Frequência respiratória observada em pacientes com problemas respiratórios associados ao sono

anp Arquivos de Neuro-Psiquiatria Arq. Neuro-Psiquiatr. 0004-282X 1678-4227 Academia Brasileira de Neurologia - ABNEURO São Paulo, SP, Brazil Em adultos normais, a frequência respiratória (f) varia de 8 a 25 min-1 com grande reprodutividade intraindividual: durante o sono, f é quase invariável. Esta variável tem sido raramente referida em estudos de pacientes com problemas respiratórios associados ao sono (SRRD). A observação ocasional de espetacular aumento da f durante o sono em pacientes com SRRD', principalmente apnéias/hipopnéias associadas à desaturação da oxi-he-moglobina, nos levou a proceder a estudo retrospectivo de 650 exames consecutivos de polisso-nografia (PSG), com a finalidade de avaliar a frequência da ocorrência desta aceleração da f e dos prováveis fatores a ela associados. Foram excluidos deste estudo pacientes com insuficiência respiratória grave. Observamos a ocorrência deste fenômeno em 16 pacientes (11 homens com média de idade 45±13 anos, índice de massa corporal (BMI) 44±11 kg/m2) para os quais a f foi maior que 25 min-1 durante o sono (grupo de taquipnéicos, T). Realizamos comparação da f entre T e grupo controle (C) de pacientes de mesmo sexo e semelhantes idades (45±12 anos) e, BMI (44±10 kg/ni2) e SRKD, em cada estado de vigilância, fazendo média de 5 contagens da f, cada uma feita durante 1 minuto e durante um período estável do determinado estado de vigilância, Observamos que: os pacientes do grupo C não apresentaram alteração significativa da f em qualquer estado de vigilância; os pacientes do grupo T já tinham f maior que os pacientes do grupo C (p < 0.05) quando acordados e esta aumentou significativamente em todos os estados do sono (p< 0.01 f quando acordados vs f durante o sono, p < 0.001 T vs C durante o sono). Comparamos os dois grupos para vários parâmetros clínicos e polissonográficos. Diferença estatisticamente significante foi observada para os dados de: PaCO-2 (pressão arterial do C02), capacidade vital (VC), volume expiratório em 1 segundo (FEV1) e da frequência do pulso (PF) durante repouso (acordados) e durante o sono. Breathing frequency in sleep related respiratory disturbances Frequência respiratória observada em pacientes com problemas respiratórios associados ao sono Márcia Pradella Sleep Laboratory, St. Luc Training Hospital Université Catholique de Louvain, Brussels SUMMARY In normal adults, breathing frequency (f) is highly reproducible within an individual ranging from 8 to 25 min-1; during sleep, f is known to change only minimally. This variable is rarely reported in studies of adults with various sleep related respiratory disturbances (SRRD). We occasionally observed a spectacular increase of f during sleep in patients with SRRD associated with hypopnea and 02 desaturation. We undertook a retrospective study of 650 consecutive all-night polysomnographic recordings, in order to evaluate how often such an increase in breathing frequency occurs and with which factors it is associated. We excluded patients with major respiratory failure. We found 16 patients (11 males; mean ± SD, age: 45 ± 13 yrs; body mass index (BMI): 44±11 kg/m2) with f > 25 min-1 during sleep (tachypneic group, T). We performed a one-for-one matching for sex, age and BMI between the T and a control (C) group (age: 45±12 yrs; BMI 44±10 kg/m2), with similar sleep disturbances but normal f during sleep. We compared the f in each vigilance state by averaging five measurements of f, each of one minute duration in a stable period. We observed that: C patients showed no significant change in f in any vigilance state; T patients showed a higher f already during wakefulness (p<0.05) and f increased significantly in all sleep stages (<0.01). We compared the two groups for many clinical and polysomnographic variables. Significant statistical differences were observed for: f, arterial C02 tension (PaC02), vital capacity (VC), forced expiratory volume at one second (FBV1) and pulse frequency (PF). Key words: breathing frequency, polysomnographic recording, sleep related respiratory disturbances. RESUMO Em adultos normais, a frequência respiratória (f) varia de 8 a 25 min-1 com grande reprodutividade intraindividual: durante o sono, f é quase invariável. Esta variável tem sido raramente referida em estudos de pacientes com problemas respiratórios associados ao sono (SRRD). A observação ocasional de espetacular aumento da f durante o sono em pacientes com SRRD', principalmente apnéias/hipopnéias associadas à desaturação da oxi-he-moglobina, nos levou a proceder a estudo retrospectivo de 650 exames consecutivos de polisso-nografia (PSG), com a finalidade de avaliar a frequência da ocorrência desta aceleração da f e dos prováveis fatores a ela associados. Foram excluidos deste estudo pacientes com insuficiência respiratória grave. Observamos a ocorrência deste fenômeno em 16 pacientes (11 homens com média de idade 45±13 anos, índice de massa corporal (BMI) 44±11 kg/m2) para os quais a f foi maior que 25 min-1 durante o sono (grupo de taquipnéicos, T). Realizamos comparação da f entre T e grupo controle (C) de pacientes de mesmo sexo e semelhantes idades (45±12 anos) e, BMI (44±10 kg/ni2) e SRKD, em cada estado de vigilância, fazendo média de 5 contagens da f, cada uma feita durante 1 minuto e durante um período estável do determinado estado de vigilância, Observamos que: os pacientes do grupo C não apresentaram alteração significativa da f em qualquer estado de vigilância; os pacientes do grupo T já tinham f maior que os pacientes do grupo C (p < 0.05) quando acordados e esta aumentou significativamente em todos os estados do sono (p< 0.01 f quando acordados vs f durante o sono, p < 0.001 T vs C durante o sono). Comparamos os dois grupos para vários parâmetros clínicos e polissonográficos. Diferença estatisticamente significante foi observada para os dados de: PaCO-2 (pressão arterial do C02), capacidade vital (VC), volume expiratório em 1 segundo (FEV1) e da frequência do pulso (PF) durante repouso (acordados) e durante o sono. Palavras-chave: frequência respiratória, registro polissonográfico, problemas respiratórios relacionados ao sono. Full text available only in PDF format. Texto completo disponível apenas em PDF. Acknowledgements — The author would like to thank director of the Sleep Laboratory at St. Luc training Hospital Prof. G Aubert and the Consultant Pneumologist of the same laboratory Prof. D. Rodenstein for their helpful remarks in the writing up of this study. Aceite: 11-setembro-1992. Dra. Márcia Pradella — Laboratoire de Sommeil, Hopital St. Luc — Avenue Hippocrate 10 — 1200 Brussels — Belgium. 1. Askanazi J, Silverberg P, Foster R, Hyman A, Milic-Emili J, Kinney J. Effects of respiratory apparatus on breathing pattern. J Appl Physiol 1980, 48:577-580. Effects of respiratory apparatus on breathing pattern J Appl Physiol 1980 577 580 48 Askanazi J Silverberg P Foster R Hyman A Milic-Emili J Kinney J 2. Aubert-Tulkens G, Rodenstein DO, Culée C, Stanescu DC Sleep apnea syndrome without apnea. In Chouard CH (ed): Chronic rhonchopathy. John Libbey Eurotext, 1988 p 152-156. Chronic rhonchopathy 1988 152 156 Aubert-Tulkens G Rodenstein DO Culée C Stanescu DC Chouard CH 3. Block AJ, Wynne JW, Boysen PG. Sleep-disordered breathing and nocturnal oxygen desaturation in post-menopausal women. Am J Med 1980, 69:75-79. Sleep-disordered breathing and nocturnal oxygen desaturation in post-menopausal women Am J Med 1980 75 79 69 Block AJ Wynne JW Boysen PG 4. Brownell LG, West P, Kriger MH. Breathing during sleep in normal pregnant women. Am Rev Respir Dis 1986, 133:38-41. Breathing during sleep in normal pregnant women Am Rev Respir Dis 1986 38 41 133 Brownell LG West P Kriger MH 5. Catterall JR, Calverley PMA, Shapiro CM, Flenley DC, Douglas NJ. Breathing and oxygenation during sleep are similar in normal men and normal women. Am Rev Respir Dis 1985, 132:86-88. Breathing and oxygenation during sleep are similar in normal men and normal women Am Rev Respir Dis 1985 86 88 132 Catterall JR Calverley PMA Shapiro CM Flenley DC Douglas NJ 6. Cherniack NS, von Euler C, Glogowska M, Homma I. Characteristics and rate of occurrence of spont and provoked augmented breaths. Acta Physiol Scand 1981, 111:349-360. Characteristics and rate of occurrence of spont and provoked augmented breaths Acta Physiol Scand 1981 349 360 111 Cherniack NS von Euler C Glogowska M Homma I 7. Cherniack NS. Respiratory dysrhythmias during sleep. N Engl J Med 1981, 305:325-330. Respiratory dysrhythmias during sleep N Engl J Med 1981 325 330 305 Cherniack NS 8. Chester C, Gottfried S, Cameron D, Strohl K. Pathophysiologic findings in a patient with Shy-Drager and alveolar hypoventilation syndromes. Chest 1988, 94:212-214. Pathophysiologic findings in a patient with Shy-Drager and alveolar hypoventilation syndromes Chest 1988 212 214 94 Chester C Gottfried S Cameron D Strohl K 9. Derderian S, Rajagopal K. Obesity, gender and sleep. Chest 1988, 93:900-901. Obesity, gender and sleep Chest 1988 900 901 93 Derderian S Rajagopal K 10. Douglas NJ, White DP, Picket CK, Weil JV, Zwillich CW. Respiration during sleep in normal man. Thorax 1982, 37:840-844. Respiration during sleep in normal man Thorax 1982 840 844 37 Douglas NJ White DP Picket CK Weil JV Zwillich CW 11. Douglas NJ. Control of breathing during sleep. Clin Sci 1984, 67:465-472. Control of breathing during sleep Clin Sci 1984 465 472 67 Douglas NJ 12. Duron B, Andrag C, Laval P. Ventilation pulmonaire globale C02 alvéolaire et consommation d'oxigène au cours du sommeil normal C R Soc Biol 1968, 162:139-145. Ventilation pulmonaire globale C02 alvéolaire et consommation d'oxigène au cours du sommeil normal C R Soc Biol 1968 139 145 162 Duron B Andrag C Laval P 13. Duron B. La fonction respiratoire pendant le sommeil physiologique. Bull Cur Physiopath Resp 1972, 8:1031-1057. La fonction respiratoire pendant le sommeil physiologique Bull Cur Physiopath Resp 1972 1031 1057 8 Duron B 14. Gould GA, Gugger M, Molloy J, et al. Breathing pattern and eye movement density during REM sleep in humans. Am Rev Respir Dis 1988, 138:874-877. Breathing pattern and eye movement density during REM sleep in humans Am Rev Respir Dis 1988 874 877 138 Gould GA Gugger M Molloy J 15. Guilleminault C, Tilkian A, Dement W. The sleep apnea syndromes. Annu Rev Med 1976, 27:465-484. The sleep apnea syndromes Annu Rev Med 1976 465 484 27 Guilleminault C Tilkian A Dement W 16. Guilleminault C. Obstructive Sleep Apnea Syndrome and its treatment in children: areas of agreement and controversy. Ped Pulm 1987, 3:429-436. Obstructive Sleep Apnea Syndrome and its treatment in children: areas of agreement and controversy Ped Pulm 1987 429 436 3 Guilleminault C 17. Guilleminault C. The role of sleep and sleep states on breathing disorders. Schw Med Wschr 1988, 118:1331-1332. The role of sleep and sleep states on breathing disorders Schw Med Wschr 1988 1331 1332 118 Guilleminault C 18. Haddad GG, Epstein RA, Epstein MA, Leistner HL, Marino PA, Mellins RB. Maturation of ventilation and ventilatory pattern in normal sleeping infants. J Appl Physiol 1979, 46:998-1002. Maturation of ventilation and ventilatory pattern in normal sleeping infants J Appl Physiol 1979 998 1002 46 Haddad GG Epstein RA Epstein MA Leistner HL Marino PA Mellins RB 19. Harman E, Wynne JW, Block AJ, Malloy-Fisher L. Sleep-disordered breathing and oxygen desaturation in obese patients. Chest 1981, 79:256-260. Sleep-disordered breathing and oxygen desaturation in obese patients Chest 1981 256 260 79 Harman E Wynne JW Block AJ Malloy-Fisher L 20. Hudgel DW, Martin RJ, Johnson B. Mechanics of the respiratory system and breathing pattern during sleep in normal humans. J Appl Physiol 1984, 56:133-137. Mechanics of the respiratory system and breathing pattern during sleep in normal humans J Appl Physiol 1984 133 137 56 Hudgel DW Martin RJ Johnson B 21. Kenyon GS, Apps MCP, Traub M. Stridor and obstructive sleep apnea in Shy-Drager syndrome treated by laryngofissure and cord lateralization. Laryngoscope 1984, 94:1106-1102. Stridor and obstructive sleep apnea in Shy-Drager syndrome treated by laryngofissure and cord lateralization Laryngoscope 1984 1106 1102 94 Kenyon GS Apps MCP Traub M 22. Kimura H, Tatsumi K, Kuriyama T, Sugita T, Watanabe S, Nishibayashi Y. Effect of chlormadinone acetate a synthetic progesterone on restoring impaired load compensation in chronic obstructive pulmonary disease. Tohoku J Exp Med 1986, 149:119-132. Effect of chlormadinone acetate a synthetic progesterone on restoring impaired load compensation in chronic obstructive pulmonary disease Tohoku J Exp Med 1986 119 132 149 Kimura H Tatsumi K Kuriyama T Sugita T Watanabe S Nishibayashi Y 23. Kopelman PG, Apps MCP, Cope T, Ingram DA, Empey DW, Evans SJ. Nocturnal hypoxia and sleep apnoea in asymptomatic obese men. Int J Obes 1986, 10:211-217. Nocturnal hypoxia and sleep apnoea in asymptomatic obese men Int J Obes 1986 211 217 10 Kopelman PG Apps MCP Cope T Ingram DA Empey DW Evans SJ 24. Krieger J, Turlot JC, Mangin P, Kurtz D. Breathing during sleep in normal young and elderly subjects: hypopneas, apenas and correlated factors. Sleep 1983, 6:108-120. Breathing during sleep in normal young and elderly subjects: hypopneas, apenas and correlated factors Sleep 1983 108 120 6 Krieger J Turlot JC Mangin P Kurtz D 25. Krieger J. Breathing during sleep in normal subject. Clin Chest Med 1985, 6:577-594. Breathing during sleep in normal subject Clin Chest Med 1985 577 594 6 Krieger J 26. Krieger J, Maglasiu N, Sforza E, Kurtz D. Breathing during sleep in normal middle-age subject. Sleep 1990, 13:143-154. Breathing during sleep in normal middle-age subject Sleep 1990 143 154 13 Krieger J Maglasiu N Sforza E Kurtz D 27. Kunitomo F, Kimura H, Tatsumi K, Kuriyama T, Watanabe S, Honda Y. Sex differences in awake ventilatory drive and abnormal breathing during sleep in eucapnic obesity. Chest 1988, 93:968-976. Sex differences in awake ventilatory drive and abnormal breathing during sleep in eucapnic obesity Chest 1988 968 976 93 Kunitomo F Kimura H Tatsumi K Kuriyama T Watanabe S Honda Y 28. Longobardo G, Cherniack N, Gothe B. Factors affecting respiratory system stability. Ann Bioeng 1989, 17:377-396. Factors affecting respiratory system stability Ann Bioeng 1989 377 396 17 Longobardo G Cherniack N Gothe B 29. Lugaresi E, Cirignotta F, Mondini S, Montagna P, Zucconi M. Sleep-related respiratory disorders. Ital J Neurol Sci 1985, 6:389-399. Sleep-related respiratory disorders Ital J Neurol Sci 1985 389 399 6 Lugaresi E Cirignotta F Mondini S Montagna P Zucconi M 30. Mallory G, Fiser D, Jackson R. Sleep-associated breathing disorders in morbidly obese children and adolescents. J Pediatr 1989, 115:829-897. Sleep-associated breathing disorders in morbidly obese children and adolescents J Pediatr 1989 829 897 115 Mallory G Fiser D Jackson R 31. Naifeh KH, Kamiya J. The nature of respiratory changes associated with sleep onset. Sleep 1981, 4:49-59. The nature of respiratory changes associated with sleep onset Sleep 1981 49 59 4 Naifeh KH Kamiya J 32. Phillipson EA. Control of breathing during sleep. Am Rev Respir Dis 1978. 118:909-939. Control of breathing during sleep Am Rev Respir Dis 1978 909 939 118 Phillipson EA 33. Phillipson E, Duffin J, Cooper J. Critical dependence of respiratory rhythmicity on metabolic C02 load. J Appl Physiol 1981, 50:45-54. Critical dependence of respiratory rhythmicity on metabolic C02 load J Appl Physiol 1981 45 54 50 Phillipson E Duffin J Cooper J 34. Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: UCLA, 1968. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects 1968 Rechtschaffen A Kales A 35. Shea SA, Walter J, Murphy K, Guz A. Evidence for individuality of breathing patterns in resting healthy man. Resp Physiol 1987, 68:331-344. Evidence for individuality of breathing patterns in resting healthy man Resp Physiol 1987 331 344 68 Shea SA Walter J Murphy K Guz A 36. Shea SA, Horner RL, Banner NR, McKenzie E, Heaton R, Yacoub MH, Guz A. The effect of human heart-lung transplantation upon breathing at rest and during sleep. Respir Physiol 1988, 72:131-149. The effect of human heart-lung transplantation upon breathing at rest and during sleep Respir Physiol 1988 131 149 72 Shea SA Horner RL Banner NR McKenzie E Heaton R Yacoub MH Guz A 37. Shore ET, Millman RP, Silage DA, Chung DCC, Pack AI. Ventilatory and arousal patterns during sleep in normal young and elderly subject. J Appl Physiol 1985, 59:1607-1615. Ventilatory and arousal patterns during sleep in normal young and elderly subject J Appl Physiol 1985 1607 1615 59 Shore ET Millman RP Silage DA Chung DCC Pack AI 38. Stradling JR, Chadwick GA, Frew AJ. Changes in ventilation and its components in normal subjects during sleep. Thorax 1985, 40:364-370. Changes in ventilation and its components in normal subjects during sleep Thorax 1985 364 370 40 Stradling JR Chadwick GA Frew AJ 39. Sullivan C, Kozar L, Murphy E, Phillipson E. Primary role of respiratory afferents in sustaining breathing rhythm. J Appl Physiol 1978, 45:11-17. Primary role of respiratory afferents in sustaining breathing rhythm J Appl Physiol 1978 11 17 45 Sullivan C Kozar L Murphy E Phillipson E 40. Sullivan CE, Issa FG. Pathophysiological mechanisms in obstructive sleep apnea. Sleep 1980, 3:235-246. Pathophysiological mechanisms in obstructive sleep apnea Sleep 1980 235 246 3 Sullivan CE Issa FG 41. Tabachnik E, Muller NL, Bryan AC, Levison H. Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Physiol 1981, 51:557-564. Changes in ventilation and chest wall mechanics during sleep in normal adolescents J Appl Physiol 1981 557 564 51 Tabachnik E Muller NL Bryan AC Levison H 42. Tobin M, Chadha T, Jenouri G, Birch S, Gazeroglu H, Sackner M. Breathing patterns: diseased subjects.. Chest 1983, 84:286-294. Breathing patterns: diseased subjects. Chest 1983 286 294 84 Tobin M Chadha T Jenouri G Birch S Gazeroglu H Sackner M 43. Vibert JF, Foutz AS, Caille D, Hugelin A. Respiratory rhythm multistability during sleep-wake states. Brain Res 1988, 448:403-405. Respiratory rhythm multistability during sleep-wake states Brain Res 1988 403 405 448 Vibert JF Foutz AS Caille D Hugelin A 44. Webb P. Periodic breathing during sleep. J Appl Psysiol 1974, 37:899-903. Periodic breathing during sleep J Appl Psysiol 1974 899 903 37 Webb P 45. White DP, Weil JV, Zwillich CW. Metabolic rate and breathing during sleep. J Appl Physiol 1985, 59:384-391. Metabolic rate and breathing during sleep J Appl Physiol 1985 384 391 59 White DP Weil JV Zwillich CW 46. Wittels E. Obesity and hormonal factors in sleep and sleep apnea. Med Clin North Am 1985. 69:1265-1280. Obesity and hormonal factors in sleep and sleep apnea Med Clin North Am 1985 1265 1280 69 Wittels E