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The sleep characteristics in symptomatic patients with Duchenne muscular dystrophy

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Abstract

Background

Duchenne muscular dystrophy (DMD) causes serious health consequences that include impairment of the respiratory system and sleep. The aim of our study is to investigate the sleep architecture and respiratory profile during sleep of symptomatic patients with DMD without ventilatory support.

Methods

We evaluated polysomnography (PSG) of boys with DMD (n = 44) and a control group (n = 79) with sleep complaints that was matched in age but without neuromuscular disease.

Results

DMD patients presented sleep impairments when compared with the control group in terms of decreased sleep efficiency (72.4 ± 1.9 vs 80.3 ± 1.4 %, P = 0.002) and increased apnea-hypopnea index (AHI) during nonrapid eye movement (NREM) sleep (1.6 ± 0.3 vs 0.3 ± 0.2/h, P = 0.003). The main changes were observed during rapid eye movement (REM) sleep: an increase in REM sleep latency (202.2 ± 11.8 vs 152.3 ± 8.6 min, P < 0.001), a reduced percentage of REM sleep (13.1 ± 0.9 vs 17.9 ± 0.7 %, P = 0.001), and exacerbation of AHI (8.7 ± 1.5 vs 1.0 ± 1.1 events/h, P = 0.001). There was an increase in the total number of apneas, especially obstructive apneas (6.8 ± 1.9 vs 0.8 ± 1.3, P = 0.013).

Conclusions

The sleep and respiratory profile during sleep of patients with DMD are compromised. The results suggest that these changes reflect the muscle weakness inherent in DMD and are demonstrated mainly during REM sleep. Thus, the use of PSG is important to identify sleep-disordered breathing at an early stage, before deciding when to introduce noninvasive respiratory support for prevention of respiratory complications.

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Abbreviations

AHI:

Apnea-hypopnea index

BMI:

Body mass index

DMD:

Duchenne muscular dystrophy

EEG:

Electroencephalogram

NREM:

Nonrapid eye movement

OSAS:

Obstructive sleep apnea syndrome

PSG:

Polysomnography

REM:

Rapid eye movement

SDB:

Sleep-disordered breathing

SpO2 :

Oxygen saturation

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Acknowledgments

This work was supported by grants from Associação Fundo de Incentivo a Pesquisa (AFIP), the São Paulo Research Foundation (FAPESP grant #14/08067-0 to KTN), and CNPq. MLA and ST are recipients of the CNPq fellowship.

Conflict of interest

Neither of the authors have any conflict of interest to disclose. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

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Authors and Affiliations

  1. Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil

    Karen Tieme Nozoe, Gustavo Antônio Moreira, José Rodolfo Corradini Tolino, Márcia Pradella-Hallinan, Sergio Tufik & Monica Levy Andersen

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  1. Karen Tieme Nozoe
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  2. Gustavo Antônio Moreira
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  3. José Rodolfo Corradini Tolino
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  4. Márcia Pradella-Hallinan
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  5. Sergio Tufik
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  6. Monica Levy Andersen
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Corresponding author

Correspondence to Monica Levy Andersen.

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Nozoe, K.T., Moreira, G.A., Tolino, J.R.C. et al. The sleep characteristics in symptomatic patients with Duchenne muscular dystrophy. Sleep Breath 19, 1051–1056 (2015). https://doi.org/10.1007/s11325-014-1103-9

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  • DOI: https://doi.org/10.1007/s11325-014-1103-9

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