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. Design Retrospective case series analyzed consecutively. Setting Multidisciplinary neuromuscular respiratory failure (NMRF) clinic at an academic institution. Participants 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). Interventions 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. Main Outcome Measures 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.