• Djamel Bensmail, Adélaïde Marquer, Nicolas Roche, Anne-Laure Godard, Frédéric Lofaso, and Maria-Antonia Quera-Salva.
• Department of Physical Medicine and Rehabilitation, R. Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, Garches, France. djamel.bensmail@rpc.aphp.fr
• Arch Phys Med Rehabil. 2012 Jan 1;93(1):96-9.

ObjectiveTo assess the impact of intrathecal baclofen (ITB) mode of administration on sleep and sleep-related breathing events in severely disabled patients with severe spasticity.DesignOpen prospective trial.SettingPhysical medicine and rehabilitation department.ParticipantsPatients (N=11) treated with ITB pump for severe spasticity.InterventionAssessment of patients' sleep before and after ITB pump implantation, and comparison of polysomnography results after continuous or bolus mode of administration of ITB.Main Outcome MeasuresPolysomnography and sleep-related breathing events.ResultsITB reduced periodic limb movements and increased the respiratory disturbance index (RDI) and central apneas in our population of patients. This study showed that ITB mode of administration may affect sleep-disordered breathing. Indeed, we observed a significant increase of respiratory events in the bolus condition (RDI and central apneas). In contrast, continuous infusion did not induce a significant modification of sleep-disordered breathing. When a sleep apnea syndrome was preexisting, it was generally severely worsened by the bolus mode of administration.ConclusionsThese results indicate that sleep function and sleep-related respiratory events should be assessed before ITB pump implantation. It is probably better to use a continuous mode of infusion if patients have preexisting sleep-disordered breathing.Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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