Sleep Disordered Breathing and Passive Limb Movement in Children with Paraplegia

描述（由申请人提供）：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的治疗具有很高的不依从性。最常见的干预措施，持续气道正压通气，对儿童和青少年造成了特殊问题，因为必要的面罩随着时间的推移会扭曲发育中的面部骨骼结构，通常需要手术重建，并且随着儿童的成长很难适应。被动肢体运动，四肢的节律性运动，没有自愿的努力，增加睡眠时的通风与完整的脊髓受试者;这种干预的影响完全胸SCI（截瘫）患者缺乏下肢的感觉信息是未知的。我们假设，在这些胸髓区以上脊髓完整的SCI患者中，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、试验前和试验后设计，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）的儿童和年轻成人进行整夜多导睡眠图，这些儿童和年轻成人早期筛选为SDB，他们将在整夜多导睡眠图中随机在前半夜或后半夜接受被动肢体（手）运动。本研究的具体目的是：1）确定PLM治疗儿童和年轻成人完全性胸部SCI是否（完全截瘫）与SDB将改善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;和2）比较基线睡眠期间和接受PLM时睡眠期间完全性胸部SCI的儿童和年轻成人的觉醒次数疗法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了通气，并且SCI患者可以耐受，则干预将提供一种廉价的非侵入性治疗，可以改变临床实践，并显着改善这一高风险患者人群的生活质量和结局。 公共卫生相关性：睡眠呼吸障碍在儿童和成人脊髓损伤患者中很常见，并且与高血压、学习障碍、焦虑和抑郁的风险增加有关。目前对睡眠呼吸障碍的治疗与高不依从性、无效性和不适有关。上肢周期性运动（被动肢体运动）可能有助于颈椎以下脊髓损伤（截瘫）患者的呼吸。被动肢体运动是一种治疗睡眠呼吸障碍的创新选择，有可能有效地治疗儿童和成人截瘫。

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.