Sleep-related breathing disorders associated with intrathecal baclofen therapy to treat patients with cerebral palsy: A cohort study and discussion

Article type: Research Article

Authors: Mohon, Ricky T.^{a; *} | Sawyer, Kim^b | Pickett, Kaci^c | Bothwell, Samantha^c | Brinton, John T.^d | Sobremonte-King, Michelle^e | DelRosso, Lourdes M.^e

Affiliations: [a] Children’s Hospital Colorado and Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA | [b] Children’s Hospital Colorado, Department of Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA | [c] Colorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA | [d] Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA | [e] Seattle Children’s Hospital and Division of Pulmonary and Sleep Medicine, University of Washington, Seattle, WA, USA

Correspondence: [*] Address for correspondence: Ricky T. Mohon, M.D., Professor of Clinical Pediatrics, Director of Sleep Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, B395, Aurora, CO 80045, USA. Tel.: +1 720 777 6181; Fax: +1720 777 7283; E-mail: ricky.mohon@childrenscolorado.org.

Abstract: BACKGROUND: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.

Keywords: Cerebral palsy, static encephalopathies, gross motor function classification system, GMFCS, nocturnal polysomnography, NPSG, Baclofen, intrathecal Baclofen, ITB, obstructive sleep apnea, OSA, central sleep apnea, CSA, periodic breathing, PB, sleep-related hypoxemia and hypoventilation

DOI: 10.3233/NRE-210012

Journal: NeuroRehabilitation, vol. 48, no. 4, pp. 481-491, 2021