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Am J Respir Crit Care Med. 2019 Oct 23. doi: 10.1164/rccm.201907-1312OC. [Epub ahead of print]

Abnormal Activity of Neck Inspiratory Muscle During Sleep as a Prognostic Indicator in COPD.

Author information

1
Sorbonne Université, 27063, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France.
2
AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pathologies du Sommeil (Département R3S), F-75013 Paris, France; stefania.redolfi@aphp.fr.
3
AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France.
4
Sorbonne Universite, 27063, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France.
5
ESPCI Paris, 52883, Equipe de Statistique Appliquée, PSL Research University, Paris, France.
6
CNRS-UMR 7225, Hôpital Pitié-Salpetrière, Paris, France.
7
Sorbonne Universite, 27063, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France.
8
AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pathologies du Sommeil (Département R3S), F-75013 Paris, France.

Abstract

RATIONALE:

In patients with chronic obstructive pulmonary disease (COPD), increased activity of neck inspiratory muscles has been reported as a compensatory response to hyperinflation-related diaphragmatic dysfunction. The persistence of this activity during sleep could attenuate sleep-related hypoventilation, but also negatively impact sleep and clinical outcomes.

OBJECTIVES:

To assess the persistence of neck muscle activity during sleep in COPD patients recovering from severe exacerbations (i.e. requiring hospitalization), and its impact on sleep quality and recurrence of exacerbation.

METHODS:

Video-polysomnography with neck muscles electromyogram was performed in COPD patients recovering from severe exacerbation. The follow-up period lasted 6 months to record the next severe exacerbation.

RESULTS:

Twenty-six out of 29 patients included (median [25th-75th] age of 71 [64-72] years, 55% male, body mass index of 24 [21-29], % predicted forced expiratory volume in the first second of expiration of 37 [29-45], and BODE index 6 [5-7]), exhibited sleep-related neck muscles activity, which was intermittent (limited to N3 sleep) in 17 and permanent throughout sleep in 9. Alpha-delta electroencephalographic activity during N3 sleep was observed in 87% of patients. Compared to patients with no or intermittent neck muscle activity, those with permanent neck muscle activity showed more disrupted sleep, had experienced more exacerbations in the previous year, and suffered their next severe exacerbation earlier.

CONCLUSIONS:

Sleep-related neck muscle activity during sleep is frequent in COPD patients recovering from severe exacerbation and seems to negatively affect sleep quality and prognosis, thus its identification might improve COPD management after severe exacerbation.

KEYWORDS:

chronic obstructive pulmonary disease; exacerbation; neck inspiratory muscles; sleep

PMID:
31644879
DOI:
10.1164/rccm.201907-1312OC

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