Analysis of sleep characteristics in post-polio syndrome patients

Abstract

The main post-polio syndrome (PPS) symptoms are new weakness, new atrophy, fatigue, pain and sleep disturbances. Polysomnography is the gold standard for sleep analysis. Objective: To analyze sleep patterns in PPS patients. Method: Sixty patients (mean age 46.8±11.3 years) at the Federal University of São Paulo (UNIFESP/EPM) complaining of sleep disturbances were evaluated by means of polysomnography, performed at the Sleep Institute. Results: Sleep efficiency was lower due to high sleep latency and arousal index. The apnea and hypopnea index (AHI) and the periodic limb movements (PLM) index were higher. Sleep architecture was also impaired. There were no abnormalities of oxygen saturation, carbon dioxide levels, respiratory rate or heart rate. Conclusion: New post-polio sleep disturbances were isolated symptoms. It appears that these symptoms were not due to post-polio features, but rather, that they were due to dysfunction of the surviving motor neurons in the brainstem. Abnormal dopamine production, which is responsible for many sleep-related breathing disorders and abnormal movements, may also have been implicated in the present findings. Key words: sleep, polysomnography, post-polio syndrome.Análise das características do sono em pacientes com síndrome pós-poliomielite RESUMO Dentre as manifestações clínicas da síndrome pós poliomielite (SPP) destacam-se nova fraqueza, fadiga, dor, nova atrofia e transtornos do sono. A polissonografia de noite inteira permanece sendo padrão ouro para análise do sono e diagnóstico de transtornos do sono. Objetivo: Verificar os transtornos de sono nos pacientes com SPP. Método: 60 pacientes com SPP (media de idade 46,8±11,3 anos), da UNIFESP/EPM,que apresentavam queixas sobre sono realizaram uma noite de polissonografia no Instituto do Sono. Resultados: A eficiência do sono é diminuída em decorrência do aumento da latência do sono e do índice de despertar. O índice de apnéia e hipopnéia (IAH) e o índice de movimentos periódicos dos membros (iPLM) estão aumentados. A arquitetura do sono é prejudicada por essas alterações. Não há alterações da saturação da oxi-hemoglobina, do gás carbônico exalado, da freqüência respiratória e cardíaca. Conclusão: Novas alterações do sono são sintomas isolados desta população. Parece que esses sintomas não ocorrem devido a outras características da SPP, mas decorrem de disfunções nos neurônios do tronco encefálico e alterações da produção de dopamina que provocam os distúrbios respiratórios do sono e os movimentos periódicos dos membros. Palavras-chave: sono, polissonografia, síndrome pós-poliomielite.

Currents issues in cardiorespiratory care of patients with post-polio syndrome

“…This inefficiency is assigned to more than 10 arousals per hour, seep-related disordered breathing, PLM, changes in the different sleep stages and muscle and/or joint pain. Polysomnographic examination demonstrated greater time spent in superficial sleep than in deeper stages 8 .This occurrence may be credited to the impairment induced by poliovirus on reticular formation, an area known to mediate initiation of REM sleep 8,9 . The latencies of tone reduction (MTR), sawtooth waves (STW), and REM seemed to be meaningfully higher in the bulbar involvement 9 .…”

“…A study reporting nine months of follow up of 21 post-polio syndrome patients was not able to prove significant difference of sleep quality between post-polio syndrome, non-post-polio syndrome and control groups 7 . Among sleep disorders related to PPS, periodic limb movements (PLM) hypopnea and, specially, obstructive sleep apnea (OSA) are the most frequent 5,6,8 . Breathing disturbances seem to be moreusual during sleep of PPS patients than in general population 8 .…”

“…Among sleep disorders related to PPS, periodic limb movements (PLM) hypopnea and, specially, obstructive sleep apnea (OSA) are the most frequent 5,6,8 . Breathing disturbances seem to be moreusual during sleep of PPS patients than in general population 8 . There are some signs and symptoms that may alert to the under ventilation, such as: orthopnea, insomnia, anxiety about going to sleep, restless fragmented sleep, morning headaches and worsening mental status 6 .…”

“…The latencies of tone reduction (MTR), sawtooth waves (STW), and REM seemed to be meaningfully higher in the bulbar involvement 9 . In case of OSA, BiPAP, respiratory physical therapy, as well as, flu vaccines are among the resources indicated 6,8,10 . These sleep disorders may contribute to a cardinal PPS symptom: fatigue 5,8,11,12 .…”

“…The main clinical findings are hypoventilation, apnea, and hypopnea associated with significant obstructions and desaturation reduced sleep efficiency due to prolonged sleep latencies and high arousal indices 8,31 . Although overnight EtCO2 provides valuable information concerning nocturnal hypoventilation, it is recommended that suspected sleep dysfunction in neuromuscular disorders be investigated with full-night in-laboratory polysomnography (PSG) 32 .…”