POSTPOLIO SEQUELAE AND SLEEP-RELATED DISORDERED BREATHING

Objective: 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). Materi al and Methods: We retrospectively reviewed the medical records of 108 consecutive patients with PPS and sleep disturbances encountered duri ng an Ii-pear period at Mayo Clinic Rochester and abstracted the featu res of acute polio, PPS, and results of sleep evaluation (overnight ox imetry or polysomnography). Only those patients who were not receiving ventilatory support were included in the study. Results: The features of PPS were dyspnea, fatigue, new weakness, and musculoskeletal pain. Of the 108 patients, 35 fulfilled the inclusion criteria. Sleep evalu ations 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 t he mean arterial carbon dioxide tension was 39, 60, and 55 mm Hg in th ese respective study groups (P<0.05). The overall mean age at onset of symptoms of SRDB was 37 years, and the mean latent period after acute polio was 37 years. Hypersomnolence was the commonest SRDB symptom, p resent in 32 of the 35 patients. Snoring was noted in 100 degrees% of patients in group O, 0% in group H, and 67% in group OH. Patients in g roup O were obese and had normal lung function. Patients in group H te nded to have normal weights and a history of diffuse neurologic defici ts involving the trunk during the acute episode of polio. Scoliosis, r estricted lung function, cor pulmonale, and decreased maximal respirat ory pressures were common in patients in group H. Patients in group OH had overlapping features of those in groups O and H. Conclusion: In p atients with PPS, we identified three patterns of sleep disturbance-ob structive sleep apnea, hypoventilation, and a combination of both. The se groups are characterized by clinical features and by results of art erial blood gas determinations, overnight oximetry, and polysomnograph y. SRDB is a late sequela of poliomyelitis, and clinical evaluation sh ould include information about sleep.