Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy.
J Clin Sleep Med. 2019 Feb 15;15(2):351-354. doi: 10.5664/jcsm.7644.
Respiratory disorders may follow brain injury and may also occur because of comorbidities and drug use, especially central depressants or muscle relaxants. Sleep can precipitate respiratory disorders, thus polysomnography can be a powerful diagnostic tool. By revealing breathing patterns that identify specific sleep disorders, polysomnography may unmask adverse pharmacological effects, for instance connecting central depressant drugs with central sleep apneas. We describe the case of a pediatric patient in rehabilitation from brain injury who developed a central sleep apnea following a baclofen dose increase within the therapeutic range, while assuming an under-dosed benzodiazepine. Polysomnography identified a typical respiration pattern, previously observed in adults treated with baclofen and other central depressants. Baclofen tapering resolved the central sleep apnea. Polysomnography, and this specific pattern, may be proposed as diagnostic tools in patients with high dose baclofen that can be used to prevent potential respiratory disorders in children.
呼吸障碍可能是脑损伤的后果，也可能由合并症和药物使用引起，尤其是中枢抑制剂或肌肉松弛剂。睡眠可能会引发呼吸障碍，因此多导睡眠图可以成为一种强大的诊断工具。通过揭示可识别特定睡眠障碍的呼吸模式，多导睡眠图可以揭示不良的药物作用，例如将中枢抑制剂与中枢性睡眠呼吸暂停联系起来。我们描述了一个脑损伤康复中的儿科患者的病例，在治疗范围内增加巴氯芬剂量后，该患者出现了中枢性睡眠呼吸暂停，同时假设使用了低剂量的苯二氮䓬类药物。多导睡眠图识别出一种典型的呼吸模式，此前在接受巴氯芬和其他中枢抑制剂治疗的成年人中观察到过这种模式。巴氯芬逐渐减量后，中枢性睡眠呼吸暂停得到解决。多导睡眠图和这种特定模式可作为高剂量巴氯芬患者的诊断工具，用于预防儿童潜在的呼吸障碍。
