Don’t Sleep On It: Underrecognized Sleep Disorders in Patients with Neuromuscular Disease
Alexander Williams1, Matthew Brock2, Timothy Fullam3, Zahari Tchopev4
1San Antonio Uniformed Services Health Education Consortium, 2United States Air Force, 3San Antonio Uniformed Health Education Consortium, 4Brooke Army Medical Center Department of Neurology
Objective:
Report on increased screening for sleep disorders in patients with symptomatic neuromuscular disease (NMD) following the addition of sleep specialists to multidisciplinary NMD clinic model
Background:
Neuromuscular multidisciplinary clinical care models are becoming common in the management of NMD. Despite high prevalence of comorbid sleep disorders, sleep medicine is not included in the standard NMD clinic model. Clinical practice guidelines published by The American College of Chest Physicians (CHEST) emphasize the importance of sleep medicine involvement by recommending screening for hypoventilation with polysomnogram (PSG) in patients with symptomatic neuromuscular weakness.
Design/Methods:
Sleep medicine physicians joined a pre-established NMD multidisciplinary clinic at our military treatment facility. The clinic was attended monthly from March 2023 to March 2024. Patients with symptomatic NMD not previously screened with PSG were identified using clinical history and chart review. The Insomnia Severity Index (ISI) was completed by patients. When indicated, patients were referred to our sleep disorders center to obtain diagnostic PSG with CO2 monitoring.
Results:
Twelve NMD patients were evaluated with 75% (n=9) having no prior insomnia screening and 50% having no prior PSG. The average ISI was 8.25 and 58.3% (n=7) were diagnosed with chronic insomnia disorder. After one year, 100% of the patient population had been screened for insomnia and PSG acquisition had improved to 100%.
Conclusions:
Recommended PSG and insomnia screening improved to 100% following implementation of sleep physicians into multidisciplinary NMD clinic model. The detection of previously undiagnosed hypoventilation, SDB, and insomnia is clinically meaningful to this population. Sleep medicine specialists are an underutilized but potentially vital resource in the NMD multidisciplinary clinic model.
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