Skip to main content
Thorax logoLink to Thorax
. 1994 Feb;49(2):157–161. doi: 10.1136/thx.49.2.157

Obstructive apnoeas in Duchenne muscular dystrophy.

Y Khan 1, J Z Heckmatt 1
PMCID: PMC474334  PMID: 8128406

Abstract

BACKGROUND--In order to clarify the treatment of sleep hypoxaemias in Duchenne muscular dystrophy polysomnographic studies were performed on patients at home with the purpose of recruiting them into two clinical therapeutic trials. Observations concerning the nature of sleep hypoxaemia in these patients are presented. METHODS--Twenty one non-ambulant patients with Duchenne muscular dystrophy aged 13-23 years with no symptoms of sleep hypoventilation or apnoea were studied for two consecutive nights with eight channel polysomnography. A comparative study was performed in 12 age matched normal male subjects. The evolution of sleep hypoxaemia with age was studied in 14 patients with Duchenne muscular dystrophy. RESULTS--Thirteen of the 21 patients had hypoxaemia below 90% during sleep, and 12 of the 13 had discrete hypoxaemic dips in association with apnoeas; 60% of all apnoeas were obstructive in nature. The hypoxaemic periods became more frequent with increasing age and, in two patients at three year follow up, were more frequently associated with central or possibly "pseudocentral" apnoeas. Although the normal subjects had a few apnoeic episodes, none had sleep hypoxaemia below 90% saturation. CONCLUSION--The sleep related breathing abnormality in Duchenne muscular dystrophy is initially obstructive and this has implications for management.

Full text

PDF
157

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baydur A., Gilgoff I., Prentice W., Carlson M., Fischer D. A. Decline in respiratory function and experience with long-term assisted ventilation in advanced Duchenne's muscular dystrophy. Chest. 1990 Apr;97(4):884–889. doi: 10.1378/chest.97.4.884. [DOI] [PubMed] [Google Scholar]
  2. Carskadon M. A., Harvey K., Dement W. C., Guilleminault C., Simmons F. B., Anders T. F. Respiration during sleep in children. West J Med. 1978 Jun;128(6):477–481. [PMC free article] [PubMed] [Google Scholar]
  3. Casey V. A., Dwyer J. T., Coleman K. A., Valadian I. Body mass index from childhood to middle age: a 50-y follow-up. Am J Clin Nutr. 1992 Jul;56(1):14–18. doi: 10.1093/ajcn/56.1.14. [DOI] [PubMed] [Google Scholar]
  4. Cherniack N. S. Respiratory dysrhythmias during sleep. N Engl J Med. 1981 Aug 6;305(6):325–330. doi: 10.1056/NEJM198108063050606. [DOI] [PubMed] [Google Scholar]
  5. Dowdell W. T., Javaheri S., McGinnis W. Cheyne-Stokes respiration presenting as sleep apnea syndrome. Clinical and polysomnographic features. Am Rev Respir Dis. 1990 Apr;141(4 Pt 1):871–879. doi: 10.1164/ajrccm/141.4_Pt_1.871. [DOI] [PubMed] [Google Scholar]
  6. Friston K. J., Sharpley A. L., Solomon R. A., Cowen P. J. Lithium increases slow wave sleep: possible mediation by brain 5-HT2 receptors? Psychopharmacology (Berl) 1989;98(1):139–140. doi: 10.1007/BF00442020. [DOI] [PubMed] [Google Scholar]
  7. Godfrey S., Kamburoff P. L., Nairn J. R. Spirometry, lung volumes and airway resistance in normal children aged 5 to 18 years. Br J Dis Chest. 1970 Jan;64(1):15–24. doi: 10.1016/s0007-0971(70)80045-6. [DOI] [PubMed] [Google Scholar]
  8. Heckmatt J. Z., Loh L., Dubowitz V. Night-time nasal ventilation in neuromuscular disease. Lancet. 1990 Mar 10;335(8689):579–582. doi: 10.1016/0140-6736(90)90357-b. [DOI] [PubMed] [Google Scholar]
  9. Hodgson S., Hart K., Abbs S., Heckmatt J., Rodillo E., Bobrow M., Dubowitz V. Correlation of clinical and deletion data in Duchenne and Becker muscular dystrophy. J Med Genet. 1989 Nov;26(11):682–693. doi: 10.1136/jmg.26.11.682. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hunter S. The heart in muscular dystrophy. Br Med Bull. 1980 May;36(2):133–134. doi: 10.1093/oxfordjournals.bmb.a071627. [DOI] [PubMed] [Google Scholar]
  11. Luque E. R. Segmental spinal instrumentation for correction of scoliosis. Clin Orthop Relat Res. 1982 Mar;(163):192–198. [PubMed] [Google Scholar]
  12. Manni R., Ottolini A., Cerveri I., Bruschi C., Zoia M. C., Lanzi G., Tartara A. Breathing patterns and HbSaO2 changes during nocturnal sleep in patients with Duchenne muscular dystrophy. J Neurol. 1989 Oct;236(7):391–394. doi: 10.1007/BF00314896. [DOI] [PubMed] [Google Scholar]
  13. Marcus C. L., Omlin K. J., Basinki D. J., Bailey S. L., Rachal A. B., Von Pechmann W. S., Keens T. G., Ward S. L. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis. 1992 Nov;146(5 Pt 1):1235–1239. doi: 10.1164/ajrccm/146.5_Pt_1.1235. [DOI] [PubMed] [Google Scholar]
  14. Mohr C. H., Hill N. S. Long-term follow-up of nocturnal ventilatory assistance in patients with respiratory failure due to Duchenne-type muscular dystrophy. Chest. 1990 Jan;97(1):91–96. doi: 10.1378/chest.97.1.91. [DOI] [PubMed] [Google Scholar]
  15. Redding G. J., Okamoto G. A., Guthrie R. D., Rollevson D., Milstein J. M. Sleep patterns in nonambulatory boys with Duchenne muscular dystrophy. Arch Phys Med Rehabil. 1985 Dec;66(12):818–821. [PubMed] [Google Scholar]
  16. Smith P. E., Calverley P. M., Edwards R. H. Hypoxemia during sleep in Duchenne muscular dystrophy. Am Rev Respir Dis. 1988 Apr;137(4):884–888. doi: 10.1164/ajrccm/137.4.884. [DOI] [PubMed] [Google Scholar]
  17. Smith P. E., Edwards R. H., Calverley P. M. Mechanisms of sleep-disordered breathing in chronic neuromuscular disease: implications for management. Q J Med. 1991 Dec;81(296):961–973. doi: 10.1093/qjmed/81.3.961. [DOI] [PubMed] [Google Scholar]
  18. Smith P. E., Edwards R. H., Calverley P. M. Oxygen treatment of sleep hypoxaemia in Duchenne muscular dystrophy. Thorax. 1989 Dec;44(12):997–1001. doi: 10.1136/thx.44.12.997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Smith P. E., Edwards R. H., Calverley P. M. Protriptyline treatment of sleep hypoxaemia in Duchenne muscular dystrophy. Thorax. 1989 Dec;44(12):1002–1005. doi: 10.1136/thx.44.12.1002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Smith P. E., Edwards R. H., Calverley P. M. Ventilation and breathing pattern during sleep in Duchenne muscular dystrophy. Chest. 1989 Dec;96(6):1346–1351. doi: 10.1378/chest.96.6.1346. [DOI] [PubMed] [Google Scholar]
  21. Staats B. A., Bonekat H. W., Harris C. D., Offord K. P. Chest wall motion in sleep apnea. Am Rev Respir Dis. 1984 Jul;130(1):59–63. doi: 10.1164/arrd.1984.130.1.59. [DOI] [PubMed] [Google Scholar]
  22. Stradling J. R., Phillipson E. A. Breathing disorders during sleep. Q J Med. 1986 Jan;58(225):3–18. [PubMed] [Google Scholar]
  23. Strohl K. P., Cherniack N. S., Gothe B. Physiologic basis of therapy for sleep apnea. Am Rev Respir Dis. 1986 Oct;134(4):791–802. doi: 10.1164/arrd.1986.134.4.791. [DOI] [PubMed] [Google Scholar]
  24. Symposium on medical aspects of exercise. Med Clin North Am. 1985 Jan;69(1):1–214. [PubMed] [Google Scholar]
  25. Tabachnik E., Muller N. L., Bryan A. C., Levison H. Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Physiol Respir Environ Exerc Physiol. 1981 Sep;51(3):557–564. doi: 10.1152/jappl.1981.51.3.557. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES