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

Details

Serval ID
serval:BIB_653C0EEAB1E8
Type
Article: article from journal or magazin.
Collection
Publications
Title
Nocturnal hypoventilation in neuromuscular disease: prevalence according to different definitions issued from the literature.
Journal
Sleep & breathing = Schlaf & Atmung
Author(s)
Ogna A., Quera Salva M.A., Prigent H., Mroue G., Vaugier I., Annane D., Lofaso F., Orlikowski D.
ISSN
1522-1709 (Electronic)
ISSN-L
1520-9512
Publication state
Published
Issued date
05/2016
Peer-reviewed
Oui
Volume
20
Number
2
Pages
575-581
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
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.
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.
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).
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.

Keywords
Acid-Base Equilibrium/physiology, Adult, Blood Gas Monitoring, Transcutaneous, Circadian Rhythm/physiology, Cross-Sectional Studies, Female, Humans, Hypoventilation/epidemiology, Hypoventilation/physiopathology, Male, Middle Aged, Neuromuscular Diseases/epidemiology, Neuromuscular Diseases/physiopathology, Oximetry, Respiratory Insufficiency/epidemiology, Respiratory Insufficiency/physiopathology, Retrospective Studies, Capno-oximetry, Diagnostic criteria, Neuromuscular disease, Nocturnal hypoventilation, Nocturnal oximetry, Prevalence
Pubmed
Web of science
Create date
25/08/2017 9:49
Last modification date
20/08/2019 14:21
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