Sleep disordered breathing assessment in patient with slowly progressive neuromuscular disease

Sleep Med. 2024 Feb:114:229-236. doi: 10.1016/j.sleep.2024.01.009. Epub 2024 Jan 12.

Abstract

Background: Sleep-disordered breathing (SDB) is common in patients with neuromuscular diseases (NMD). Focusing on hypercapnia may lead to the neglect of other SDB such as obstructive and/or central sleep apnea syndrome (SAS). Our objectives were to assess the risk of inappropriate SDB management according to different screening strategies and to evaluate the prevalence and determinants of isolated and overlapping sleep apnea in patients with slowly progressive NMD.

Methods: This monocentric, cross-sectional, retrospective study analyzed medical records of adult NMD patients referred to a sleep department. Diagnostic strategies, including respiratory polygraphy (RP), nocturnal transcutaneous capnography (tcCO2), and blood gases (BG), were assessed for their performance in diagnosing SDB. Demographics and pulmonary function test results were compared between patients with or without SDB to identify predictors.

Results: Among the 149 patients who underwent a full diagnostic panel (RP + tcCO2 + BG), 109 were diagnosed with SDB. Of these, 33% had isolated SAS, and central apneas were predominant. Using single diagnostic strategies would lead to inappropriate SDB management in two thirds of patients. A combination of 2 diagnostic tools resulted respectively in 21.1, 22.9 and 42.2 % of inappropriate SDB management for RP + tcCO2, RP + BG and tcCO2 + BG.

Conclusion: The significant prevalence of sleep apnea syndrome in patients with slowly progressive NMD highlights the need for increased awareness among clinicians. Improved diagnostics involve a systematic approach addressing both sleep apnea and diurnal and nocturnal alveolar hypoventilation to avoid inappropriate management and limit the consequences of SDB.

Keywords: Neuromuscular diseases; Nocturnal hypoventilation; Sleep apnea; Sleep disordered breathing.

MeSH terms

  • Adult
  • Blood Gas Monitoring, Transcutaneous
  • Cross-Sectional Studies
  • Humans
  • Neuromuscular Diseases* / complications
  • Neuromuscular Diseases* / epidemiology
  • Retrospective Studies
  • Sleep Apnea Syndromes* / diagnosis
  • Sleep Apnea Syndromes* / epidemiology
  • Sleep Apnea, Central* / diagnosis
  • Sleep Apnea, Central* / epidemiology