Patients with cerebral palsy and other static encephalopathies (CP) are known to be at increased risk of sleep-related breathing disorders (SRBD). Few studies have reviewed whether intrathecal baclofen (ITB) can contribute to SRBD.
OBJECTIVE:
To assess the prevalence of SRBD in patients with CP receiving ITB by using nocturnal polysomnography (NPSG).
METHODS:
We performed a retrospective chart review of patients receiving ITB who had NPSG at Children’s Hospital Colorado (CHCO) and Seattle Children’s Hospital (SCH) from 1995 to 2019. The Gross Motor Function Classification System (GMFCS) measured the severity of motor disability. Screening sleep questionnaires collected subjective data and NPSG provided objective data of SRBD.
RESULTS:
All patients except one were GMFCS 4 or 5 with median age at ITB pump placement of 9.7 years. The screening questionnaire for SRBD detected one or more nighttime symptoms in > 82% of all patient groups. Pre-ITB criteria for a SRBD was met in 83% of patients at CHCO and 91% at SCH. Post-ITB prevalence remained similarly high.
CONCLUSIONS:
NPSG identified a high prevalence of SRBD in these cohorts from CHCO and SCH. Our study showed neither improvement nor worsening of SRBD in patients receiving ITB.
American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd edDarien, IL: American Academy of Sleep Medicine, 2014.
3.
Bensmail,D., Marquer,A., Roche,N., Godard,A-L., Lofaso,F., & Quera-Salva,M-A. (2012). Pilot study assessing the impact of intrathecal baclofen administration mode on sleep-related respiratory parameters. Archives of Physical Medicine and Rehabilitation, 93(1), 96–99.
4.
Bensmail,D., Quera-Salva,M. A., Roche,N., BenyahiaS., Bohic,M., Denys,P., Bussel,B., & Lofaso,F. (2006). Effect of intrathecal baclofen on sleep and respiratory function in patients with spasticity. Neurology, 67(8), 1432–1436.
5.
Berry,R. B., Quan,S. F., Abreu,A. R., et al.: for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.6. Darien, IL: American Academy of Sleep Medicine, 2020.
6.
BuizerA. I., MartensB. H. M., Grandbois van RavenhorstC., SchoonmadeL. J., BecherJ. G., & VermeulenR. J. (2019). Effect of continuous intrathecal baclofen therapy in children: a systematic review. Developmental Medicine and Child Neurology, 61(2), 128–134.
7.
Davidoff,R. A. (1985). Antispasticity drugs: mechanisms of action. Annals of Neurology, 17(2), 107–116.
8.
Derrick,B., Dobson-Mckittrick,A., Toher,D., & White,P. (2015). Test statistics for comparing two proportions with partially overlapping samples. Journal of Applied Quantitative Methods, 10(3), 1–14.
9.
Derrick,B., Russ,B., Toher,D., & White,P. (2017). Test statistics for the comparison of means for two samples which include both paired observations and independent observations, Journal of Modern Applied Statistical Methods, 16(1), 137–157.
10.
Derrick,B. (2018). Partiallyoverlapping: Partially Overlapping Samples Tests. R package version 3.1.3.
11.
Grote,L. (2018). Drug-induced sleep-disordered breathing and ventilatory impairment. Sleep Medicine Clinics, 13(2), 161–168.
12.
Grychtol,R., & Chan,E. Y. (2018). Use of non-invasive ventilation in cerebral palsy. Archives of Disease in Childhood, 103(12), 1170–1177.
13.
Harris,P. A., Taylor,R., Thielke,R., Payne,J., Gonzalez,N., & Conde,J. G. (2009). Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381.
14.
Hasnat,M. J., & Rice,J. E. (2015). Intrathecal baclofen for treating spasticity in children with cerebral palsy. Cochrane Database of Systematic Reviews, (11), CD004552, doi: 10.1002/14651858.CD004552.pub2.
15.
Horwood,L., Li,P., Mok,E., Oskoui,M., Shevell,M., & Constantin,E. (2019). Behavioral difficulties, sleep problems, and nighttime pain in children with cerebral palsy. Research in Developmental Disabilities, 95, 103500.
16.
Horwood,L., Li,P., Mok,E., Shevell,M., & Constantin,E. (2019). A systematic review and meta-analysis of the prevalence of sleep problems in children with cerebral palsy: how do children with cerebral palsy differ from each other and from typically developing children?Sleep Health, 5(6), 555–571.
17.
Koyuncu,E., Türkkani,M. H., Sarikaya,F. G., & Özgirgin,N. (2017). Sleep disordered breathing in children with cerebral palsy. Sleep Medicine, 30, 146–150.
18.
Krach,L. E. (2001). Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. Journal of Child Neurology, 16(1), 31–36.
19.
Krach,L. E. (2009). Intrathecal baclofen use in adults with cerebral palsy. Developmental Medicine & Child Neurology, 51, 106–112.
20.
Lake,W., & Shah,H. (2019). Intrathecal baclofen infusion for the treatment of movement disorders. Neurosurgery Clinics of North America, 30(2), 203–209.
21.
Locatelli,F., Formica,F., Galbiati,S., Avantaggiato,P., Beretta,E., Carnovale,C., Pozzi,M., Clementi,E., & Strazzer,S. (2019). Polysomnographic analysis of a pediatric case of baclofen-induced central sleep apnea. Journal of Clinical Sleep Medicine, 15(2), 351–354.
22.
Mohon,R. T., Khan,E., & DelRosso,L. M. (2020). Increasingly familiar breathing pattern in an unfamiliar population: sleep-related breathing disorder in high-risk patients. Annals of the American Thoracic Society, 17(7), 895–898.
23.
Newman,C. J., O’Regan,M., & Hensey,O. (2006). Sleep disorders in children with cerebral palsy. Developmental Medicine & Child Neurology, 48(7), 564–568.
24.
Olivier,P. Y., Joyeux-Faure,M., Gentina,T., Launois,S. H., d’Ortho,M. P., Pepin,J. L., & Gagnadoux,F. (2016). Severe central sleep apnea associated with chronic baclofen therapy: a case series. Chest, 149(5), e127–131.
25.
Palisano,R. J., Avery,L., Gorter,J. W., Galuppi,B., & McCoy,S. W. (2018). Stability of the gross motor function classification system, manual ability classification system, and communication function classification system. Developmental Medicine & Child Neurology, 60(10), 1026–1032.
26.
Robinson,S., Robertson,F. C., Dasenbrock,H. H., O’Brien,C. P., Berde,C., & Padua,H. (2017). Image-guided intrathecal baclofen pump catheter implantation: a technical note and case series. Journal of Neurosurgery Spine, 26(5), 621–627.
Sandella,D. E., O’Brien,L. M., Shank,L. K., & Warschausky,S. A. (2011). Sleep and quality of life in children with cerebral palsy. Sleep Medicine, 12(3), 252–256.
