Sleep disorders in neuromuscular diseases
Sleep disorders in neuromuscular diseases
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DOI：
10.1097/01.mcp.0000245704.92311.1e
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发表时间：
2006-11-01
影响因子：
3.3
通讯作者：
Dhand, Rajiv
中科院分区：
文献类型：
--
作者：
Dhand, Upinder K.;Dhand, Rajiv
综述目的神经肌肉疾病（NMD）患者特别容易发生睡眠相关功能障碍。NMD患者的睡眠呼吸障碍通常先于日间呼吸衰竭，需要及时识别和无创通气（NIV）管理。本文综述了各种神经肌肉疾病中睡眠障碍的机制、诊断评估和治疗。最新研究结果NMD的严重程度、持续时间和类型影响睡眠障碍的模式。一些研究人员已经解决了其他临床方面，包括睡眠投诉，hypocretin-1缺乏症，白天过度嗜睡，以及睡眠障碍与强直性肌营养不良中CTG三核苷酸重复序列长度的关系的评级量表。NIV对慢性NMD成人和儿童的生活质量和生存率的益处已得到充分证实，最近甚至在夜间通气不足和白天二氧化碳正常的患者中也有记录。相比之下，调查与多导睡眠图和启动NIV.Summary慢性NMD患者应定期评估睡眠呼吸障碍和睡眠投诉的时间，因为这些是可治疗的并发症，否则进行性疾病的过程。需要进一步的研究来确定多导睡眠图的适应症，并确定启动NIV治疗神经肌肉疾病患者睡眠呼吸障碍的最佳时机。
Purpose of review Patients with neuromuscular disorders (NMD) are especially vulnerable to sleep-related dysfunction. Sleep-disordered breathing often precedes diurnal respiratory failure in NMD patients, requiring timely recognition and management with noninvasive ventilation (NIV). This paper reviews the mechanisms, diagnostic evaluation, and management of sleep disorders in various neuromuscular diseases.Recent findings The severity, duration, and type of NMD influence the pattern of sleep disturbance. Several investigators have addressed other clinical aspects including rating scales for sleep complaints, hypocretin-1 deficiency, excessive daytime somnolence, and relation of sleep disorder with length of CTG trinucleotide repeats in myotonic dystrophy. Benefits of NIV on quality of life and survival in adults and children with chronic NMD are well established, and recently have been documented even in patients with nocturnal hypoventilation and daytime normocapnia. In contrast, the timing for investigation with polysomnography and for initiation of NIV is debated.Summary Patients with chronic NMD should be routinely assessed for sleep-disordered breathing and sleep complaints, because these are treatable complications in an otherwise progressive disease process. Further research is needed to establish the indications for polysomnography and to determine the optimal timing for initiating NIV to treat sleep-disordered breathing in patients with neuromuscular diseases.