Sleep Disorders in Neuromuscular Diseases

Abstract

Sleep is a state of increased physiologic vulnerability associated with impairments in gas exchange and blunted ventilatory control. These changes are particularly prominent during the rapid eye movement (REM) sleep. Involvement of respiratory muscles in patients with neuromuscular diseases (NMDs) initially manifests in the form of sleep-disordered breathing events including “pseudocentral” hypopneas, sleep hypoventilation, obstructive and central apneas/hypopneas and periodic breathing. These changes are compensated by the recruitment of accessory inspiratory and expiratory muscles and with the reduction or abolishment of REM sleep. The implementation of noninvasive ventilatory support during sleep can improve quality of sleep, quality of life and survival, and can additionally alter sleep respiratory physiology by inducing glottic closure, changes in ventilatory drive and various asynchronies. Non-respiratory sleep problems are also frequently reported in patients with NMDs.