Торакоскопия
На главную Написать письмо
История метода
Оборудование и инструменты
Диагностика и лечение заболеваний плевры
Торакоскопическая биопсия легкого
Лечение спонтанного пневмоторакса
Торакоскопическая диагностика и лечение заболеваний средостения
Резекция легкого при очаговом образовании
Анатомическая резекция легкого
Торакоскопические операции на пищеводе
Торакоскопическая симпатэктомия и спланхникэктомия
Лечение патологии грудной стенки
Лечение патологии диафрагмы
Грыжи диафрагмы
Релаксация диафрагмы
Повреждения диафрагмального нерва
Литература по проблеме

Консультации
Литература для специалистов
Обратная связь













ПАРАЛИЧ ДИАФРАГМЫ И СОН

Приобретенная релаксация диафрагмы (у взрослых)
ПАРЕЗЫ И ПАРАЛИЧИ ДИАФРАГМЫ
ОПРЕДЕЛЕНИЕ И ВСТУПЛЕНИЕ ПО ПРОБЛЕМЕ ПАРЕЗОВ И ПАРАЛИЧЕЙ ДИАФРАГМЫ
ФИЗИОЛОГИЯ И ПАТОФИЗИОЛОГИЯ ДИАФРАГМЫ
ЭТИОЛОГИЯ ПАРЕЗОВ И ПАРАЛИЧЕЙ ДИАФРАГМЫ
КЛИНИЧЕСКИЕ ПРОЯВЛЕНИЯ ПАРЕЗОВ И ПАРАЛИЧЕЙ ДИАФРАГМЫ
ПАРАЛИЧ ДИАФРАГМЫ И СОН
ДИАГНОСТИКА ПАРАЛИЧЕЙ ДИАФРАГМЫ
ЛЕЧЕНИЕ ПАРАЛИЧЕЙ И ПАРЕЗОВ ДИАФРАГМЫ
Early studies revealed alveolar hypoventilation and hypercapnia during sleep as well as symptoms of poor sleep quality, including daytime hypersomnolence and morning headaches, in patients with bilateral diaphragmatic paralysis.4 Furthermore, the most profound hypoventilation and hypoxemia have been found to occur during rapid eye movement (REM) sleep.15 In REM sleep, the voluntary muscles including the accessory muscles of respiration are paralyzed, so breathing becomes dependent on activity of the diaphragm. In normal subjects, tidal volume is largely preserved in REM sleep owing to an increase in diaphragmatic muscle activity,16 although minute ventilation is slightly decreased due to a decreased respiratory rate. However, in the setting of diaphragmatic paralysis, tidal volume cannot be maintained in REM sleep, which results in hypoventilation and oxygen desaturation.15,17 In a recent study of patients with ALS, Arnulf and coauthors18 found that those patients with diaphragmatic weakness had little or no REM sleep. Interestingly, among those ALS patients with diaphragmatic weakness, longer REM duration was associated with preservation of accessory muscle function during REM. There is even some evidence that patients with bilateral diaphragmatic paralysis can maintain a normal quantity of REM sleep through activation of accessory muscles arising from brainstem reorganization.19 The poor sleep quality observed in patients with diaphragmatic weakness is thought to be due to increasing desaturation at night. Because of the frequent awakenings, diaphragmatic weakness may present clinically with symptoms of poor sleep quality, such as daytime hypersomnolence and morning headaches.
Although diaphragmatic paralysis classically has been associated with nocturnal hypoventilation and hypoxemia,4,15,20 recent studies have had conflicting results. In one study of six patients with isolated bilateral diaphragmatic paralysis in the absence of generalized neuromuscular weakness, only two showed significant oxygen desaturation, and PCO2 levels remained within normal limits in all patients. In addition, the number of arousals was normal and there were no detectable symptoms of poor sleep quality.10 The authors conclude that nocturnal hypoventilation requires generalized neuromuscular weakness rather than isolated diaphragmatic paralysis. In fact, some reports suggest that even patients with generalized neuromuscular disease who have fragmented sleep, particularly in the REM phase, may not demonstrate the profound nocturnal hypoventilation and desaturation that is classically associated with diaphragmatic weakness.18 However, the data are conflicting, as some patients with even isolated diaphragmatic paralysis demonstrate severe oxygen desaturation during REM sleep.21 Full polysomnography should be part of the routine workup of patients with diaphragmatic dysfunction.


2003 © www.thoracoscopy.ru
Design, programming, content
and promotion by A4-design
Rambler's Top100   Рейтинг@Mail.ru