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
• 负责人: RONALD Marven HARPER
• 金额: $ 14.6万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8463626
• 关键词: Adolescent; Adult; Age; Air Sacs; American; Animals; Anxiety; Apnea; Arousal; Brain; Brain region; Breathing; Carbon Dioxide; Cardiovascular system; Central Sleep Apnea; Cervical spine; Chest; Child; Childhood; Cognitive; Continuous Positive Airway Pressure; Data; Detection; Disease; Economic Inflation; Effectiveness; Emotional; Environmental air flow; Event; Experimental Designs; Forearm; Gold; Hand; Hour; Human; Hypercapnic respiratory failure; Hypertension; Incidence; Intervention; Learning Disorders; Limb structure; Lower Extremity; Magnetic Resonance Imaging; Masks; Mental Depression; Morbidity - disease rate; Movement; Obstructive Sleep Apnea; Operative Surgical Procedures; Outcome; Oxygen; Paraplegia; Patients; Pattern; Performance; Polysomnography; Population; Pre-Post Tests; Publishing; Pulse Oximetry; Quality of life; Randomized; Recruitment Activity; Reporting; Respiration; Respiratory Diaphragm; Risk; Sampling; Schools; Sensory; Sensory Process; Short-Term Memory; Signal Transduction; Sleep; Sleep Apnea Syndromes; Spinal Cord; Spinal Cord Lesions; Spinal Injuries; Spinal cord injury; Spinal cord injury patients; Structure; Thoracic spinal cord structure; Time; Upper Extremity; Vulnerable Populations; Wrist; clinical practice; cognitive function; cost; design; effective therapy; expiration; face bone structure; follow-up; foot; foot sole; high risk; improved; indexing; innovation; limb movement; mortality; nerve injury; non-compliance; novel; patient population; pressure; reconstruction; relating to nervous system; respiratory; screening; standard care; young adult

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.

描述（由申请人提供）：患有脊髓损伤（SCI）的儿童和年轻人通常表现出睡眠呼吸障碍（SDB），这与发病率和死亡率增加有关，保守报告的发病率超过 30%。由于相关的不适或缺乏疗效，目前的 SDB 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问题，因为随着时间的推移，必要的面罩会扭曲正在发育的面部骨骼结构，常常迫使进行手术重建，并且随着孩子的成长而难以适应。被动肢体运动，即无需自愿努力的四肢节律运动，可以增加脊髓完整的受试者睡眠期间的通气量；这种干预对缺乏下肢感觉信息的完全胸部 SCI（截瘫）患者的影响尚不清楚。我们假设这些胸髓区域以上脊髓完整的 SCI 患者的被动肢体运动 (PLM) 将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，并且在夜间不会唤醒受试者。使用单组、准实验、测试前和测试后设计，我们将进行 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监测，这些人之前经过筛查以显示 SDB，他们将被随机分配在夜间多导睡眠监测期间的前半夜或后半夜进行被动肢体（手）运动。本研究的具体目的是： 1) 确定对伴有 SDB 的完全性胸部 SCI（完全性截瘫）儿童和年轻人进行 PLM 治疗是否会改善 SDB（如呼吸暂停-呼吸过度指数所示）、通气（呼气末二氧化碳）和氧饱和度； 2) 比较患有完全胸部 SCI 的儿童和年轻人在基线睡眠期间和接受 PLM 治疗时的睡眠期间的觉醒次数。本研究的目的是确定一种新的治疗方法——被动肢体运动——能否改善患有 SDB 的完全性胸部 SCI 青少年和年轻人的通气，并且对睡眠的干扰最小。如果被动肢体运动改善通气并且 SCI 患者能够耐受，那么干预措施将提供一种廉价的非侵入性治疗，可以改变临床实践并显着改善这一高危患者群体的生活质量和结果。