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Boulos MI, Chi L, Chernyshev OY. The mobile sleep medicine model in neurologic practice: Rationale and application. Front Neurol 2022; 13:1032463. [PMID: 36388176 PMCID: PMC9650181 DOI: 10.3389/fneur.2022.1032463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Undiagnosed obstructive sleep apnea (OSA) is prevalent in neurological practice and significantly contributes to morbidity and mortality. OSA is prevalent in US adults and causes poor quality sleep and significant neurocognitive, cardiovascular, and cerebrovascular impairments. Timely treatment of OSA reduces cardio-cerebrovascular risks and improves quality of life. However, most of the US population has limited systematic access to sleep medicine care despite its clinical significance. Focus We discuss the importance of systematic screening, testing, and best-practice management of OSA and hypoventilation/hypoxemia syndromes (HHS) in patients with stroke, neurocognitive impairment, and neuromuscular conditions. This review aims to introduce and describe a novel integrated Mobile Sleep Medicine (iMSM) care model and provide the rationale for using an iMSM in general neurological practice to assist with systematic screening, testing and best-practice management of OSA, HHS, and potentially other sleep conditions. Key points The iMSM is an innovative, patient-centered, clinical outcome-based program that uses a Mobile Sleep Medicine Unit—a “sleep lab on wheels”—designed to improve access to OSA management and sleep care at all levels of health care system. The protocol for the iMSM care model includes three levels of operations to provide effective and efficient OSA screening, timely testing/treatment plans, and coordination of further sleep medicine care follow-up. The iMSM care model prioritizes effective, efficient, and patient-centered sleep medicine care; therefore, all parties and segments of care that receive and provide clinical sleep medicine services may benefit from adopting this innovative approach.
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Affiliation(s)
- Mark I. Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Luqi Chi
- Washington University School of Medicine, St. Louis, MO, United States
| | - Oleg Y. Chernyshev
- Sleep Medicine Division, Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, United States
- Ochsner LSU Health Sleep Medicine Center, Shreveport, LA, United States
- *Correspondence: Oleg Y. Chernyshev
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De Vito EL, Arce SC, Monteiro SG, Vaca Ruiz GA. Central drive and ventilatory failure in late-onset Pompe disease: At the gates of a new phenotype. Neuromuscul Disord 2019; 29:444-447. [PMID: 31130377 DOI: 10.1016/j.nmd.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/23/2019] [Accepted: 03/17/2019] [Indexed: 01/14/2023]
Abstract
Subjects with late-onset Pompe disease (LOPD) typically present as slowly progressive proximal muscle weakness. Respiratory muscle weakness and diaphragmatic paralysis are common features, and may be the initial manifestation of the disease. There is often a poor correlation between the severity of limb and respiratory muscle weakness. Early clinical observations about disproportionate hypercapnia to the respiratory muscular weakness in late-onset Pompe disease were recognized and will be discussed with special reference to blunted respiratory drive, and the connections between early clinical observations, respiratory functional studies and anatomical findings. According to new evidence about blunted respiratory drive in Pompe disease, it is necessary to rethink what is meant by "asymptomatic Pompe disease" and propose a new phenotype with its therapeutic implications. The conceptual model of the mechanisms leading to respiratory failure in this disease could be considered according to these new findings. It may broaden the diagnostic spectrum of the adult forms and warrants a closer interaction between neurologists and pulmonologists. The recognition of this new phenotype of predominant central alveolar hypoventilation in Pompe disease will improve the understanding of the underlying mechanisms of ventilatory failure and could lead to improved future therapeutic strategies.
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Affiliation(s)
- E L De Vito
- Department of Pneumology and Pulmonary Laboratory, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Combatientes de Malvinas 3150, Zip Code 1427, Ciudad Autónoma de Buenos Aires, Argentina.
| | - S C Arce
- Department of Pneumology and Pulmonary Laboratory, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Combatientes de Malvinas 3150, Zip Code 1427, Ciudad Autónoma de Buenos Aires, Argentina
| | - S G Monteiro
- Department of Pneumology and Pulmonary Laboratory, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Combatientes de Malvinas 3150, Zip Code 1427, Ciudad Autónoma de Buenos Aires, Argentina
| | - G A Vaca Ruiz
- Department of Pneumology and Pulmonary Laboratory, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Combatientes de Malvinas 3150, Zip Code 1427, Ciudad Autónoma de Buenos Aires, Argentina
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Fayssoil A, Behin A, Ogna A, Mompoint D, Amthor H, Clair B, Laforet P, Mansart A, Prigent H, Orlikowski D, Stojkovic T, Vinit S, Carlier R, Eymard B, Lofaso F, Annane D. Diaphragm: Pathophysiology and Ultrasound Imaging in Neuromuscular Disorders. J Neuromuscul Dis 2018; 5:1-10. [PMID: 29278898 PMCID: PMC5836400 DOI: 10.3233/jnd-170276] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Respiratory muscles are classically involved in neuromuscular disorders, leading to a restrictive respiratory pattern. The diaphragm is the main respiratory muscle involved during inspiration. Ultrasound imaging is a noninvasive, radiation-free, accurate and safe technique allowing assessment of diaphragm anatomy and function. The authors review the pathophysiology of diaphragm in neuromuscular disorders, the methodology and indications of diaphragm ultrasound imaging as well as possible pitfalls in the interpretation of results.
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Affiliation(s)
- Abdallah Fayssoil
- APHP, Raymond Poincare University Hospital, Garches, France.,Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Anthony Behin
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Adam Ogna
- Lausanne University Hospital, Lausanne, Switzerland
| | | | - Helge Amthor
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Bernard Clair
- APHP, Raymond Poincare University Hospital, Garches, France
| | - Pascal Laforet
- Myology Institute, Pitié Salpetrière Hospital, Paris, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Arnaud Mansart
- APHP, Raymond Poincare University Hospital, Garches, France
| | - Helene Prigent
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | | | - Tanya Stojkovic
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Stéphane Vinit
- INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Robert Carlier
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Bruno Eymard
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Frederic Lofaso
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
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Abstract
The respiratory and central nervous systems are intimately connected. Ventilatory control is strictly regulated by central mechanisms in a complex process that involves central and peripheral chemoreceptors, baroreceptors, the cardiovascular system, and specific areas of the brain responsible for autonomic control. Disorders of the lung and respiratory system can interfere with these mechanisms and temporarily or permanently disrupt this complex network resulting in mild to severe neurological sequelae. This article explores the wide variety of neurological problems resulting from respiratory dysfunction, with emphasis on its pathophysiology, clinical features, prognosis, and long-term outcome.
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Abstract
Many neurologic diseases can cause acute respiratory decompensation, therefore a familiarity with these diseases is critical for any clinician managing patients with respiratory dysfunction. In this article, we review the anatomy of the respiratory system, focusing on the neurologic control of respiration. We discuss general mechanisms by which diseases of the peripheral and central nervous systems can cause acute respiratory dysfunction, and review the neurologic diseases which can adversely affect respiration. Lastly, we discuss the diagnosis and general management of acute respiratory impairment due to neurologic disease.
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Affiliation(s)
- Rachel A. Nardin
- From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Frank W. Drislane
- From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Aboussouan LS. Sleep-disordered Breathing in Neuromuscular Disease. Am J Respir Crit Care Med 2015; 191:979-89. [DOI: 10.1164/rccm.201412-2224ci] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Neuromyopathies in the Critically Ill. CRITICAL CARE STUDY GUIDE 2010. [PMCID: PMC7119990 DOI: 10.1007/978-0-387-77452-7_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
After studying this chapter, you should be able to: Be aware of the different neuromuscular disorders that are encountered in the ICU. Know the effects of neuromuscular dysfunction on the respiratory system. Know the proper initial evaluation and management of patients with neuromuscular dysfunction and respiratory failure. Be aware of the various therapies used to treat neuromuscular disorders that are most commonly encountered in the ICU.
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Bach JR, Gonçalves MR, Páez S, Winck JC, Leitão S, Abreu P. Expiratory Flow Maneuvers in Patients with Neuromuscular Diseases. Am J Phys Med Rehabil 2006; 85:105-11. [PMID: 16428900 DOI: 10.1097/01.phm.0000197307.32537.40] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare cough peak flows (CPF), peak expiratory flows (PEF), and potentially confounding flows obtained by lip and tongue propulsion (dart flows, DF) for normal subjects and for patients with neuromuscular disease/restrictive pulmonary syndrome and to correlate them with vital capacity and maximum insufflation capacity. DESIGN A cross-sectional analytic study of 125 stable patients and 52 normal subjects in which CPF, PEF, and DF were measured by peak flow meter and vital capacity and maximum insufflation capacity by spirometer. RESULTS In normal subjects and in patients, the DF significantly exceeded PEF and CPF (P < or = 0.001). For normal subjects, PEF and CPF were not significantly different. For patients with neuromuscular disease/restrictive pulmonary syndrome, the CPF significantly exceeded PEF (P < 0.05). No normal subjects but 14 patients had DF lower than CPF. Thirteen of these 14 had the ability to air stack (maximum insufflation capacity greater than vital capacity), indicating greater compromise of mouth and lip than of glottic muscles. For 14 of 88 patients, maximum insufflation capacity values did not exceed vital capacity, mostly because of inability to close the glottis (inability to air stack). Nonetheless, for 11 of these 14 patients, the DF were within a standard deviation of the whole patient group; thus, bulbar-innervated muscle dysfunction was not uniform. CPF and PEF correlated with vital capacity (r = 0.85 and 0.86, respectively), and with maximum insufflation capacity (r = 0.76 and 0.72, respectively). CONCLUSIONS Measurements of CPF, PEF, and DF are useful for assessing bulbar-innervated, inspiratory, and expiratory muscle function. Care must be taken to not confuse them.
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Affiliation(s)
- John R Bach
- Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School, 150 Bergen Street, Newark, NJ 07871, USA
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Pressão de oclusão das vias aéreas na avaliação do comando nervoso da respiração e da resposta muscular. REVISTA PORTUGUESA DE PNEUMOLOGIA 1995. [DOI: 10.1016/s0873-2159(15)31224-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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