title: Home-based overnight transcutaneous capnography/pulse oximetry for diagnosing nocturnal hypoventilation associated with neuromuscular disorders.
abstract: OBJECTIVE
  To determine the utility of home-based, unsupervised transcutaneous partial pressure of carbon dioxide (tc-Pco(2)) monitoring/oxygen saturation by pulse oximetry (Spo(2)) for detecting nocturnal hypoventilation (NH) in individuals with neuromuscular disorders.
  
  
  METHODS
  Retrospective case series analyzed consecutively.
  
  
  METHODS
  Multidisciplinary neuromuscular respiratory failure (NMRF) clinic at an academic institution.
  
  
  METHODS
  Subjects (N=35, 68.6% men; mean age, 46.9y) with spinal cord injury (45.7%) or other neuromuscular disorders underwent overnight tests with tc-Pco(2)/Spo(2) monitoring. Fifteen (42.9%) were using nocturnal ventilatory support, either bilevel positive airway pressure (BiPAP) or tracheostomy ventilation (TV).
  
  
  METHODS
  A respiratory therapist brought a calibrated tc-Pco(2)/Spo(2) monitor to the patient's home and provided instructions for data collection during the subject's normal sleep period. Forced vital capacity (FVC), body mass index (BMI), and exhaled end-tidal Pco(2) (ET-Pco(2)) were recorded at a clinic visit before monitoring.
  
  
  METHODS
  Detection of NH (tc-Pco(2) ≥50mmHg for ≥5% of monitoring time). Data were also analyzed to determine whether nocturnal oxygen desaturation (Spo(2) ≤88% for ≥5% of monitoring time), FVC, BMI, or daytime ET-Pco(2) could predict the presence of NH.
  
  
  RESULTS
  NH was detected in 18 subjects (51.4%), including 53.3% of those using BiPAP or TV. NH was detected in 43.8% of ventilator-independent subjects with normal daytime ET-Pco(2) (present for 49.4%±31.5% [mean ± SD] of the study period), and in 75% of subjects with an elevated daytime ET-Pco(2) (present for 92.3%±8.7% of the study period). Oxygen desaturation, BMI, and FVC were poor predictors of NH. Only 3 attempted monitoring studies failed to produce acceptable results.
  
  
  CONCLUSIONS
  Home-based, unsupervised monitoring with tc-Pco(2)/Spo(2) is a useful method for diagnosing NH in NMRF.
authors.affiliation: Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI. krisbaum@umich.edu
authors.forename: Kristy A
authors.initials: KA
authors.lastname: Bauman
authors.forename: Armando
authors.initials: A
authors.lastname: Kurili
authors.forename: Shelley L
authors.initials: SL
authors.lastname: Schmidt
authors.forename: Gianna M
authors.initials: GM
authors.lastname: Rodriguez
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Chiodo
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sitrin
mesh_terms: D000328:Adult; D000368:Aged; D019296:Capnography / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007040:Hypoventilation / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D009468:Neuromuscular Diseases / Q000150:complications* / Q000503:physiopathology; D010092:Oximetry / Q000379:methods*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology