Role of Polysomnography in Tracheostomy Decannulation in Neuromuscular Disease: A Case Report.

Tracheostomy decannulation in patients with neuromuscular disease presents significant challenges due to impaired airway clearance, pharyngolaryngeal hypotonia, and chronic hypoventilation. Polysomnography (PSG) may provide an objective assessment of ventilatory stability and support safe decision-making. We describe a 54-year-old woman with sequelae of Arnold-Chiari malformation type I, syringomyelia, and tetraplegia (AIS D, neurological level C1), who developed chronic respiratory insufficiency requiring tracheostomy. Despite achieving nocturnal normocapnia with non-invasive ventilation, she exhibited persistent daytime hypercapnia and severely impaired cough. A capped tracheostomy PSG performed under nasal-mask non-invasive ventilation demonstrated no worsening of baseline hypoventilation, confirming ventilatory stability and supporting decannulation readiness. Anxiety delayed the procedure, but multidisciplinary evaluation continued to indicate safety for future decannulation. This case highlights the utility of PSG in the assessment of complex neuromuscular patients with multifactorial hypoventilation, where standard pulmonary function testing may be limited.