Download PDF
Sleep Breath 2003; 07(3): 143-146
DOI: 10.1055/s-2003-43075
CASE REPORT

Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Expiratory-Synchronized Sleep in a Quadriplegic Patient Using Inspiratory Neck Muscles To Breathe

Isabelle Arnulf1 , Christian Straus2 , Christian Delafosse1 , Jean-Philippe Derenne1 , Thomas Similowski1
  • 1Service de Pneumologie, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, and UPRES EA 397, Université Paris VI, Paris, France
  • 2Service Central d'Explorations Fonctionnelles Respiratoires, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, and UPRES EA 397, Université Paris VI, Paris, France
Further Information

Publication History

Publication Date:
21 October 2003 (online)

    Permissions and Reprints

ABSTRACT

In a patient with C3 quadriplegia causing complete diaphragm paralysis who developed inspiratory neck muscles (INM) hypertrophy to sustain ventilation, spontaneous breathing deeply altered sleep architecture, relegating sleep to the expiratory phase of the ventilatory cycle. A polysomnographic recording performed during mechanical ventilation (without INM activity), showed that sleep was abnormal but unaffected by the respiratory cycle. During spontaneous breathing, the polygraphic recordings showed expiratory microsleep episodes, with inspiratory arousals synchronous to bursts of INM activity. This case report illustrates the powerful adaptability of the respiratory and sleep control systems to maintain each vital function.

KEYWORDS

Diaphragm - respiratory muscles - sleep - sleep-related respiratory disorders - tetraplegia - control of breathing - brain plasticity

REFERENCES

  • 1 Stradling J R, Kozar L F, Dark J, Kirby T, Andrey S M, Phillipson E A. Effect of acute diaphragm paralysis on ventilation in awake and sleeping dogs.  Am Rev Respir Dis . 1987;  136 633-637
    PubMedSearch in Google Scholar
  • 2 Similowski T, Straus C, Attali V, Duguet A, Jourdain B, Derenne J P. Assessment of the motor pathway to the diaphragm using cortical and cervical magnetic stimulation in the decision-making process of phrenic pacing.  Chest . 1996;  110 1551-1557
    PubMedSearch in Google Scholar
  • 3 American Sleep Disorders Association. EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association.  Sleep . 1992;  15 173-184
    PubMedSearch in Google Scholar
  • 4 Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects.  Los Angeles, CA: University of California Pr; 1968 .
    PubMed
  • 5 Weese-Mayer D E, Hunt C E, Brouillette R T. Alveolar hypoventilation syndromes. In: Beckerman RC, Brouillette RT, Hunt CE, eds. Respiratory Control Disorders in Infants and Children Baltimore, MD: Williams & Wilkins 1992 : 231-241
    Search in Google Scholar
  • 6 Valley V, Broughton R. The physiological (EEG) nature of drowsiness and its relation to performance deficits in narcoleptics.  Electroencephalogr Clin Neurophysiol . 1983;  55 243-251
    PubMedSearch in Google Scholar
  • 7 Coleridge H M. Reflexes evoked from tracheobronchial tree and lungs. In: Geiger SR, Widdicombe JG, Cherniack NS, Fishman AP, eds. Handbook of Physiology, Section 3: The Respiratory System Vol. 2. Bethesda, MD: American Physiological Soc; 1986: 395-429
    Search in Google Scholar
  • 8 Killian K J, Campbell E JM. Dyspnea. In: Crystal RG, West JB, eds. The Lung: Scientific Foundations New York, NY: Raven Pr Ltd 1991: 1433-1443
    Search in Google Scholar