Journal of International Medical Research (Mar 2018)

Detection of early nocturnal hypoventilation in neuromuscular disorders

  • Federica Trucco,
  • Marina Pedemonte,
  • Chiara Fiorillo,
  • Hui-leng Tan,
  • Annalisa Carlucci,
  • Giacomo Brisca,
  • Paola Tacchetti,
  • Claudio Bruno,
  • Carlo Minetti

DOI
https://doi.org/10.1177/0300060517728857
Journal volume & issue
Vol. 46

Abstract

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Objective Nocturnal hypoventilation (NH) is a complication of respiratory involvement in neuromuscular disorders (NMD) that can evolve into symptomatic daytime hypercapnia if not treated proactively with non-invasive ventilation. This study aimed to assess whether NH can be detected in the absence of other signs of nocturnal altered gas exchange. Methods We performed nocturnal transcutaneous coupled (tc) pCO 2 /SpO 2 monitoring in 46 consecutive cases of paediatric-onset NMD with a restrictive respiratory defect (forced vital capacity 50 mmHg for > 25% of recorded time, and hypoxemia as tcSpO 2 5 minutes. Daytime symptoms and bicarbonate were recorded after overnight monitoring. Results Twenty-nine of 46 consecutive patients showed NH. Twenty-three patients did not have nocturnal hypoxemia and 18 were clinically asymptomatic. In 20 patients, PaCO 2 in daytime blood samples was normal. Finally, 13/29 patients with NH had isolated nocturnal hypercapnia without nocturnal hypoxia, clinical NH symptoms, or daytime hypercapnia. Conclusions Paediatric patients with NMD can develop NH in the absence of clinical symptoms or significant nocturnal desaturation. Therefore, monitoring of NH should be included among nocturnal respiratory assessments of these patients as an additional tool to determine when to commence non-invasive ventilation.