Pilot study assessing the impact of intrathecal baclofen administration mode on sleep-related respiratory parameters.
OBJECTIVE
To assess the impact of intrathecal baclofen (ITB) mode of administration on sleep and sleep-related breathing events in severely disabled patients with severe spasticity.


METHODS
Open prospective trial.


METHODS
Physical medicine and rehabilitation department.


METHODS
Patients (N=11) treated with ITB pump for severe spasticity.


METHODS
Assessment of patients' sleep before and after ITB pump implantation, and comparison of polysomnography results after continuous or bolus mode of administration of ITB.


METHODS
Polysomnography and sleep-related breathing events.


RESULTS
ITB reduced periodic limb movements and increased the respiratory disturbance index (RDI) and central apneas in our population of patients. This study showed that ITB mode of administration may affect sleep-disordered breathing. Indeed, we observed a significant increase of respiratory events in the bolus condition (RDI and central apneas). In contrast, continuous infusion did not induce a significant modification of sleep-disordered breathing. When a sleep apnea syndrome was preexisting, it was generally severely worsened by the bolus mode of administration.


CONCLUSIONS
These results indicate that sleep function and sleep-related respiratory events should be assessed before ITB pump implantation. It is probably better to use a continuous mode of infusion if patients have preexisting sleep-disordered breathing.
Department of Physical Medicine and Rehabilitation, R. Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, Garches, France. djamel.bensmail@rpc.aphp.fr
Djamel
D
Bensmail
Adélaïde
A
Marquer
Nicolas
N
Roche
Anne-Laure
AL
Godard
Frédéric
F
Lofaso
Maria-Antonia
MA
Quera-Salva
D001418:Baclofen / Q000008:administration & dosage*; D006233:Persons with Disabilities; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000150:complications / Q000175:diagnosis; D010865:Pilot Projects; D017286:Polysomnography; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects; D012891:Sleep Apnea Syndromes / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis; D016896:Treatment Outcome
D009125:Muscle Relaxants, Central; D001418:Baclofen