1
|
Laveneziana P, Fossé Q, Bret M, Patout M, Dudoignon B, Llontop C, Morélot-Panzini C, Cayetanot F, Bodineau L, Straus C, Similowski T. Defective exercise-related expiratory muscle recruitment in patients with PHOX2B mutations: A clue to neural determinants of the congenital central hypoventilation syndrome. Pulmonology 2024:S2531-0437(24)00009-6. [PMID: 38403573 DOI: 10.1016/j.pulmoe.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/28/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES The human congenital central hypoventilation syndrome (CCHS) is caused by mutations in the PHOX2B (paired-like homeobox 2B) gene. Genetically engineered PHOX2B rodents exhibit defective development of the brainstem retrotrapezoid nucleus (RTN), a carbon dioxide sensitive structure that critically controls expiratory muscle recruitment. This has been linked to a blunted exercise ventilatory response. Whether this can be extrapolated to human CCHS is unknown and represents the objective of this study. MATERIALS AND METHODS Thirteen adult CCHS patients and 13 healthy participants performed an incremental symptom-limited cycle cardiopulmonary exercise test. Responses were analyzed using guideline approaches (ventilation V'E, tidal volume VT, breathing frequency, oxygen consumption, carbon dioxide production) complemented by a breathing pattern analysis (i.e. expiratory and inspiratory reserve volume, ERV and IRV). RESULTS A ventilatory response occurred in both study groups, as follows: V'E and VT increased in CCHS patients until 40 W and then decreased, which was not observed in the healthy participants (p<0.001). In the latter, exercise-related ERV and IRV decreases attested to concomitant expiratory and inspiratory recruitment. In the CCHS patients, inspiratory recruitment occurred but there was no evidence of expiratory recruitment (absence of any ERV decrease, p<0.001). CONCLUSIONS Assuming a similar organization of respiratory rhythmogenesis in humans and rodents, the lack of exercise-related expiratory recruitment observed in our CCHS patients is compatible with a PHOX2B-related defect of a neural structure that would be analogous to the rodents' RTN. Provided corroboration, ERV recruitment could serve as a physiological outcome in studies aiming at correcting breathing control in CCHS.
Collapse
Affiliation(s)
- P Laveneziana
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpitaux Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre de Référence Maladies Rares "Syndrome d'Ondine" (Département R3S), F-75013 Paris, France.
| | - Q Fossé
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpitaux Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - M Bret
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie (Département R3S), F-75013 Paris, France
| | - M Patout
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre de Référence Maladies Rares "Syndrome d'Ondine" (Département R3S), F-75013 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), F-75013 Paris, France
| | - B Dudoignon
- Université de Paris, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique Centre du Sommeil-CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, F-75019 Paris, France
| | - C Llontop
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie (Département R3S), F-75013 Paris, France
| | - C Morélot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre de Référence Maladies Rares "Syndrome d'Ondine" (Département R3S), F-75013 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie (Département R3S), F-75013 Paris, France
| | - F Cayetanot
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - L Bodineau
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - C Straus
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpitaux Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre de Référence Maladies Rares "Syndrome d'Ondine" (Département R3S), F-75013 Paris, France
| | - T Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre de Référence Maladies Rares "Syndrome d'Ondine" (Département R3S), F-75013 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, F-75013 Paris, France
| |
Collapse
|
2
|
Eldaabossi S, Alrashdan M, Aljanobi G, Warsha N, Abo Elhassan S, Mahdi W, Farouk A, Taha A, Qabil A, Maklad S, Nabway U, Kenany H, Jaber Y, Zaghloul B. A rare association: Obesity hypoventilation syndrome with myasthenia gravis and systemic lupus erythematosus, case report. Respir Med Case Rep 2023; 44:101848. [PMID: 37251356 PMCID: PMC10209446 DOI: 10.1016/j.rmcr.2023.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/16/2023] [Accepted: 04/06/2023] [Indexed: 05/31/2023] Open
Abstract
Background Shrinking lung syndrome (SLS) is an uncommon complication of systemic lupus erythematosus (SLE) that has also been seen in other autoimmune diseases and is linked with a high risk of acute or chronic respiratory failure. Alveolar hypoventilation in the presence of obesity-hypoventilation syndrome, systemic lupus erythematosus (SLE), and myasthenia gravis (MG) is uncommon and poses a diagnostic and therapeutic challenge. Case report We reported a 33-year-old female patient from Saudi Arabia who suffered from obesity, bronchial asthma, newly diagnosed essential hypertension, type 2 diabetes mellitus, with recurrent acute alveolar hypoventilation, secondary to obesity hypoventilation syndrome and mixed autoimmune disease (systemic lupus erythematosus and myasthenia gravis), based on the correct constellation of clinical findings and laboratory evidence. Conclusion The interesting aspect of this case report: is the presentation of the overlap of obesity hypoventilation syndrome and shrinking lung syndrome due to systemic lupus erythematosus with generalized and respiratory muscle dysfunction due to myasthenia gravis with good outcomes after therapy.
Collapse
Affiliation(s)
- Safwat Eldaabossi
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Man Alrashdan
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Ghada Aljanobi
- Rheumatology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Noha Warsha
- Rheumatology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Saber Abo Elhassan
- Neurology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia. Department of Neurology, Assuit Faculty of Medicine, Egypt
| | - Waheed Mahdi
- Critical Care and Pulmonary Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia. Department of Chest Diseases, Banha Faculty of Medicine, Egypt
| | - Abdullah Farouk
- Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia. Department of Critical Care, Alexandria Faculty of Medicine, Egypt
| | - Ahmad Taha
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Ahmad Qabil
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Sameh Maklad
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Usama Nabway
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Hatem Kenany
- Consultant Critical Care and Anesthesia, Al Azhar Faculty of Medicine, Egypt
| | - Yasser Jaber
- Radiology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia. Department of Radiology, Al Azhar Faculty of Medicine, Egypt
| | - Boshra Zaghloul
- Department of Radiology, Al Azhar Faculty of Medicine for Girls, Egypt
| |
Collapse
|
3
|
Ronco L, Khirani S, Vedrenne-Cloquet M, Barrois R, Barnerias C, Desguerre I, Bignamini E, Fauroux B. Limitations of the apnea-hypopnea index in children and young adults with neuromuscular disorders. Neuromuscul Disord 2023; 33:468-473. [PMID: 37196510 DOI: 10.1016/j.nmd.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
There are no validated criteria to initiate noninvasive ventilation (NIV) in children and young adults with neuromuscular disease (NMD). In order to analyze NIV initiation criteria, we reviewed the polysomnography (PSG) criteria that led to the initiation of NIV in 61 consecutive patients with NMD, median age 4.1 (0.8-21) years, who had a PSG during their routine care. NIV was initiated on abnormal PSG data (apnea-hypopnea index (AHI) > 10 events/h and/or a transcutaneous carbon dioxide pressure > 50 mmHg and/or a pulse oximetry 〈 90%, both during at least 2% sleep time or 〉 5 consecutive minutes) in 11 (18%) patients. Six of these 11 patients had an AHI ≤ 10 events/h and would not have been ventilated if only AHI was retained. However, one of these 6 patients had isolated nocturnal hypoxemia, 3 isolated nocturnal hypercapnia and 2 abnormal respiratory events. Six (10%) patients with a normal PSG were started on NIV on clinical criteria. Our results show the limitation of the AHI when taken as the unique PSG criterion for NIV initiation in young patients with NMD and underline the need to include also abnormalities of overnight gas exchange into the NIV decision-making process.
Collapse
Affiliation(s)
- Lucia Ronco
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Hôpital Necker-Enfants malades, F-75015 Paris, France; Pediatric Pulmonology department, Regina Margherita Children Hospital, Turin, Italy
| | - Sonia Khirani
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Hôpital Necker-Enfants malades, F-75015 Paris, France; Université de Paris, VIFASOM, F-75004 Paris, France; ASV Santé, F-92000 Gennevilliers, France
| | - Meryl Vedrenne-Cloquet
- Pediatric intensive care unit, AP-HP, Hôpital Necker-Enfants malades, F-75015 Paris, France, France
| | - Remi Barrois
- Pediatric neurology, AP-HP, Hôpital Necker-Enfants malades, F-75015 Paris; National Reference Center on Neuromuscular Diseases, France
| | - Christine Barnerias
- Pediatric neurology, AP-HP, Hôpital Necker-Enfants malades, F-75015 Paris; National Reference Center on Neuromuscular Diseases, France
| | - Isabelle Desguerre
- Pediatric neurology, AP-HP, Hôpital Necker-Enfants malades, F-75015 Paris; National Reference Center on Neuromuscular Diseases, France
| | - Elisabetta Bignamini
- Pediatric Pulmonology department, Regina Margherita Children Hospital, Turin, Italy
| | - Brigitte Fauroux
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Hôpital Necker-Enfants malades, F-75015 Paris, France; Université de Paris, VIFASOM, F-75004 Paris, France.
| |
Collapse
|
4
|
Langenbruch L, Perez-Mengual S, Glatz C, Young P, Boentert M. Disorders of sleep in spinal and bulbar muscular atrophy (Kennedy's disease). Sleep Breath 2020; 25:1399-1405. [PMID: 33219909 DOI: 10.1007/s11325-020-02253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/02/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Spinal and bulbar muscular atrophy (SBMA) is a progressive, X-linked lower motor neuron disorder exclusively affecting men. Since knowledge on sleep disorders in SBMA is scarce compared to other motoneuron diseases, this retrospective case-control study aimed to investigate sleep and sleep-related breathing in patients with SBMA. METHODS In 23 non-ventilated patients with SBMA (median age 52 years), clinical disease characteristics, forced vital capacity and diagnostic polysomnographies were retrospectively evaluated. In 16 patients, overnight transcutaneous capnometry was available. Twenty-three male control subjects with chronic insomnia were matched for age and body mass index. RESULTS In patients with SBMA obstructive sleep apnoea (OSA, apnoea-hypopnoea index/AHI > 5/h) was more frequent than in control subjects (14/23 or 61% vs. 6/23 or 26%, p = 0.02), and median AHI was significantly higher in patients (9.0/h vs. 3.4/h, p < 0.01). Among SBMA patients, the AHI was not related to age or body mass index. Alveolar hypoventilation as reflected by nocturnal hypercapnia was found in 3/16 patients. Rapid eye movement (REM) sleep without atonia was present in 44% of SBMA patients but only in 4% of controls (p < 0.01). During REM and non-REM sleep, no behavioural abnormalities were observed in either group. Periodic limb movements in sleep (index > 15/h) were frequent in SBMA patients but rarely disrupted sleep. CONCLUSIONS In patients with SBMA, sleep-disordered breathing may comprise both OSA and nocturnal hypoventilation. REM sleep without atonia may also be found, but its clinical significance remains unclear. In patients complaining of sleep-related symptoms, cardiorespiratory polysomnography and transcutaneous capnometry are recommended.
Collapse
Affiliation(s)
- Lisa Langenbruch
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Salvador Perez-Mengual
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Christian Glatz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Peter Young
- Department of Neurology, Medical Park Bad Feilnbach, Bad Feilnbach, Germany
| | - Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany. .,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany.
| |
Collapse
|
5
|
Tissier-Ducamp D, Martinez S, Alagha K, Charpin D, Chanez P, Palot A. [Bilateral diaphragmatic paralysis due to Parsonage-Turner syndrome]. Rev Mal Respir 2014; 32:742-6. [PMID: 25534571 DOI: 10.1016/j.rmr.2014.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 11/11/2014] [Indexed: 11/24/2022]
Abstract
We report the case of a 49-years-old patient who presented to the accident and emergency department with sudden onset dyspnea associated with acute shoulder pain. He was breathless at rest with supine hypoxemia. He had an amyotrophic left shoulder with localized paresis of the shoulder. Both hemi-diaphragms were elevated on chest X-rays. Pulmonary function tests showed a restrictive pattern and both phrenic nerve conduction velocities were decreased. At night, alveolar hypoventilation was evidenced by elevated mean capnography (PtcCO2: 57mmHg). Neuralgic amyotrophy, Parsonage-Turner syndrome was the final diagnosis. This syndrome is a brachial plexus neuritis with a predilection for the suprascapular and axillary nerves. Phrenic nerve involvement is rare but where present can be the most prominent clinical feature as in our case report.
Collapse
Affiliation(s)
- D Tissier-Ducamp
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France.
| | - S Martinez
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| | - K Alagha
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| | - D Charpin
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| | - P Chanez
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| | - A Palot
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| |
Collapse
|
6
|
Karcz M, Papadakos PJ. Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Can J Respir Ther 2013; 49:21-9. [PMID: 26078599 PMCID: PMC4456822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
General anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and result in decreased oxygenation in the postanesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the preanesthesia value. It has been shown that pulmonary atelectasis is a common finding in anesthetized individuals because it occurs in 85% to 90% of healthy adults. Furthermore, there is substantial evidence that atelectasis, in combination with alveolar hypoventilation and ventilation-perfusion mismatch, is the core mechanism responsible for postoperative hypoxemic events in the majority of patients in the postanesthesia care unit (PACU). Many concomitant factors also must be considered, such as respiratory depression from the type and anatomical site of surgery altering lung mechanics, the consequences of hemodynamic impairment and the residual effects of anesthetic drugs, most notably residual neuromuscular blockade. The appropriate use of anesthetic and analgesic techniques, when combined with meticulous postoperative care, clearly influences pulmonary outcomes in the PACU. The present review emphasizes the major pathophysiological mechanisms and treatment strategies of critical respiratory events in the PACU to provide health care workers with the knowledge needed to prevent such potentially adverse outcomes from occurring.
Collapse
Affiliation(s)
- Marcin Karcz
- Correspondence: Dr Marcin Karcz, Department of Anesthesiology, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642, USA. Telephone 585-764-4099, e-mail
| | | |
Collapse
|