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Nocturnal hypoventilation in neuromuscular disease: prevalence according to different definitions issued from the literature

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Restrictive respiratory failure is a major cause of morbidity and mortality in neuromuscular diseases (NMD). Home mechanical ventilation (HMV) is used to treat hypoventilation, identified by daytime hypercapnia or nocturnal desaturation. Recently, transcutaneous measure of CO2 (TcCO2) has been increasingly used to detect hypoventilation, using different cut-offs. We aimed to compare the prevalence of hypoventilation in an unselected adult NMD population according to different definitions issued from the literature.

Methods

All consecutive nocturnal capno-oximetries performed between 2010 and 2014 in unventilated adult NMD patients were analysed retrospectively. Concomitant blood gas analysis and lung function data were collected. Patients on oxygen therapy were excluded. Hypoventilation was defined according to eight criteria, based on daytime PaCO2, daytime base excess, nocturnal SpO2 or TcCO2.

Results

Data from 232 patients were analysed (mean age 43.1 ± 15.4 years; 50.0 % women; vital capacity 59.2 ± 24.2 % of predicted). The hypoventilation prevalence was 10.3 to 61.2 %, depending on the used definition. The different definitions showed 49.1 to 94.8 % concordance (Cohen’s kappa for agreement 0.115 to 0.763). Overall agreement between the eight definitions was poor (Light’s kappa 0.267), and agreement between definitions based on nocturnal SpO2 and those based on TcCO2 was even lower (Light’s kappa 0.204).

Conclusions

We found large differences in hypoventilation prevalence according to the used definition. This has practical consequences, as HMV indication relies upon hypoventilation detection. We believe that capno-oximetry should be included in the diagnostic tools used to detect hypoventilation but this requires an update of consensus guidelines to agree upon the best definition.

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Author contributions

AO, MQS, HP, GM, IV, DA, FL and DO: designed the experiment; AO, MQS, HP, DA and DO: conducted the research; AO, GM, IV, FL and DO: analysed the data and performed the statistical analyses; AO, HP and DO: wrote the manuscript; AO and DO: have primary responsibility for the integrity of the data and the accuracy of the data analysis. All authors had full access to all of the data (including statistical reports and tables) in the study, revised the manuscript for important intellectual content and approved the final version of the manuscript.

Conflict of interest

A. Ogna, G. Mroue, I. Vaugier and D. Annane declare that they have no conflict of interest. MA. Quera Salva acts as consultant for Servier France and Vanda Pharmaceuticals for sleep medications. Prof F. Lofaso and H. Prigent have no conflict of interest related to the present work to disclose; the Service de Physiologie-Explorations Fonctionnelles of Garches received research funds from ResMed France, not related to the present work. Pr. D. Orlikowski has no conflict of interest related to the present work. The CIC 14.29 of Garches received research funds from BREAS Medical for a project on end-tidal CO2.

Compliance with ethical standards

The study was conducted in accordance with the Declaration of Helsinki and was approved by the French national regulatory board (CNIL, N.1817118). For this type of study, formal patients’ consent is not required.

Author information

Authors and Affiliations

  1. Service de Réanimation médicale et unité de ventilation à domicile, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France

    Adam Ogna, Djillali Annane & David Orlikowski

  2. Unité du Sommeil, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France

    Maria-Antonia Quera Salva, Ghassane Mroue & Frederic Lofaso

  3. Service de Physiologie-Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France

    Helene Prigent & Frederic Lofaso

  4. INSERM CIC 14.29, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France

    Isabelle Vaugier & David Orlikowski

Authors
  1. Adam Ogna
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  2. Maria-Antonia Quera Salva
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  3. Helene Prigent
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  4. Ghassane Mroue
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  7. Frederic Lofaso
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  8. David Orlikowski
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Correspondence to Adam Ogna.

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Ogna, A., Quera Salva, MA., Prigent, H. et al. Nocturnal hypoventilation in neuromuscular disease: prevalence according to different definitions issued from the literature. Sleep Breath 20, 575–581 (2016). https://doi.org/10.1007/s11325-015-1247-2

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  • DOI: https://doi.org/10.1007/s11325-015-1247-2

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