Is polysomnographic examination necessary for subjects with diaphragm pathologies?

Abstract

OBJECTIVES:While respiratory distress is accepted as the only indication for diaphragmatic plication surgery, sleep disorders have been underestimated. In this study, we aimed to detect the sleep disorders that accompany diaphragm pathologies. Specifically, the association of obstructive sleep apnea syndrome with diaphragm eventration and diaphragm paralysis was evaluated.METHODS:This study was performed in Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital between 2014–2016. All patients had symptoms of obstructive sleep apnea (snoring and/or cessation of breath during sleep and/or daytime sleepiness) and underwent diaphragmatic plication via video-assisted mini-thoracotomy. Additionally, all patients underwent pre- and postoperative full-night polysomnography. Pre- and postoperative clinical findings, polysomnography results, Epworth sleepiness scale scores and pulmonary function test results were compared.RESULTS:Twelve patients (7 males) with a mean age of 48 (range, 27-60) years and a mean body mass index of 25 (range, 20-30) kg/m2 were included in the study. Preoperative polysomnography showed obstructive sleep apnea syndrome in 9 of the 12 patients (75%), while 3 of the patients (25%) were regarded as normal. Postoperatively, patient complaints, apnea hypopnea indices, Epworth sleepiness scale scores and pulmonary function test results all demonstrated remarkable improvement.CONCLUSION:All patients suffering from diaphragm pathologies with symptoms should undergo polysomnography, and patients diagnosed with obstructive sleep apnea syndrome should be operated on. In this way, long-term comorbidities of sleep disorders may be prevented.

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

“…Sleep-disordered breathing (SDB) may be more prevalent than previously thought in patients with unilateral diaphragm weakness [88,89]. A recent study [88] showed increased neural respiratory drive to the diaphragm during non-rapid eye movement (NREM) sleep and a significantly higher respiratory disturbance index (RDI) in this population compared with control subjects, even in the absence of diurnal symptoms.…”

“…In the presence of more severe diaphragm paresis or in patients with underlying obesity or cardiorespiratory diseases, orthopnea, dyspnea when bending forward, coughing, chest pain and dyspnea on exertion may become evident [85,86,87,88], as can symptoms of sleep-disordered breathing [88,89]. In contrast, patients presenting with bilateral diaphragm weakness very frequently report severe dyspnea when supine and during exertion [87,90,91,92,93] and are likely to show features of sleep-disordered breathing [37,94,95,96,97].…”

“…Most respiratory events seem to be central hypopnea secondary to weakness of the respiratory pump, even in the setting of compensatory increased neural drive to breathe, and were particularly prevalent in patients with more severe diaphragm weakness (unilateral Pdi,tw < 5 cmH 2 O) [88]. In accordance, polysomnography could be considered in this population even in the absence of diurnal symptoms [89]. …”

Unraveling sleep respiratory dysfunction in amyotrophic lateral sclerosis: Beyond the apnea-hypopnea index and sleep-related hypoxia

“…Thus, objective tests are mandatory to ensure a reliable validation of patients’ condition. Literature evidence suggests that patients with various sorts of diaphragmatic weakness, including neuromuscular disorders, especially when symptomatic for non-refreshing sleep, should undergo sleep recording, to rule out the coexistence of obstructive sleep apnea (OSA) [ 15 , 16 ]. Although this first point is key in the timely identification of patients deserving further attention from sleep clinicians and pulmonologists, we emphasize the importance of other less common nocturnal breathing patterns that can be observed in polygraphic sleep recording, which could help predicting the ongoing respiratory failure.…”

Diaphragm and Lung Transplantation

“…The polysomnography is not specific for the diaphragm; however, it has been shown that unilateral diaphragmatic dysfunction has been linked to a higher prevalence of OSAS compared to healthy subjects [14,[18][19][20][21][22]. Thus, in patients suffering from diaphragmatic dysfunction, it may reveal a diagnosis of OSAS.…”