Sleep Disordered Breathing and Passive Limb Movement in Children with Paraplegia

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为睡眠呼吸障碍(SDB)，这与发病率和死亡率的增加有关，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治疗方法有很高的不依从性。最常见的干预措施是持续气道正压，这对儿童和青少年造成了特殊的问题，因为随着时间的推移，必要的口罩会扭曲发育中的面部骨骼结构，通常会迫使手术重建，而且随着孩子的成长很难适应。被动肢体运动，即肢体的有节奏的运动，在没有自愿努力的情况下，增加了脊髓完整的受试者在睡眠时的通气量；这种干预对缺乏来自下肢的感觉信息的完全性胸部脊髓损伤(截瘫)患者的影响尚不清楚。我们假设，这些脊髓在胸髓以上完整的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)]，改善呼吸和氧合，并且这样做不会在夜间唤醒受试者。采用一组、准实验、前后试验设计，我们将对26名患有完全性胸髓损伤(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，早期筛查显示SDB，他们将被随机安排在夜间多导睡眠监测期间进行被动肢体(手)运动。这项研究的具体目的是：1)确定PLM治疗完全性胸部脊髓损伤(完全性截瘫)合并SDB是否能改善SDB(如呼吸暂停-高呼吸指数所示)、通气量(呼气末二氧化碳)和血氧饱和度；2)比较儿童和年轻人完全性胸部脊髓损伤患者在基线睡眠和接受PLM治疗时的觉醒次数。这项研究的目的是确定一种新的治疗方法，被动肢体运动，是否可以改善完全性胸部脊髓损伤青少年和患有SDB的年轻人的呼吸，并且对睡眠的干扰最小。如果被动肢体运动改善了呼吸，并且对脊髓损伤患者是耐受的，那么这种干预将提供一种廉价、非侵入性的治疗方法，可以改变临床实践，显著提高这一高危患者的生活质量和预后。

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.