Hsu A A, Staats B A
Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1998 Mar;73(3):216-24. doi: 10.4065/73.3.216.
To analyze the clinical manifestations and various types of sleep-related disordered breathing (SRDB) in patients with a history of poliomyelitis and with current "postpolio" sequelae (PPS).
We retrospectively reviewed the medical records of 108 consecutive patients with PPS and sleep disturbances encountered during an 11-year period at Mayo Clinic Rochester and abstracted the features of acute polio, PPS, and results of sleep evaluation (overnight oximetry or polysomnography). Only those patients who were not receiving ventilatory support were included in the study.
The features of PPS were dyspnea, fatigue, new weakness, and musculoskeletal pain. Of the 108 patients, 35 fulfilled the inclusion criteria. Sleep evaluations revealed three general types of disturbances: obstructive sleep apnea (group O, N = 19); hypoventilation (group H, N = 7); and both (group OH, N = 9). The mean apnea/hypopnea index was 37, 4, and 16 per hour in patients in groups O, H, and OH, respectively (P < 0.05), and the mean arterial carbon dioxide tension was 39, 60, and 55 mm Hg in these respective study groups (P < 0.05). The overall mean age at onset of symptoms of SRDB was 47 years, and the mean latent period after acute polio was 37 years. Hypersomnolence was the commonest SRDB symptom, present in 32 of the 35 patients. Snoring was noted in 100% of patients in group O, 0% in group H, and 67% in group OH. Patients in group O were obese and had normal lung function. Patients in group H tended to have normal weights and a history of diffuse neurologic deficits involving the trunk during the acute episode of polio. Scoliosis, restricted lung function, cor pulmonale, and decreased maximal respiratory pressures were common in patients in group H. Patients in group OH had overlapping features of those in groups O and H.
In patients with PPS, we identified three patterns of sleep disturbances--obstructive sleep apnea, hypoventilation, and a combination of both. These groups are characterized by clinical features and by results of arterial blood gas determinations, overnight oximetry, and polysomnography. SRDB is a late sequela of poliomyelitis, and clinical evaluation should include information about sleep.
分析患有脊髓灰质炎病史且目前存在“脊髓灰质炎后”后遗症（PPS）患者的临床表现及各类睡眠相关呼吸障碍（SRDB）。
我们回顾性分析了梅奥诊所罗切斯特分院在11年期间连续收治的108例患有PPS及睡眠障碍患者的病历，提取了急性脊髓灰质炎、PPS的特征以及睡眠评估结果（夜间血氧饱和度测定或多导睡眠图）。仅纳入未接受通气支持的患者。
PPS的特征为呼吸困难、疲劳、新发无力及肌肉骨骼疼痛。108例患者中，35例符合纳入标准。睡眠评估显示三种常见的障碍类型：阻塞性睡眠呼吸暂停（O组，N = 19）；通气不足（H组，N = 7）；以及两者皆有（OH组，N = 9）。O组、H组和OH组患者的平均呼吸暂停/低通气指数分别为每小时37次、4次和16次（P < 0.05），这些研究组各自的平均动脉血二氧化碳分压分别为39 mmHg、60 mmHg和55 mmHg（P < 0.05）。SRDB症状出现的总体平均年龄为47岁，急性脊髓灰质炎后的平均潜伏期为37年。嗜睡是最常见的SRDB症状，35例患者中有32例出现。O组100%的患者有打鼾，H组为0%，OH组为67%。O组患者肥胖且肺功能正常。H组患者体重往往正常，在脊髓灰质炎急性发作期间有涉及躯干的弥漫性神经功能缺损病史。脊柱侧弯、肺功能受限、肺心病及最大呼吸压力降低在H组患者中常见。OH组患者具有O组和H组患者的重叠特征。
在患有PPS的患者中，我们识别出三种睡眠障碍模式——阻塞性睡眠呼吸暂停、通气不足以及两者兼有。这些组通过临床特征以及动脉血气测定、夜间血氧饱和度测定和多导睡眠图结果来表征。SRDB是脊髓灰质炎的晚期后遗症，临床评估应包括睡眠相关信息。
