ABSTRACT
AIM: To evaluate the contribution of somatosensory evoked potentials after median nerve (MN-SEPs) and posterior tibial nerve (PTN-SEPs) stimulation in functional assessment of cervical and lumbar spinal stenosis in children with achondroplasia. METHOD: We reviewed MN-SEPs, PTN-SEPs, and spinal magnetic resonance imaging (MRI) examinations performed in 58 patients with achondroplasia (25 males, 33 females; age range 21d-16y 10mo; mean age 4y 3mo [SD 4y 1mo]). Patients were subdivided into four age categories: <2 years, between 2 to 4 years, between 4 to 8 years, and ≥8 years. The peak latency of P37 for PTN-SEPs, the peak latencies of N11, N13, P14, and N20, and the N13-N20 interpeak latency (IPL) for MN-SEPs were collected; the diagnostic accuracy measures of these parameters (analysis of receiver operating characteristic [ROC] curves) with respect to the presence of foramen magnum or lumbar spinal stenosis were analysed in each age category. RESULTS: The ROC curve analysis showed that the most sensitive parameter in detecting the presence of foramen magnum stenosis was P37 latency in the first two age categories (<2y and ≥2-4y; sensitivity 0.63, specificity 1.00, and sensitivity 1.00, specificity 0.75 respectively). In the third age category (≥4-8y), the most sensitive parameter in detecting the presence of foramen magnum stenosis was IPLs N13-N20 (sensitivity 0.73, specificity 0.87), whereas in the last age category (≥8y), the most important parameter was N20 latency (sensitivity 0.75, specificity 0.77). INTERPRETATION: In children with achondroplasia, the cortical component of PTN-SEPs is more sensitive than the cortical component and central conduction time of MN-SEPs in detection of cervical spinal cord compression at early ages.
Subject(s)
Achondroplasia/complications , Constriction, Pathologic/complications , Constriction, Pathologic/pathology , Evoked Potentials, Somatosensory/physiology , Foramen Magnum/pathology , Achondroplasia/diagnostic imaging , Adolescent , Age Factors , Child , Child, Preschool , Constriction, Pathologic/diagnostic imaging , Electric Stimulation , Female , Foramen Magnum/diagnostic imaging , Humans , Infant , Magnetic Resonance Imaging , Male , ROC Curve , Reaction Time/physiology , Spinal Cord/diagnostic imaging , Tibial Nerve/physiopathologyABSTRACT
BACKGROUND: Recent research has found evidence of an association between motor vehicle accidents (MVAs) or near miss accidents (NMAs), and excessive daytime sleepiness (EDS) or its main medical cause, Obstructive Sleep Apnea (OSA). However, EDS can also be due to non-medical factors, such as sleep debt (SD), which is common among professional truck drivers. On the opposite side, rest breaks and naps are known to protect against accidents. STUDY OBJECTIVES: To investigate the association of OSA, SD, EDS, rest breaks and naps, with the occurrence of MVAs and NMAs in a large sample of truck drivers. METHODS: 949 male truck drivers took part in a cross-sectional medical examination and were asked to complete a questionnaire about sleep and waking habits, risk factors for OSA and EDS. RESULTS: MVAs and NMAs were reported by 34.8% and 9.2% of participants, respectively. MVAs were significantly predicted by OSA (OR = 2.32 CI95% = 1.68-3.20), SD (OR = 1.45 CI95% = 1.29-1.63), EDS (OR = 1.73 CI95% = 1.15-2.61) and prevented by naps (OR = 0.59 CI95% = 0.44-0.79) or rest breaks (OR = 0.63 CI95% = 0.45-0.89). NMAs were significantly predicted by OSA (OR = 2.39 CI95% = 1.47-3.87) and SD (OR = 1.49 CI95% = 1.27-1.76) and prevented by naps (OR = 0.52 CI95% = 0.32-0.85) or rest breaks (OR = 0.49 CI95% = 0.29-0.82). CONCLUSIONS: When OSA, SD or EDS are present, the risk of MVAs or NMAs in truck drivers is severely increased. Taking a rest break or a nap appear to be protective against accidents.
