (median, 93% vs. 94%, respectively; P = 0.005), whereas no difference was found in the mean SaO₂ value during sleep. In patients with scoliosis, pAHI scores were higher when lying on the convex side of the thoracic curve compared with the concave side (2.34 vs. 2.28, respectively; P = 0.044), whereas no such difference was observed in the control group.

CONCLUSIONS

Patients with scoliosis have more respiratory events of apnea and hypopnea during sleep than the control group. The minimal SaO₂ value in patients with scoliosis is lower than the normal population. Sleeping on the convex side of the thoracic curve results in higher pAHI scores than on the concave side.

Currents issues in cardiorespiratory care of patients with post-polio syndrome

ABSTRACT Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

Sleep disorders in patients with myasthenia gravis: a systematic review

[Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9–490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed.

Neuroglia and their roles in central respiratory control; an overview

While once viewed as mere housekeepers, providing structural and metabolic support for neurons, it is now clear that neuroglia do much more. Phylogenetically, they have undergone enormous proliferation and diversification as central nervous systems grew in their complexity. In addition, they: i) are morphologically and functionally diverse; ii) play numerous, vital roles in maintaining CNS homeostasis; iii) are key players in brain development and responses to injury; and, iv) via gliotransmission, are likely participants in information processing. In this review, we discuss the diverse roles of neuroglia in maintaining homeostasis in the CNS, their evolutionary origins, the different types of neuroglia and their functional significance for respiratory control, and finally consider evidence that they contribute to the processing of chemosensory information in the respiratory network and the homeostatic control of blood gases.

Sleep disorders in spinal and bulbar muscular atrophy (Kennedy's disease): a controlled polysomnographic and self-reported questionnaires study

No data are available regarding the occurrence of sleep disorders in spinal and bulbar muscular atrophy (SBMA). We investigated the sleep-wake cycle in SBMA patients compared with healthy subjects. Nine SBMA outpatients and nine age-matched and sex-matched healthy controls were evaluated. Subjective quality of sleep was assessed by means of the Pittsburgh Sleep Quality Index (PSQI). The Epworth Sleepiness Scale was used in order to evaluate excessive daytime sleepiness. All participants underwent a 48-h polysomnography followed by the multiple sleep latency test. Time in bed, total sleep time and sleep efficiency were significantly lower in SBMA than controls. Furthermore, the apnea-hypopnea index (AHI) was significantly higher in SBMA than controls. Obstructive sleep apnea (OSA: AHI >5/h) was evident in 6/9 patients (66.6 %). REM sleep without atonia was evident in three patients also affected by OSA and higher AHI in REM; 2/9 (22.2 %) SBMA patients showed periodic limb movements in sleep. The global PSQI score was higher in SBMA versus controls. Sleep quality in SBMA is poorer than in controls. OSA is the most common sleep disorder in SBMA. The sleep impairment could be induced both by OSA or/and the neurodegenerative processes involving crucial areas regulating the sleep-wake cycle.

Sleep-Wake Cycle and Daytime Sleepiness in the Myotonic Dystrophies

Myotonic dystrophy is the most common type of muscular dystrophy in adults and is characterized by progressive myopathy, myotonia, and multiorgan involvement. Two genetically distinct entities have been identified, myotonic dystrophy type 1 (DM1 or Steinert's Disease) and myotonic dystrophy type 2 (DM2). Myotonic dystrophies are strongly associated with sleep dysfunction. Sleep disturbances in DM1 are common and include sleep-disordered breathing (SDB), periodic limb movements (PLMS), central hypersomnia, and REM sleep dysregulation (high REM density and narcoleptic-like phenotype). Interestingly, drowsiness in DM1 seems to be due to a central dysfunction of sleep-wake regulation more than SDB. To date, little is known regarding the occurrence of sleep disorders in DM2. SDB (obstructive and central apnoea), REM sleep without atonia, and restless legs syndrome have been described. Further polysomnographic, controlled studies are strongly needed, particularly in DM2, in order to clarify the role of sleep disorders in the myotonic dystrophies.