Neurologie Aspects of Sleep Apnea and Related Respiratory Disturbances

Perinatal spinal cord injury requiring long-term home mechanical ventilation: a report of four cases

Although perinatal spinal cord injury has been discussed in detail in the literature with respect to aetiology and diagnosis, few studies address long-term outcome, and none address the outcome of long-term home mechanical ventilation in this population. The four patients reported here with perinatal spinal cord injury have used home mechanical ventilation for time periods ranging from 6 to 17 years, with varying results. Their courses with respect to respiratory, neuromuscular, neuropsychological, and nutritional issues are described with reference to the current literature. It is believed that, with the advent of organized home mechanical ventilation programmes and increased acceptance of this technology by the lay public and medical community, the prognosis of the child with perinatal spinal cord injury requiring assisted ventilation is much improved, and may be more positive than the literature currently suggests.

Sleep polygraphic parameters in neuromuscular diseases

In a polysomnographic study of 32 neuromuscular patients-22 with a form of muscular dystrophy, 3 with a form of congenital myopathy, 4 with a form of spinal muscular atrophy, 1 with a recurrent form of polymyositis and 1 with osteogenesis imperfecta syndrome--of which 21 were nonambulatory, we observed sleep related respiratory disturbances represented by: drops in oxygen saturation (SaO2), cardiac arrhythmia, sleep disruption, apneas, tachypnea, tachycardia and snoring. Nine out of the cohort of 32 patients presented with significant desaturations periods. These patients presented with an associated restrictive syndrome and thoracic deformities, some with tachypnea and/or SaO2 below 90% during wakefulness. In this group, snoring was observed in those patients with a form of muscular dystrophy while tachypnea was observed in patients who presented the highest desaturations levels. Sleep quantification revealed an increase of stage 1 sleep coupled with a decrease or even total absence of REM sleep. This is, we believe, a likely consequence of episodic desaturations that may accompany sleep hypoventilation which is potentialised during REM sleep stage.

Obstructive Sleep Apnea Syndrome: Pathophysiology, Upper Airway Evaluation and Surgical Treatment

This paper describes the pathophysiology of the upper airway and the methods of evaluation which include mainly the Mueller maneuver, and cephalometrics. The management of Obstructive Sleep Apnea Syndrome (OSAS) is determined by the level of daytime dysfunction, the degree of cardiopulmonary complications, age, co-existing medical problems, life style, and the extent of the upper airway obstruction and abnormality. Continuous positive airway pressure (C-PAP), uvulopalatopharyngoplasty (UPPP), and permanent tracheostomy are procedures indicated depending on the severity of the case. Midline laser glossectomy was introduced as a new surgical procedure approach to the treatment of OSAS, as an alternative to maxillofacial surgery. When combined with UPPP, the successful results are improved.