A patient with unilateral diaphragmatic paralysis is most at risk for?

A patient with unilateral diaphragmatic paralysis is particularly susceptible to experiencing sleep disordered breathing during REM sleep due to the physiological changes that occur in this sleep stage. During REM sleep, muscle tone is generally decreased, which can exacerbate the difficulties in maintaining adequate ventilation when the diaphragm is not functioning optimally on one side. This can lead to hypoventilation and a corresponding decrease in oxygen levels, making it more challenging for a patient with unilateral diaphragmatic paralysis to breathe effectively during this time.

REM sleep is characterized by atonia of skeletal muscles, potentially leading to impaired respiratory function if the diaphragm cannot adequately compensate on the affected side. Consequently, the combination of weakened respiratory mechanics and diminished drive to breathe during REM can significantly increase the risk of sleep disordered breathing in these individuals.

While other conditions such as obstructive or central sleep apnea may occur, they are not as directly related to the specific issue of unilateral diaphragmatic paralysis, making the likelihood of sleep disordered breathing during REM the most pronounced risk in this patient population. Insomnia does not pertain directly to the mechanical issues caused by diaphragmatic paralysis, further supporting the emphasis on REM-related breathing difficulties.