Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Dev Med Child Neurol. 2013 Aug;55(8):751-7. doi: 10.1111/dmcn.12149. Epub 2013 Apr 15.
Night-time postural equipment (NTPE) can prevent hip subluxation in children with severe motor disorders (SMDs). However, it is unclear how it affects ventilatory function. The aims of the study were to determine how NTPE use affects ventilatory function and to compare night-to-night variability of ventilatory function in children with SMDs and typically developing healthy children.
Fifteen NTPE users (six males, nine females), aged 1 to 19 years (mean age 8y 7mo) alternated sleep condition between NTPE and sleeping unsupported for 14 nights. In all but two participants, gross motor function was classified as Gross Motor Function Classification System (GMFCS) level V; in the other two it was level IV. Oxyhaemoglobin saturation (SpO2 ) was monitored each night and transcutaneous CO2 (PtcCO2 ) for one night in each sleep condition. In 17 healthy children of similar age, home SpO2 only was monitored for seven nights.
In 13 of 15 NTPE users and 12 of the 17 typically developing children, SpO2 monitoring was satisfactorily completed. Of the children with SMDs, two had mean SpO2 levels below the treatment threshold for supplemental oxygen, which was uniquely associated with use of NTPE in only one participant, and three had nocturnal hypoventilation, which was uniquely associated with NTPE use in only one case. Night-to-night SpO2 variability was higher in children with SMDs than in typically developing children.
NTPE may impair or enhance ventilatory function in a minority of children. Owing to night-to-night variability in SpO2 , at least three nights of monitoring are recommended to determine optimal positioning for effective ventilation before and after NTPE introduction.
夜间姿势设备（NTPE）可预防严重运动障碍（SMD）儿童的髋关节半脱位。然而，其对通气功能的影响尚不清楚。本研究旨在确定 NTPE 使用如何影响通气功能，并比较 SMD 儿童与健康同龄儿童的夜间通气功能的变异性。
15 名 NTPE 用户（6 名男性，9 名女性），年龄 1 至 19 岁（平均年龄 8 岁 7 个月），在 14 个晚上交替使用 NTPE 和不支持的睡眠条件。除了两名参与者外，所有参与者的粗大运动功能均被归类为粗大运动功能分类系统（GMFCS）水平 V；另外两名参与者为水平 IV。每晚监测血氧饱和度（SpO2），在每种睡眠条件下监测一夜的经皮二氧化碳（PtcCO2）。在 17 名年龄相近的健康儿童中，仅在家中监测了 7 晚的 SpO2。
在 13 名 NTPE 用户和 12 名健康儿童中，SpO2 监测得以顺利完成。在 SMD 儿童中，有 2 名儿童的平均 SpO2 水平低于补充氧气的治疗阈值，这与唯一一名参与者使用 NTPE 有关，有 3 名儿童有夜间通气不足，这与仅一名参与者使用 NTPE 有关。SMD 儿童的夜间 SpO2 变异性高于健康同龄儿童。
NTPE 可能会损害或增强少数儿童的通气功能。由于 SpO2 的夜间变异性，建议在引入 NTPE 之前和之后至少监测 3 晚，以确定有效的通气的最佳体位。
