Evaluation of sleep-disordered breathing in patients with neuromuscular and chest wall disease
- Naomi R Kramer, MD
Naomi R Kramer, MD
- Assistant Professor of Medicine
- Warren Alpert Medical School of Brown University
- Richard P Millman, MD
Richard P Millman, MD
- Professor of Medicine and Pediatrics
- Warren Alpert Medical School of Brown University
- Nicholas S Hill, MD
Nicholas S Hill, MD
- Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
- M Safwan Badr, MD
M Safwan Badr, MD
- Section Editor — Sleep Related Breathing Disorders
- Professor and Chief, Pulmonary Critical Care and Sleep Medicine
- Wayne State University School of Medicine
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 . (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".)
INDICATIONS FOR EVALUATION OF SLEEP-DISORDERED BREATHING
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:
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