Sleep quality may be very poor in postpolio patients and the poor sleep quality may be related to abnormal breathing during sleep. Because of the effect of polio on respiratory control and respiratory function, the variability in these results was not unexpected. Somewhat unexpected was the fact that several of the patients who were receiving mechanical ventilatory assistance (rocking beds) were clearly not being optimally treated. In two patients on rocking beds, there was paradoxic rib cage abdominal breathing. In two patients, there was the desynchronization of respirations with the patient attempting a breath between breaths generated by the bed, at times leading to upper airway obstruction likely secondary to desynchronization between the patients upper airway and the rocking bed. The fact that they had been apparently stable for so long led to a false impression of the stability of their ventilatory status. buy ortho tri-cyclen
Patients with remote poliomyelitis who are not currently on mechanical ventilation should be assessed for a sleep disorder, particularly hypoventilation and/or obstructive apnea if clinically they have developed some of the daytime features suggestive of sleep respiratory abnormalities. These features include excessive daytime sleepiness, disrupted sleep, snoring, and the unexplained development of peripheral edema and/or polycythemia.