Indications for a nighttime sleep study in patients with neuromuscular and chest wall disease

Symptoms of SDB (eg, excessive daytime sleepiness, disrupted sleep, choking during sleep, snoring, morning headaches)

Arterial blood gases showing hypoventilation (PaCO₂ >45 mmHg [6 kPa]), or daytime hypoxemia

FVC <50% predicted

Severely reduced PImax (<60% predicted)

Unexplained cor pulmonale, elevated serum bicarbonate, or polcythemia

We have a low threshold to suspect SDB in patients with neuromuscular and chest wall disorders where SDB is a known complication (eg, those with respiratory muscle weakness). This includes, but is not limited to, patients with a history of poliomyelitis (especially with initial involvement of respiratory, trunk, or bulbar involvement), kyphoscoliosis, diaphragmatic paralysis, amyotrophic lateral sclerosis, or Duchenne muscular dystrophy.

NMD: neuromuscular disease; SDB: sleep disordered breathing; PaCO₂: arterial tension of carbon dioxide; FVC: forced vital capacity; PImax: maximal inspiratory pressure at the mouth.

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Indications for a nighttime sleep study in patients with neuromuscular and chest wall disease