Top

Sleep and Breathing

Published in:

30-06-2021 | Sleep Apnea | Hypoxia • Original Article

Sleep-related breathing disorders in diaphragmatic pathologies

Authors: Sema Sarac, Cuneyt Salturk, Ozlem Oruc, Serda Kanbur Metin, Serkan Bayram, Zuhal Karakurt, Irfan Yalcınkaya

Published in: Sleep and Breathing | Issue 2/2022

Abstract

Objective

The diaphragm is the most significant muscle involved in breathing. There are very few studies and cases evaluating sleep-related breathing disorders in diaphragmatic pathologies. This study compares preoperative and postoperative polysomnography (PSG) and pulmonary function test (PFT) results in diaphragmatic pathologies.

Material and methods

The study included 28 patients who underwent video-assisted mini-thoracotomy (VATS) due to diaphragm eventration and paralysis between January 2014 and October 2019. Pulmonary function tests (PFT) and polysomnography (PSG) were performed preoperatively in all patients, and PSG and PFT were repeated 2 months after the surgery.

Results

Twenty-five of the 28 patients were found to have apnea–hypopnea index (AHI) ≥ 5 (89%). A significant decrease in the preoperative TST, stage 3, and REM periods was observed. Nineteen of these patients (76%) were supine isolated or supine dominant. There was a marked improvement in AHI and PFT values after the surgery. Only five patients required a PAP device.

Conclusion

Doctors should perform PSG in patients with diaphragm pathologies, and these patients should be operated on after considering the comorbidities when OSA is detected.

Hamit Q, Shonnon J, Martin J (2005) Physiologic basis of respiratory disease. Moss IR. Neural control of breathing. In: Chapter 21. 1st ed. Hamilton, Ontario BBC Decker Inc, :251–62

Ko MA, Darling GE (2009) Acquired paralysis of the diaphragm. Thorac Surg Clin 19(4):501–510CrossRef

Hu LG, Wei L, Deslauriers J (2015) Diaphragmatic eventration and paralysis. In: Deslauriers J Atlas of thoracic surgical techniques. Chapter 19:200–209

Gibson GJ (1989) Diaphragmatic paresis: pathophysiology, clinical features, and investigation. Thorax 44(11):960–970CrossRef

Gaudette E, Rj K (2010) Pathophysology of OSA. Eur Respir Mon 2010:31–50

Schwab RJ, Kuna ST (2011) Anatomy and physiology of upper airway obstruction. In: Kryger MH, Roth T, Dement WC. Principles and practise of sleep medicine. Chapter 101:502–505

Dj E, Malthora A (2008) Pathophysology of adult obstructive sleep apnea. Proc Am Thorac Soc 5:144–153CrossRef

Steier J, Jolley C, Seymour J, Kaul S, Luo YM, Rafferty GF et al (2008) Sleep disordered breathing in unilateral diaphragm paralysis or severe weakness. Eur Respir J 32:1479–1487CrossRef

Oruc O, Sarac S, Afsar GC et al (2016) Is polysomnographic examination necessary for subjects with diaphragm pathologies? Clinics 71:506–510CrossRef

10.

Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. J Clin Sleep Med 8:597–619CrossRef

11.

Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ (2005) Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 128:2130–2137CrossRef

12.

Santos C, Braghiroli A, Mazzini L, Pratesi R, Oliveira LV, Mora G (2003) Sleep-related breathing disorders in amyotrophic lateral sclerosis. Monaldi Arch Chest Dis 59(2):160–165PubMed

13.

Boentert M, Glatz C, Helmle C, Okegwo A, Young P (2018) Prevalence of sleep apnoea and capnographic detection of nocturnal hypoventilation in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 89(4):418–424. https://doi.org/10.1136/jnnp-2017-316515CrossRefPubMed

14.

Boentert M, Brenscheidt I, Glatz C, Young P (2015) Effects of noninvasive ventilation on objective sleep and nocturnal respiration in patients with amyotrophic lateral sclerosis. J Neurol 262(9):2073–2082. https://doi.org/10.1007/s00415-015-7822-4CrossRefPubMed

15.

Katzberg HD, Selegiman A, Guion L et al (2013) Effects of noninvasive ventilation on sleep outcomes in amyotrophic lateral sclerosis. J Clin Sleep Med 9(4):345–351. https://doi.org/10.5664/jcsm.2586CrossRefPubMedPubMedCentral

16.

Katz I, Zarne N, Slutsky S, Rebuck S, Hoffstein V (1990) An evaluation of flow-volume curves as a screening test for obstructive sleep apnea. Chest 98:337–340CrossRef

17.

Haponik E, Smith P, Bohlman M, Allan R, Goldman S, Bleecker E (1983) Computerized tomography in obstructive sleep apnea: correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis 127:221–226PubMed

18.

Baltzan M, Scott AS, Wolkove N (2012) Unilateral hemidiaphragm weakness is associated with positional hypoxemia in REM sleep. J Clin Sleep Med 8(1):51–58CrossRef

19.

Malik V, Smith D, Lee-Chiong T (2012) Respiratory physiology during sleep. Sleep Med Clin 7(3):497–505CrossRef

20.

Ravesloot MJ, van Maanen JP, Dun L, de Vries N (2013) The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea-a review of the literature. Sleep Breath 17(1):39–49CrossRef

21.

Ravesloot MJ, Frank MH, van Maanen JP, Verhagen EA, de Lange J, de Vries N (2016) Positional OSA part 2: retrospective cohort analysis with a new classification system (APOC). Sleep Breath 20(2):881–888CrossRef

22.

Oksenberg A, Silverberg DS, Arons E, Radwan H (1997) Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest 112(3):629–639CrossRef

23.

Teerapraipruk B, Chirakalwasan N, Simon R et al (2012) Clinical and polysomnographic data of positional sleep apnea and its predictors. Sleep Breath 16(4):1167–1172CrossRef

24.

Gibson GJ (2009) Clinical tests of respiratory function, 3rd edn. Hodder Arnold, London

25.

Rombolá C, Crespo MG, Lopez PT, Martinez AH, Atance PL, Ramirez AT et al (2014) Video-assisted minithoracotomy diaphragmatic plication: respiratory effects in adults. In: Georg Thieme Verlag KG Stuttgart · New York. Thorac Cardiovasc Surg 2016; 64(08):647–653

26.

Dunning J (2015) Thoracoscopic diaphragm plication. Interact CardioVasc Thorac Surg 20(5):689–690. https://doi.org/10.1093/icvts/ivv018. [ Links ]

27.

Gazala S, Hunt I, Bédard EL (2012) Diaphragmatic plication offers functional improvement in dyspnoea and better pulmonary function with low morbidity. Interact Cardiovasc Thorac Surg 15(3):505–508. https://doi.org/10.1093/icvts/ivs238CrossRefPubMedPubMedCentral

28.

Yalcinkaya I, Evman S, Lacin T, Alpay L, Kupeli M, Ocakcıoglu I (2017) Video-assisted minimally invasive diapragmatic plication: feasibility of a recognised procedure through an uncharacteristic hybrid approach. Surg Endoscop 31(4):1772–1774CrossRef

Title: Sleep-related breathing disorders in diaphragmatic pathologies
Authors: Sema Sarac
Cuneyt Salturk
Ozlem Oruc
Serda Kanbur Metin
Serkan Bayram
Zuhal Karakurt
Irfan Yalcınkaya
Publication date: 30-06-2021
Publisher: Springer International Publishing
Keywords: Sleep Apnea
Pulmonary-Function Tests
Sleep-Related Breathing Disorder
Polysomnography
Pathology
Published in: Sleep and Breathing / Issue 2/2022
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02422-z

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Sleep-related breathing disorders in diaphragmatic pathologies

Abstract

Objective

Material and methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Material and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2022

Cardiac imageology changes in patients with mild obstructive sleep apnea without cardiovascular disease

Assessing air travel safety in neuromuscular disease: standard versus prolonged hypoxic challenge tests

Temporomandibular disorders in patients with polysomnographic diagnosis of sleep bruxism: a case–control study

A meta-analysis of the diagnostic value of NoSAS in patients with sleep apnea syndrome

Automatic sleep staging by cardiorespiratory signals: a systematic review

Evaluation of a non-contact ultra-wideband bio-radar sleep monitoring device for screening of sleep breathing disease

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page