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[Assessment and treatment of respiratory dysfunction in severely handicapped children: respiratory disorders during
C Shimomura1, H Choh, M Funabashi
1Department of Pediatrics, Tokyo Children's Rehabilitation Hospital.
Insights
Severely handicapped patients often experience sleep hypoxemia due to respiratory disorders. Oxygen therapy improved REM sleep and reduced hypoxemia in some patients, highlighting sleep stage importance.
Area of Science:
- Neurology
- Pulmonology
- Sleep Medicine
Context:
- Severely handicapped patients face challenges with chronic respiratory insufficiency and recurrent hypoxemia during sleep.
- Latent respiratory insufficiency can manifest during sleep even without daytime distress.
Purpose:
- To investigate the pathophysiology of sleep-related respiratory disorders in severely handicapped individuals.
- To correlate arterial oxygen saturation (SaO2) levels with sleep stages and respiratory events.
Summary:
- Polygraphical all-night studies in 5 severely handicapped patients revealed frequent sleep hypoxemia.
- Hypoxemia severity correlated with apnea intensity, with both obstructive and central sleep apnea observed.
- Obstructive sleep apnea impacted REM sleep density, while central apnea affected REM sleep recurrence.
Impact:
- Findings underscore the prevalence and mechanisms of sleep hypoxemia in this patient group.
- Oxygen inhalation demonstrated potential to improve REM sleep and alleviate hypoxemia.
- This research highlights the significance of sleep stage monitoring in managing respiratory issues in handicapped patients.
Abstract:
In severely handicapped patients, chronic respiratory insufficiencies and recurrent hypoxemia especially during sleep are one of the major problems to take care of them. To clarify the pathophysiology of respiratory disorders during sleep, we examined 5 severely handicapped patients with no respiratory distress during wakefulness, but with signs of latent respiratory insufficiency by means of polygraphical all-night study including the arterial oxygen saturation (SaO2) monitoring. In the severely handicapped patients, sleep hypoxemia occurred frequently. The value of SaO2 decreased in proportion to the intensity of apnea determined by polygraph. The relationship between the value of SaO2 and sleep stage was variable in each patient. Four patients had mainly obstructive respiratory disorders and one had a central type respiratory disorder. The density of REM stage decreased in the obstructive type. In the central type, the repeat of REM stage with normal REM density was not observed. In one patient with obstructive type and one with central type, hypoxemia was improved with an increased number of REM stage by O2 inhalation.