Expiratory-synchronized sleep in a quadriplegic patient using inspiratory neck muscles to breathe.
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.
Arnulf
Isabelle
I
Service de Pneumologie, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, and UPRES EA 397, Université Paris VI, Paris, France.
Straus
Christian
C
Delafosse
Christian
C
Derenne
Jean-Philippe
JP
Similowski
Thomas
T
D000328:Adult; D004569:Electroencephalography; D004576:Electromyography / Q000295:instrumentation; D005540:Forced Expiratory Flow Rates / Q000502:physiology*; D006801:Humans; D008297:Male; D009334:Neck Muscles / Q000502:physiology*; D009473:Neuronal Plasticity; D017286:Polysomnography; D011782:Quadriplegia / Q000150:complications*; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000503:physiopathology*