Study objectives: To investigate whether the
localization of multiple sclerosis (MS), the duration of the disease,
and the level of neurologic functioning in patients with MS predispose
them to disturbed breathing control.
Setting: Outpatient pneumology
department of a university hospital.
Twenty-three MS patients and 51 healthy control subjects.
Measurements and results: Resting mouth occlusion pressure
at 0.1 s after onset of inspiratory effort
(P0.1) was measured during the hypercapnic response (HCR)
and the hypoxic response (HR) in all subjects. The Kurtzke expanded
disability status scale and the functional system score were used to
describe the level of neurologic functioning of the MS patients.
Predictors of HCR and HR were assessed by multiple regression analysis.
Low maximal inspiratory pressure (MIP) values correlated with low
resting P0.1 values (r = 0.44; p = 0.05), although in
neuromuscular diseases, high resting P0.1 values are
usually found to compensate for low MIPs. Detrusor-sphincter
dyssynergia (DSD) was the only predictor for lower ventilatory HCR
(p = 0.006; r2 = 0.52), lower P0.1 HCR
(p = 0.004; r2 = 0.47), lower ventilatory HR
(p = 0.04; r2 = 0.28), and lower P0.1 HR
(p = 0.04; r2 = 0.10); low MIPs and pyramidal tract
involvement had no role.
Conclusions: (1) Impaired
control of breathing in some MS patients is related mainly to central
defects. (2) DSD is the most important predictor of disturbed
ventilatory control, presumably because the micturition and pneumotaxic
center are closely related and located in the rostral pons. (3) No
relationship with the duration of the MS disease could be demonstrated,
which can be explained by the variable course of MS