Sleep and neuromuscular disease

The prevalence of sleep disorders in patients with neuromuscular disease (NMD) is thought to be 40%, but with sleepiness often attributed to the underlying neuromuscular disorder, this may be an underestimation. Risk assessment, diagnostic approach, and maintenance considerations often require understanding of the underlying disease. The diversity of NMD further complicates efforts to make global recommendations. Sleep specialty training provides expertise in noninvasive ventilation (NIV), assessment of synchrony and sleep quality, and response to therapy. Advanced training develops expertise in various mask interfaces and interpretation of NIV compliance monitoring. Because patients with NMD may present to both the sleep clinic and sleep laboratory for consultation, a comprehensively trained sleep clinician should appreciate the respiratory physiology complexities in the neuromuscular patient population as well as the complicated anatomy that presents challenges in diagnosis and intervention. In many neuromuscular disorders, expert sleep medicine care complements the longitudinal care delivered by neurology and pulmonology to improve quality of life—particularly during sleep.