Dataset Information

Non-REM sleep-predominant reversible paradoxical breathing effort indicates dysregulation of diaphragm movements in multiple system atrophy.

ABSTRACT:

Study objectives

In multiple system atrophy, sleep-disordered breathing has a broad spectrum of phenotypes, among them inspiratory stridor and obstructive sleep apnea being most frequent.

Methods

We present a case of a 59-year-old woman with cerebellar-type multiple system atrophy, who showed transient paradoxical breathing effort during non-rapid eye movement sleep on diagnostic polysomnography. Because this thoraco-abdominal paradox was atypical for and did not coincide with upper airway obstruction, it most likely indicated central dysregulation of the diaphragm.

Results

Continuous positive airway pressure therapy with low pressure (5 cm H₂O) was sufficient to completely resolve this type of respiratory dysregulation.

Conclusions

This case extends the clinical spectrum of sleep-disordered breathing in multiple system atrophy.

SUBMITTER: Ha J

PROVIDER: S-EPMC8314623 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

Non-REM sleep-predominant reversible paradoxical breathing effort indicates dysregulation of diaphragm movements in multiple system atrophy.

Ha Jongmok J Park Jaehong J Youn Jinyoung J Cho Jin Whan JW Joo Eun Yeon EY

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 20210701 7

<h4>Study objectives</h4>In multiple system atrophy, sleep-disordered breathing has a broad spectrum of phenotypes, among them inspiratory stridor and obstructive sleep apnea being most frequent.<h4>Methods</h4>We present a case of a 59-year-old woman with cerebellar-type multiple system atrophy, who showed transient paradoxical breathing effort during non-rapid eye movement sleep on diagnostic polysomnography. Because this thoraco-abdominal paradox was atypical for and did not coincide with upp ...[more]

PMID: 33739261

Similar Datasets

Project description:ObjectivesLung- and diaphragm-protective ventilation is a novel concept that aims to limit the detrimental effects of mechanical ventilation on the diaphragm while remaining within limits of lung-protective ventilation. The premise is that low breathing effort under mechanical ventilation causes diaphragm atrophy, whereas excessive breathing effort induces diaphragm and lung injury. In a proof-of-concept study, we aimed to assess whether titration of inspiratory support based on diaphragm effort increases the time that patients have effort in a predefined "diaphragm-protective" range, without compromising lung-protective ventilation.DesignRandomized clinical trial.SettingMixed medical-surgical ICU in a tertiary academic hospital in the Netherlands.PatientsPatients (n = 40) with respiratory failure ventilated in a partially-supported mode.InterventionsIn the intervention group, inspiratory support was titrated hourly to obtain transdiaphragmatic pressure swings in the predefined "diaphragm-protective" range (3-12 cm H2O). The control group received standard-of-care.Measurements and main resultsTransdiaphragmatic pressure, transpulmonary pressure, and tidal volume were monitored continuously for 24 hours in both groups. In the intervention group, more breaths were within "diaphragm-protective" range compared with the control group (median 81%; interquartile range [64-86%] vs 35% [16-60%], respectively; p < 0.001). Dynamic transpulmonary pressures (20.5 ± 7.1 vs 18.5 ± 7.0 cm H2O; p = 0.321) and tidal volumes (7.56 ± 1.47 vs 7.54 ± 1.22 mL/kg; p = 0.961) were not different in the intervention and control group, respectively.ConclusionsTitration of inspiratory support based on patient breathing effort greatly increased the time that patients had diaphragm effort in the predefined "diaphragm-protective" range without compromising tidal volumes and transpulmonary pressures. This study provides a strong rationale for further studies powered on patient-centered outcomes.

Dataset Information

Non-REM sleep-predominant reversible paradoxical breathing effort indicates dysregulation of diaphragm movements in multiple system atrophy.

Study objectives

Methods

Results

Conclusions

Publications

Non-REM sleep-predominant reversible paradoxical breathing effort indicates dysregulation of diaphragm movements in multiple system atrophy.

Similar Datasets

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