Home polysomnography in the management of noninvasive ventilation in neuromuscular patients

Background: Patients with neuromuscular disease (NMD) on long-term noninvasive ventilation (NIV) require reevaluation of ventilator setting, which is better performed during nocturnal polysomnography (PSG). Studies on the role of home PSG in the management of NIV in NMD patients are lacking. Objective: To compare feasibility, reliability, subjective and objective sleep quality and patients' acceptance of PSG during NIV performed either in hospital or at home. Methods: Fifty-two consecutive NMD patients on long-term NIV were assigned to home or to unassisted hospital PSG during NIV application. A 7 item selfquestionnaire was administered after PSG to explore perceived sleep efficiency, sleep quality, awakenings, and acceptance of the polysomnographic procedure. Sleep was scored according to AASM rules. Results: One home and 1 hospital PSG were not reliable due, respectively, to insufficient sleep or to signal loss. Four hospital and three home recordings showed minor technical problems that did not affect their reliability. The remaining 43 recordings were technically excellent both as regards neurological and respiratory signals. Subjective (382.80±114.28 vs 347.94±77.3 minutes, respectively) and objective total sleep time and sleep efficiency (68.80±19.40 vs 72.03±15.86%), that were correlated to each other, were similar in the two groups. Acceptance of home PSG (8.28±1.99 on a scale from 0 to 10) was higher than for hospital PSG (6.84±2.42, p=0.02) Conclusion: In ventilated NMD patients, feasibility and reliability of PSG, as well as subjective and objective sleep quality, do not differ if it is performed in hospital or at home. Acceptance of the procedure in the home environment is higher.