Diaphragmatic dysfunction at the first visit to a chest diseases outpatient clinic in 500 patients with amyotrophic lateral sclerosis

医学 仰卧位 低氧血症 多导睡眠图 肌萎缩侧索硬化 膈式呼吸 麻醉 门诊部 通风(建筑) 肺活量 心脏病学 内科学 呼吸暂停 疾病 病理 扩散能力 替代医学 工程类 机械工程 肺功能
作者
Aylin Pıhtılı,Züleyha Bingöl,Hacer Durmuş,Yeşim Parman,Esen Kıyan
出处
期刊:Muscle & Nerve [Wiley]
卷期号:63 (5): 683-689 被引量:3
标识
DOI:10.1002/mus.27200
摘要

Abstract Introduction In this study, we aimed to evaluate diaphragmatic dysfunction (DD) by using a practical approach in patients with amyotrophic lateral sclerosis (ALS) at the first visit to a chest diseases outpatient clinic. Methods Patients with ALS seen in our outpatient clinic for the past 5 y and followed up for at least 1 y, were retrospectively evaluated. Having at least one of the following three criteria was accepted as DD: (a) paradoxical abdominal movement (PAM), (b) sitting‐supine forced vital capacity (FVC) difference ≥ 20%, (c) sitting‐supine arterial oxygen saturation measured by pulse oximetry (SpO 2 ) difference ≥ 4%. Respiratory symptoms, arterial blood gas analysis, sleep studies, noninvasive mechanical ventilation use, and mortality were recorded. Results Five‐hundred patients with ALS were included (female/male: 220/280, age: 58.9 ± 11.3 y). Of the patients, 22.8% had daytime hypercapnia. DD was observed in 55% of the patients (PAM in 112, sitting‐supine FVC difference ≥ 20% in 50, and sitting‐supine SpO 2 difference ≥ 4% in 113 patients). Of the patients with DD, 31.6% (n = 87) had no respiratory symptoms, 46.4% had FVC > 70% and 33.5% had FVC <50%. Nocturnal hypoxemia (sleep time spent with SpO 2 < 90% ≥30%) was present in 59.7%, and all patients with nocturnal hypoxemia had DD. Obstructive sleep apnea (8 severe, 14 moderate, 39 mild) was detected in 55% of the patients with polysomnography (n = 61) or polygraphy (n = 50). During follow‐up, 52.2% of the patients died. Mean survival time was shorter in patients with DD ( P < .001). Conclusion Paradoxical abdomimal movement (PAM), sitting‐supine SpO 2 difference ≥ 4% and sitting‐supine FVC difference ≥ 20% are indicators of DD, which should be routinely evaluated at every outpatient visit.
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