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Sleep Breath 2003; 07(3): 143-146
DOI: 10.1055/s-2003-43075
CASE REPORT

Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Expiratory-Synchronized Sleep in a Quadriplegic Patient Using Inspiratory Neck Muscles To Breathe

Isabelle Arnulf1 , Christian Straus2 , Christian Delafosse1 , Jean-Philippe Derenne1 , Thomas Similowski1
  • 1Service de Pneumologie, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, and UPRES EA 397, Université Paris VI, Paris, France
  • 2Service Central d'Explorations Fonctionnelles Respiratoires, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, and UPRES EA 397, Université Paris VI, Paris, France
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Publication History

Publication Date:
21 October 2003 (online)

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ABSTRACT

In a patient with C3 quadriplegia causing complete diaphragm paralysis who developed inspiratory neck muscles (INM) hypertrophy to sustain ventilation, spontaneous breathing deeply altered sleep architecture, relegating sleep to the expiratory phase of the ventilatory cycle. A polysomnographic recording performed during mechanical ventilation (without INM activity), showed that sleep was abnormal but unaffected by the respiratory cycle. During spontaneous breathing, the polygraphic recordings showed expiratory microsleep episodes, with inspiratory arousals synchronous to bursts of INM activity. This case report illustrates the powerful adaptability of the respiratory and sleep control systems to maintain each vital function.

KEYWORDS

Diaphragm - respiratory muscles - sleep - sleep-related respiratory disorders - tetraplegia - control of breathing - brain plasticity

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