Sleep Disordered Breathing and Passive Limb Movement in Children with Paraplegia
截瘫儿童睡眠呼吸障碍和被动肢体运动
基本信息
- 批准号:8241281
- 负责人:
- 金额:$ 25.33万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2012
- 资助国家:美国
- 起止时间:2012-05-01 至 2014-04-30
- 项目状态:已结题
- 来源:
- 关键词:AdolescentAdultAgeAir SacsAmericanAnimalsAnxietyApneaArousalBrainBrain regionBreathingCarbon DioxideCardiovascular systemCentral Sleep ApneaCervical spineChestChildChildhoodCognitiveContinuous Positive Airway PressureDataDetectionDiseaseEconomic InflationEffectivenessEmotionalEnvironmental air flowEventExperimental DesignsForearmGoldHandHourHumanHypercapnic respiratory failureHypertensionIncidenceInterventionLearning DisordersLimb structureLower ExtremityMagnetic Resonance ImagingMasksMental DepressionMorbidity - disease rateMovementObstructive Sleep ApneaOperative Surgical ProceduresOutcomeOxygenParaplegiaPatientsPatternPerformancePolysomnographyPopulationPre-Post TestsPublishingPulse OximetryQuality of lifeRandomizedRecruitment ActivityReportingRespirationRespiratory DiaphragmRiskSamplingSchoolsScreening procedureSensorySensory ProcessShort-Term MemorySignal TransductionSleepSleep Apnea SyndromesSpinal CordSpinal Cord LesionsSpinal InjuriesSpinal cord injurySpinal cord injury patientsStructureThoracic spinal cord structureTimeUpper ExtremityVulnerable PopulationsWristclinical practicecognitive functioncostdesigneffective therapyexpirationface bone structurefollow-upfootfoot solehigh riskimprovedindexinginnovationlimb movementmortalitynerve injurynon-compliancenovelpatient populationpressurereconstructionrelating to nervous systemrespiratorystandard careyoung adult
项目摘要
DESCRIPTION (provided by applicant): Children and young adults with spinal cord injury (SCI) commonly show sleep-disordered breathing (SDB), which is associated with increased morbidity and mortality, with an incidence conservatively reported at over 30%. Current treatments for SDB have high non-compliance due to associated discomfort or lack of efficacy. The most common intervention, continuous positive airway pressure, poses special problems with children and young adolescents, since the necessary masks distort developing facial bone structure over time, often forcing surgical reconstruction, and are difficult to fit as the child grows. Passive limb movement, the rhythmic movement of extremities without voluntary effort, increases ventilation during sleep in subjects with intact spinal cords; the impact of this intervention in complete thoracic SCI (paraplegic) patients lacking sensory information from the lower limbs is unknown. We hypothesize that passive limb movement (PLM) in these SCI patients with intact spinal cords above the thoracic cord region will decrease SDB [decrease the Apnea- Hypopnea Index (AHI)] for both obstructive and central apnea events, improve ventilation and oxygenation, and do so without arousing subjects during the night.. Using a one-group, quasi-experimental, pre- and post- test design, we will perform overnight polysomnography on 26 pediatric and young adults with complete thoracic spinal cord injury (ASIA A paraplegia, age 12-25 years), earlier screened to show SDB, who will be randomized to undergo passive limb (hand) movement either during the first or last half of the night during overnight polysomnography. The specific aims for this study are to: 1) Determine whether PLM therapy in pediatric and young adults with complete thoracic SCI (complete paraplegia) with SDB will improve SDB (as indicated by apnea-hyperpnoea index), ventilation (end-tidal carbon dioxide), and oxygen saturation; and 2) Compare number of arousals in pediatric and young adults with complete thoracic SCI during baseline sleep and during sleep when they are receiving PLM therapy. The objective of this study is to determine whether a novel treatment, passive limb movement, will improve ventilation in complete thoracic SCI adolescents and young adults with SDB, and do so with minimal disturbance to sleep. If passive limb movement improves ventilation and is tolerable to SCI patients, the intervention will provide an inexpensive, non-invasive therapy that could change clinical practice and significantly improve quality of life and outcomes in this high risk patient population.
PUBLIC HEALTH RELEVANCE: Sleep-disordered breathing is common in children and adult spinal cord injury patients, and is associated with increased risk for high blood pressure, learning disorders, anxiety, and depression. Current treatments for sleep-disordered breathing are associated with high non-compliance, ineffectiveness, and discomfort. Upper limb cyclic movement (passive limb movement) may assist breathing in patients with spinal cord lesions below the cervical vertebrae (paraplegia). Passive limb movement is an innovative treatment option for sleep- disordered breathing which has the potential to effectively treat both children and adults with paraplegia.
描述(由申请人提供):儿童和青少年脊髓损伤(SCI)通常表现为睡眠呼吸障碍(SDB),与发病率和死亡率增加有关,保守报道的发病率超过30%。由于相关的不适或缺乏疗效,目前SDB的治疗有很高的不依从性。最常见的干预措施是持续气道正压通气,这给儿童和青少年带来了特殊的问题,因为随着时间的推移,必要的口罩会扭曲正在发育的面部骨骼结构,常常迫使手术重建,并且随着儿童的成长很难适应。被动肢体运动,即肢体无自主动作的有节奏运动,可增加脊髓完好受试者睡眠时的通气;这种干预对缺乏下肢感觉信息的完全性胸椎SCI(截瘫)患者的影响尚不清楚。我们假设,在这些胸椎以上脊髓完整的SCI患者中,被动肢体运动(PLM)会降低阻塞性和中枢性呼吸暂停事件的SDB[降低呼吸暂停-低通气指数(AHI)],改善通气和氧合,并且在夜间不唤醒受试者的情况下这样做。采用单组、准实验、测试前和测试后设计,我们将对26名患有完全性胸脊髓损伤(ASIA a截瘫,年龄12-25岁)的儿童和年轻人进行夜间多导睡眠描画,早期筛选显示SDB,他们将被随机分配在夜间多导睡眠描画期间的前半部分或后半部分进行被动肢体(手)运动。本研究的具体目的是:1)确定PLM治疗对患有SDB的小儿和青年完全胸椎SCI(完全截瘫)患者是否会改善SDB(以呼吸暂停-高通气指数为指标)、通气(潮末二氧化碳)和血氧饱和度;2)比较小儿和青壮年完全性胸椎脊髓损伤患者在基线睡眠和接受PLM治疗时的睡眠唤醒次数。本研究的目的是确定一种新的治疗方法——被动肢体运动,是否能在对睡眠干扰最小的情况下改善完全性胸椎脊髓损伤青少年和患有SDB的年轻人的通气。如果被动肢体运动可以改善通气,并且对脊髓损伤患者是可容忍的,那么这种干预将提供一种廉价、无创的治疗方法,可以改变临床实践,显著改善这一高危患者群体的生活质量和预后。
项目成果
期刊论文数量(0)
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RONALD Marven HARPER其他文献
RONALD Marven HARPER的其他文献
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{{ truncateString('RONALD Marven HARPER', 18)}}的其他基金
Sleep Disordered Breathing and Passive Limb Movement in Children with Paraplegia
截瘫儿童睡眠呼吸障碍和被动肢体运动
- 批准号:
8463626 - 财政年份:2012
- 资助金额:
$ 25.33万 - 项目类别:
Passive Foot Movement and Sleep-Disordered Breathing in Heart Failure
心力衰竭患者的被动足部运动和睡眠呼吸障碍
- 批准号:
7979474 - 财政年份:2010
- 资助金额:
$ 25.33万 - 项目类别:
Passive Foot Movement and Sleep-Disordered Breathing in Heart Failure
心力衰竭患者的被动足部运动和睡眠呼吸障碍
- 批准号:
8127821 - 财政年份:2010
- 资助金额:
$ 25.33万 - 项目类别:
NEURAL SITES MEDIATING OBSTGRUCTIVE SLEEP APNEA
调节阻塞性睡眠呼吸暂停的神经部位
- 批准号:
7724342 - 财政年份:2008
- 资助金额:
$ 25.33万 - 项目类别:
NEURAL SITES MEDIATING OBSTGRUCTIVE SLEEP APNEA
调节阻塞性睡眠呼吸暂停的神经部位
- 批准号:
7627699 - 财政年份:2007
- 资助金额:
$ 25.33万 - 项目类别:
NEURAL SITES MEDIATING OBSTGRUCTIVE SLEEP APNEA
调节阻塞性睡眠呼吸暂停的神经部位
- 批准号:
7369437 - 财政年份:2006
- 资助金额:
$ 25.33万 - 项目类别:
Neural Sites Mediating Obstructive Sleep Apnea
调节阻塞性睡眠呼吸暂停的神经部位
- 批准号:
6741089 - 财政年份:2003
- 资助金额:
$ 25.33万 - 项目类别:
NEURAL SITES MEDIATING OBSTRUCTIVE SLEEP APNEA
调节阻塞性睡眠呼吸暂停的神经部位
- 批准号:
6505104 - 财政年份:2001
- 资助金额:
$ 25.33万 - 项目类别:
NEURAL SITES MEDIATING OBSTRUCTIVE SLEEP APNEA
调节阻塞性睡眠呼吸暂停的神经部位
- 批准号:
6349180 - 财政年份:2000
- 资助金额:
$ 25.33万 - 项目类别:
NEURAL SITES MEDIATING OBSTRUCTIVE SLEEP APNEA
调节阻塞性睡眠呼吸暂停的神经部位
- 批准号:
6202626 - 财政年份:1999
- 资助金额:
$ 25.33万 - 项目类别:
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