Sleep disorders in neuromuscular diseases

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Curr Opin Pulm Med. 2006 Nov;12(6):402-8.

Sleep disorders in neuromuscular diseases.

Dhand UK, Dhand R.

Department of Neurology, USA bDepartment of Internal Medicine,

Division of Pulmonary, Critical Care and Environmental Medicine,

University of Missouri, Columbia, Missouri, USA.

PURPOSE OF REVIEW: Patients with neuromuscular disorders (NMD) are

especially vulnerable to sleep-related dysfunction. Sleep-disordered

breathing often precedes diurnal respiratory failure in NMD

patients, requiring timely recognition and management with

noninvasive ventilation (NIV). This paper reviews the mechanisms,

diagnostic evaluation, and management of sleep disorders in various

neuromuscular diseases.

RECENT FINDINGS: The severity, duration, and type of NMD influence

the pattern of sleep disturbance. Several investigators have

addressed other clinical aspects including rating scales for sleep

complaints, hypocretin-1 deficiency, excessive daytime somnolence,

and relation of sleep disorder with length of CTG trinucleotide

repeats in myotonic dystrophy. Benefits of NIV on quality of life

and survival in adults and children with chronic NMD are well

established, and recently have been documented even in patients with

nocturnal hypoventilation and daytime normocapnia. In contrast, the

timing for investigation with polysomnography and for initiation of

NIV is debated.

SUMMARY: Patients with chronic NMD should be routinely assessed for

sleep-disordered breathing and sleep complaints, because these are

treatable complications in an otherwise progressive disease process.

Further research is needed to establish the indications for

polysomnography and to determine the optimal timing for initiating

NIV to treat sleep-disordered breathing in patients with

neuromuscular diseases.