Ventilatory function in children with severe motor disorders using night‐time postural equipment

Abstract

Aim Night‐time postural equipment (NTPE) can prevent hip subluxation in children with severe motor disorders (SMDs). However, it is unclear how it affects ventilatory function. The aims of the study were to determine how NTPE use affects ventilatory function and to compare night‐to‐night variability of ventilatory function in children with SMDs and typically developing healthy children. Method Fifteen NTPE users (six males, nine females), aged 1 to 19 years (mean age 8y 7mo) alternated sleep condition between NTPE and sleeping unsupported for 14 nights. In all but two participants, gross motor function was classified as Gross Motor Function Classification System (GMFCS) level V; in the other two it was level IV. Oxyhaemoglobin saturation (SpO2) was monitored each night and transcutaneous CO2 (PtcCO2) for one night in each sleep condition. In 17 healthy children of similar age, home SpO2 only was monitored for seven nights. Results In 13 of 15 NTPE users and 12 of the 17 typically developing children, SpO2 monitoring was satisfactorily completed. Of the children with SMDs, two had mean SpO2 levels below the treatment threshold for supplemental oxygen, which was uniquely associated with use of NTPE in only one participant, and three had nocturnal hypoventilation, which was uniquely associated with NTPE use in only one case. Night‐to‐night SpO2 variability was higher in children with SMDs than in typically developing children. Interpretation NTPE may impair or enhance ventilatory function in a minority of children. Owing to night‐to‐night variability in SpO2, at least three nights of monitoring are recommended to determine optimal positioning for effective ventilation before and after NTPE introduction.

Sleep concerns in children and young people with cerebral palsy in their home setting

“…Therefore, this is not a study of the overall prevalence of these factors in children and young people with CP, nor does it address the unique psychosocial or emotional aspects that determine families’ capacity to deal with the associated challenges of everyday life. Nevertheless, this study adds a home‐based perspective to the previous studies which report the wide diversity of concerns in relation to sleep for this population . It shows that, in clinical practice, identification of only one or two sleep concerns may greatly underestimate the extent of the problems.…”

Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?

“…Twenty‐nine papers used the GMFCS only to describe participants . Eleven other papers used the GMFCS only to define eligibility criteria . While reliability and validity of GMFCS have been demonstrated in children with CP, none of these articles reported reliability or validity of these GMFCS categorizations in other conditions/clinical descriptions.…”

“…Among the 118 papers, 76 did not mention that the GMFCS was developed specifically for use with children with CP or discuss its measurement properties . Twenty noted that the GMFCS was created for children with CP but did not justify its application to their condition/clinical description . Three of these papers stated that the GMFCS had not been validated in their condition/clinical description of interest, or that none of their participants had CP .…”

Ventilatory function in children with severe motor disorders

“…Dawson et al . have measured oxygen saturation (SO 2 ) and tcPCO 2 in the blood of children with SMD and have shown that these children have a less stable ventilation during the night compared to typically developing children.…”

“…They have also measured tcPC0 2 but conclude that this measurement contains errors and in general is overestimating actual arterial (a) P a CO 2 . Due to metabolic CO 2 production in the living cells of the epidermis and circulatory disturbances that permit the gas to accumulate in the tissue, tcPCO 2 is higher than P a CO 2 .…”