Chest
Volume 79, Issue 6, June 1981, Pages 626-630
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Severe Kyphoscoliosis, Breathing, and Sleep: The “Quasimodo” Syndrome During Sleep

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Five adult subjects with severe kyphoscoliosis were monitored during sleep. Several types of breathing abnormalities, including obstructive apnea and hypopnea, were noted. The lowest oxygen desaturations occurred during rapid eye movement (REM) sleep. Arterial pressure, continuously measured in one subject, progressively increased throughout the night in association with abnormal breathing. The use of a cuirass ventilator did not improve the nocturnal problem.

Section snippets

Patient Population

The five patients were all adult men with a mean age of 51 years (range, 43 to 62, Table 1). Their mean weight was 65.6 kg (range 57 to 71), and all were within 5 percent of their ideal weight corrected for age. Two patients (1 and 4) were seen for a complaint of severe daytime sleepiness, and one patient (3) complained of disrupted nocturnal sleep with feelings of tiredness the following day (disorder of maintaining sleep).2 One patient (2) was referred for possible obstructive apnea during

RESULTS

The results of the initial screening polysomnographic studies are presented in Table 2. All patients had apneic events during sleep that were associated with oxygen desaturation. However, the number and type of apneas and amount of desaturation varied in each case. During sleep, all patients presented evidence of apnea and sleep-related hypopnea. Hypopnea has been defined as a decrease in abdominal and thoracic movements, decreased air flow, and a fall in oxygen saturation; when endoesophageal

COMMENT

Patients with severe thoracic deformation are known to have varying degrees of pulmonary disability. A recent review by Bergofsky1 outlined the impact of severe kyphoscoliosis on breathing during wakefulness. As of now, little attention has been given to the effect of kyphoscoliosis on sleep and sleep states in these patients. It is reasonable to suggest that the supine position may well have an impact on the respiratory function of these patients whose upright pulmonary function tests are

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This research was supported in part by Public Health Service Research Grant R.R.-70 from the General Clinical Research Centers, Division of Research Resources; and by INSERM to CG.

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