I sat across from a patient whom I had treated for obstructive sleep apnea (OSA) during several previous visits, listening to her symptoms. She reported feeling weaker, and said she was expending a lot of effort to breathe.
This patient had a history of asthma, so I assumed that might be causing the problem. When I asked her if she had ever experienced these symptoms before, she told me for the first time that she had had bulbar poliomyelitis as a child.
My patient contracted polio in 1942, along with 35,000 others that year. Luckily, she survived with no lasting effects — or so she had thought. Post-polio syndrome (PPS) affects approximately 25% to 50% of polio survivors. PPS symptoms include increased muscle weakness, fatigue and muscle atrophy.
The exact cause of PPS is unknown, but degeneration of individual nerve terminals in the motor units that remain in the brainstem and spinal cord are believed to be involved.1 The illness progresses slowly, and there may be period of stability alternating with decline.
Although there are no lab tests available to confirm PPS, there are a few criteria that can help diagnose the condition. These are:
- Prior history of poliomyelitis
- A period of partial or complete recovery from poliomyelitis
- An interval of at least 15 years of stable neuromuscular function
- PPS symptoms present for at least one year
- Exclusion of other neuromuscular or medical problems
If the patient has a history of bulbar polio, as was the case with this patient, complaints of difficulty swallowing or breathing are good evidence that PPS is present.
PPS symptoms typically first occur during the night. Patients may say that they feel more comfortable sleeping in an upright, seated position. They may experience frightful dreams and complain of poor sleep quality. OSA is common, as throat muscle weakness allows the airway to collapse. Patients with bulbar polio are at a higher risk for PPS, because they typically have swallowing issues and difficulty breathing.
Presently, there is no way to prevent PPS. Patients should get plenty of sleep, avoid smoking, use continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) nightly if they have OSA, control their body weight, exercise as tolerated and follow a healthy diet. If patients with PPS report difficulty breathing or sleep problems, refer them to a pulmonologist or a sleep specialist.
As the population ages remember that patients who are in their late 50s or older may have had polio as a child. PPS is an illness that we may be seeing more of, but may not often consider.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.