Department of Medicine, University of Calgary, Calgary, Alberta.
Section of Respiratory Medicine, Alberta Health Services, Calgary, Alberta.
J Clin Sleep Med. 2023 Nov 1;19(11):1975-1979. doi: 10.5664/jcsm.10730.
Shrinking lung syndrome is a rare complication of systemic lupus erythematosus; its impact on sleep-disordered breathing is not well understood. We describe a case of a 36-year-old female with systemic lupus erythematosus experiencing shrinking lung syndrome and frequent pain crises. We review manifestations of her disease during non-rapid eye movement (NREM) and rapid eye movement sleep. Shrinking lung syndrome with its restrictive physiology and associated diaphragmatic myopathy is expected to decrease minute ventilation during NREM and rapid eye movement sleep. Normalization of respiratory rate during NREM, as opposed to rapid eye movement and awake state, should alert clinicians to dysfunctional breathing that is suppressed in NREM when cortical breathing is overridden by involuntary breathing. Recognition of dysfunctional breathing disorders by sleep providers is important for addressing all contributors to dyspnea in patients with systemic lupus erythematosus; polysomnogram can be a valuable tool in detecting incongruent ventilation parameters that deviate from expected NREM and rapid eye movement norms and point to dysfunctional breathing disorders. Abnormalities in respiratory rate and gas exchange that improve or vanish in NREM sleep can serve as an additional diagnostic clue of dysfunctional breathing disorders.
Saleh D, Loewen A. Shrinking lung syndrome: vanishing in non-rapid eye movement sleep. . 2023;19(11):1975-1979.
缩肺综合征是系统性红斑狼疮的罕见并发症，其对睡眠呼吸紊乱的影响尚不清楚。我们描述了一例 36 岁女性系统性红斑狼疮患者出现缩肺综合征和频繁疼痛危象。我们回顾了她在非快速眼动（NREM）和快速眼动睡眠期间疾病的表现。缩肺综合征具有限制生理和相关膈肌肌病，预计会在 NREM 和快速眼动睡眠期间减少分钟通气量。与快速眼动和清醒状态相反，NREM 期间呼吸频率的正常化应提醒临床医生注意呼吸功能障碍，当皮质呼吸被无意识呼吸掩盖时，呼吸功能障碍在 NREM 期间受到抑制。睡眠提供者对呼吸功能障碍的认识对于解决系统性红斑狼疮患者呼吸困难的所有因素非常重要；多导睡眠图可以作为一种有价值的工具，用于检测与预期 NREM 和快速眼动标准不一致的不协调通气参数，并提示呼吸功能障碍。在 NREM 睡眠中改善或消失的呼吸率和气体交换异常可作为呼吸功能障碍的另一个诊断线索。
