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Respiratory muscle activity during REM sleep in patients with diaphragm paralysis

From the National Heart and Lung Institute (J.R. Bennett, H.M.A. Dunroy, and N. Hart, and Drs. Corfield and Morrell), Imperial College School of Medicine; and Sleep and Ventilation Unit (Drs. Simonds, Polkey, and Morrell), Royal Brompton Hospital, London, UK.

Address correspondence and reprint requests to Dr. M.I. Polkey, Sleep and Ventilation Unit, Royal Brompton Hospital (South Block), Fulham Road, London SW3 6NP, UK; e-mail: m.polkey{at}rbh.nthames.nhs.uk

The diaphragm is the main inspiratory muscle during REM sleep. It was hypothesized that patients with isolated bilateral diaphragm paralysis (BDP) might not be able to sustain REM sleep. Polysomnography with EMG recordings was undertaken from accessory respiratory muscles in patients with BDP and normal subjects. Patients with BDP had a normal quantity of REM sleep (mean ± SD, 18.6 ± 7.5% of total sleep time) achieved by inspiratory recruitment of extradiaphragmatic muscles in both tonic and phasic REM, suggesting brainstem reorganization.

Received January 29, 2003. Accepted in final form August 27, 2003.