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Evaluation of sleep-disordered breathing in patients with neuromuscular and chest wall disease

Naomi R Kramer, MD
Richard P Millman, MD
Nicholas S Hill, MD
Section Editors
Jeremy M Shefner, MD, PhD
M Safwan Badr, MD
Deputy Editor
April F Eichler, MD, MPH


Patients with neuromuscular or chest wall disease commonly have respiratory problems resulting from some combination of respiratory muscle dysfunction and decreased lung and chest wall compliance. These factors may contribute to difficulty with clearance of airway secretions, ventilation-perfusion mismatching, and eventually global alveolar hypoventilation [1]. (See "Continuous noninvasive ventilatory support for patients with respiratory muscle dysfunction".)

Sleep-disordered breathing is a significant cause of morbidity and mortality among patients with neuromuscular and chest wall disorders [2-5]. It is most often due to obstructive sleep apnea (OSA, a disorder characterized by obstructive apneas and hypopneas) or nocturnal hypoventilation, but central sleep apnea (CSA) can also be seen in patients with myotonic and muscular dystrophy [6-8]. (See "Central sleep apnea: Pathogenesis".)


The presence of symptoms is the major factor favoring evaluation of the patient for obstructive sleep apnea (OSA), central sleep apnea (CSA), or hypoventilation. However, some patients may have sleep-disordered breathing without symptoms but with suggestive physiologic parameters, eg, severe restriction on pulmonary function tests or unexplained cor pulmonale. Such patients should be evaluated with an arterial blood gas and a sleep study.

Classic symptoms of sleep-disordered breathing include excessive daytime sleepiness, morning headache, and restless sleep, but insomnia may also be seen. In addition:

Some patients with OSA may awaken with choking or shortness of breath

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Literature review current through: Nov 2017. | This topic last updated: Mar 13, 2017.
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