Sleep Study
Polysomnogram, also known as sleep study, is sometimes useful, perhaps more so for children with Neuromuscular Disease (NMD) than for adults with NMD. It may not be required to determine if someone needs nighttime breathing support for noninvasive ventilation (NIV). Sometimes individuals are told that insurance coverage for NIV in the United States (US) requires a sleep study and/or documented inability to tolerate CPAP during sleep, but that is not always the case. Often the combination of the affected individual’s symptoms, their NMD diagnosis, and the results of their pulmonary function test or spirometry indicate the need to start use of a bi-level breathing support device for sleep and may result in insurance approval of the necessary equipment (BPAP or portable ventilator). Less frequently, an Arterial Blood Gas (ABG) and a sleep study in a hospital or clinic setting, or an overnight home desaturation/oximetry study, are required, depending on the US insurance coverage.
“While a sleep study is not required per Centers for Medicare & Medicaid coverage criteria for the use of respiratory assist devices in patients with neuromuscular disease, polysomnography is valuable for identifying early nocturnal respiratory impairment before the appearance of symptoms and daytime abnormalities in gas exchange and is better than home testing for distinguishing different types of events (including pseudocentrals). It also is helpful for determining the appropriate pressures needed for ventilatory support and for assessing the need for a backup rate, Dr. Singh said.” Reference: https://www.mdedge.com/chestphysician/article/242654/sleep-medicine/sleep-disordered-breathing-neuromuscular-disease-early
“When respiratory muscle weakness causes nighttime breathing problems, it doesn’t take a polysomnogram to diagnose it, says John Bach, a physical medicine and rehabilitation specialist at University Hospital in Newark, N.J.
In patients with neuromuscular disease, Bach determines the need for ventilatory therapy by assessing symptoms and measuring exhaled carbon dioxide and vital capacity while the person is sitting and lying down. If those measurements don’t yield useful information in the clinic, he has patients do them at home overnight.
Patients showing signs of hypoventilation should be offered a trial of nocturnal ventilation, Bach advises, “and if they feel better using it, let them do so.”
Bach questions the usefulness of polysomnograms for people with muscle diseases because the test “interprets all abnormalities as central or obstructive apneas rather than muscle weakness,” he says — especially when read by physicians unfamiliar with neuromuscular disease.
This misdiagnosis then leads to improper treatment, he says.
“All symptomatic, weak patients need full nocturnal inspiratory muscle rest with very high-span BiPAP or use of portable ventilators to fully rest muscles — not CPAP, oxygen or low-span BiPAP,” Bach says. “Treat the patient, not the polysomnogram.”” Reference: https://www.mda.org/quest/article/not-enough-zzzzzzs
Some affected individuals in the US are offered what is called an at-home sleep study or what is called overnight oximetry. It can be difficult for those with muscle weakness to sleep and function in an environment outside of their own adapted home, so these are at-home alternatives. Whether you are having an in-lab study or have the option for a take-home recording device, it is important that both Oxygen saturation and Carbon Dioxide (CO2) levels are assessed during sleep.
“A 5-minute period with an oxygen saturation less than 90% has been considered an indication of respiratory muscle weakness.” Reference: https://www.dovepress.com/respiratory-management-of-patients-with-neuromuscular-disease-current--peer-reviewed-fulltext-article-DNND?fbclid=IwAR0goBwaUFlL3oGFtAXiVlhvREeCtoK8dGZvtVJGz9wLv1fV_NwZe0aPr7Y
“Addition of monitoring for carbon dioxide levels may reveal sleep hypoventilation due to muscle weakness. Several modalities of capnography exist, namely end-tidal capnography or transcutaneous capnography. Transcutaneous capnography is currently recommended by the American Academy of Sleep Medicine.” Reference: https://www.dovepress.com/respiratory-management-of-patients-with-neuromuscular-disease-current--peer-reviewed-fulltext-article-DNND?fbclid=IwAR0goBwaUFlL3oGFtAXiVlhvREeCtoK8dGZvtVJGz9wLv1fV_NwZe0aPr7Y
Opinions among clinicians vary as to whether sleep study is necessary for appropriate determination of optimal ventilatory support settings. The clinicians who specialize in NMD breathing weakness in the US who have decades of experience often know what settings to start a patient on and work to fine tune those settings for comfort and optimal breathing muscle rest with the input of a Registered Respiratory Therapist (RRT) employed by the company that rents the bi-level device to the individual with NMD, along with the patient’s input.
See also:
Swallowing
Pulmonary Function/Spirometry
Blood Gases
Polysomnogram, also known as sleep study, is sometimes useful, perhaps more so for children with Neuromuscular Disease (NMD) than for adults with NMD. It may not be required to determine if someone needs nighttime breathing support for noninvasive ventilation (NIV). Sometimes individuals are told that insurance coverage for NIV in the United States (US) requires a sleep study and/or documented inability to tolerate CPAP during sleep, but that is not always the case. Often the combination of the affected individual’s symptoms, their NMD diagnosis, and the results of their pulmonary function test or spirometry indicate the need to start use of a bi-level breathing support device for sleep and may result in insurance approval of the necessary equipment (BPAP or portable ventilator). Less frequently, an Arterial Blood Gas (ABG) and a sleep study in a hospital or clinic setting, or an overnight home desaturation/oximetry study, are required, depending on the US insurance coverage.
“While a sleep study is not required per Centers for Medicare & Medicaid coverage criteria for the use of respiratory assist devices in patients with neuromuscular disease, polysomnography is valuable for identifying early nocturnal respiratory impairment before the appearance of symptoms and daytime abnormalities in gas exchange and is better than home testing for distinguishing different types of events (including pseudocentrals). It also is helpful for determining the appropriate pressures needed for ventilatory support and for assessing the need for a backup rate, Dr. Singh said.” Reference: https://www.mdedge.com/chestphysician/article/242654/sleep-medicine/sleep-disordered-breathing-neuromuscular-disease-early
“When respiratory muscle weakness causes nighttime breathing problems, it doesn’t take a polysomnogram to diagnose it, says John Bach, a physical medicine and rehabilitation specialist at University Hospital in Newark, N.J.
In patients with neuromuscular disease, Bach determines the need for ventilatory therapy by assessing symptoms and measuring exhaled carbon dioxide and vital capacity while the person is sitting and lying down. If those measurements don’t yield useful information in the clinic, he has patients do them at home overnight.
Patients showing signs of hypoventilation should be offered a trial of nocturnal ventilation, Bach advises, “and if they feel better using it, let them do so.”
Bach questions the usefulness of polysomnograms for people with muscle diseases because the test “interprets all abnormalities as central or obstructive apneas rather than muscle weakness,” he says — especially when read by physicians unfamiliar with neuromuscular disease.
This misdiagnosis then leads to improper treatment, he says.
“All symptomatic, weak patients need full nocturnal inspiratory muscle rest with very high-span BiPAP or use of portable ventilators to fully rest muscles — not CPAP, oxygen or low-span BiPAP,” Bach says. “Treat the patient, not the polysomnogram.”” Reference: https://www.mda.org/quest/article/not-enough-zzzzzzs
Some affected individuals in the US are offered what is called an at-home sleep study or what is called overnight oximetry. It can be difficult for those with muscle weakness to sleep and function in an environment outside of their own adapted home, so these are at-home alternatives. Whether you are having an in-lab study or have the option for a take-home recording device, it is important that both Oxygen saturation and Carbon Dioxide (CO2) levels are assessed during sleep.
“A 5-minute period with an oxygen saturation less than 90% has been considered an indication of respiratory muscle weakness.” Reference: https://www.dovepress.com/respiratory-management-of-patients-with-neuromuscular-disease-current--peer-reviewed-fulltext-article-DNND?fbclid=IwAR0goBwaUFlL3oGFtAXiVlhvREeCtoK8dGZvtVJGz9wLv1fV_NwZe0aPr7Y
“Addition of monitoring for carbon dioxide levels may reveal sleep hypoventilation due to muscle weakness. Several modalities of capnography exist, namely end-tidal capnography or transcutaneous capnography. Transcutaneous capnography is currently recommended by the American Academy of Sleep Medicine.” Reference: https://www.dovepress.com/respiratory-management-of-patients-with-neuromuscular-disease-current--peer-reviewed-fulltext-article-DNND?fbclid=IwAR0goBwaUFlL3oGFtAXiVlhvREeCtoK8dGZvtVJGz9wLv1fV_NwZe0aPr7Y
Opinions among clinicians vary as to whether sleep study is necessary for appropriate determination of optimal ventilatory support settings. The clinicians who specialize in NMD breathing weakness in the US who have decades of experience often know what settings to start a patient on and work to fine tune those settings for comfort and optimal breathing muscle rest with the input of a Registered Respiratory Therapist (RRT) employed by the company that rents the bi-level device to the individual with NMD, along with the patient’s input.
See also:
Swallowing
Pulmonary Function/Spirometry
Blood Gases