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Asynchronous breathing during sleep
  1. J Kohyama,
  2. T Shiiki,
  3. M Shimohira,
  4. T Hasegawa
  1. Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo 113-8519, Japan
  1. Dr Kohyamajkohyama.ped{at}


BACKGROUND Children rarely complain of symptoms associated with sleep disordered breathing (SDB). Paradoxical inward rib cage movement (PIRCM) during sleep might prove useful for detecting SDB.

AIMS (1) To determine the correlation between the degree of PIRCM and other measures of disordered breathing during sleep. PIRCM occurs physiologically throughout rapid eye movement sleep in neonates, while no PIRCM has been reported during sleep in adolescents. (2) To determine the chronological changes in the degree of PIRCM.

METHODS PIRCM was quantified by means of the laboured breathing index (LBI). LBI was determined by respiratory inductive plethysmography; PIRCM accompanies a high LBI. Sleep recordings obtained for 101 subjects for various reasons (aged from 3.5 months to 19 years) were analysed.

RESULTS In 22 records, the minimum Sao2 value was 90% or more and no obstructive apnoea of more than 10 seconds was observed. In these 22 records, LBI during rapid eye movement sleep decreased significantly with age, reaching the mature low level at 3.3 years of age. In the other 79 records, LBI correlated well with measures of obstructed breathing during sleep.

CONCLUSIONS By paying more attention to PIRCM, more obstructed breathing during sleep might be found among children aged 3 years or more.

  • asynchronous breathing
  • sleep disordered breathing
  • obstructive sleep apnoea
  • laboured breathing index

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