Respiration during sleep in kyphoscoliosis

Eleven subjects with non-paralytic and 10 with paralytic kyphoscoliosis and nine normal control subjects were studied during sleep. The Cobb angle of those with kyphoscoliosis varied from 60 degrees to 140 degrees (median 100 degrees) and the vital capacity varied from 17% to 56% (median 28%) of the value predicted on the basis of span. Recordings made during sleep included expired carbon dioxide tension at the nose, gas flow at the mouth, arterial oxygen saturation, chest wall movement, and the electroencephalogram, electro-oculogram, and electrocardiogram. In three subjects transcutaneous carbon dioxide tension was measured simultaneously. Patients with kyphoscoliosis hypoventilated during sleep, particularly in rapid eye movement sleep, resulting in a rise in end tidal and transcutaneous carbon dioxide tension, and a reduction in oxygen saturation to a degree not observed in normal subjects. Reduced chest wall movement was the major cause of these episodes, which were more frequent and occupied a greater proportion of sleep time in those with kyphoscoliosis than in normal subjects. Serious cardiac arrhythmias were rarely associated. It is concluded that disturbances of respiration during sleep occur in patients with kyphoscoliosis and that these may be important in the pathogenesis of cardiorespiratory failure.