Comparing home polysomnography with transcutaneous CO2 monitoring to laboratory polysomnography in children with neuromuscular disorders.

STUDY

OBJECTIVES

Clinical utility of home polysomnography in children with neuromuscular disorders is limited by lack of evidence that sleep-disordered breathing can be reliably identified and inability to diagnose hypoventilation because carbon dioxide is not measured.

METHODS

This study aimed to determine the feasibility, accuracy, and parent satisfaction for home polysomnography performed with a type 2 portable monitoring device and a transcutaneous CO2 monitor. Results of laboratory and home polysomnography were compared with Mann-Whitney U tests and random intercept regression models.

RESULTS

Nineteen paired polysomnograms were performed for participants with various neuromuscular disorders at a median age of 9 years. Feasibility, defined as adequate data recorded from the portable monitoring device and transcutaneous CO2 monitor, was 68%. Adequate transcutaneous CO2 data were recorded in 89% of home studies. Significant differences were higher total sleep time, less awake time, and less N1 sleep during home polysomnography. Home polysomnography had a sensitivity of 50% for diagnosis of hypoventilation and 78% for obstructive sleep apnea. Home polysomnography underestimated severity of obstructive sleep apnea in 3 cases. Parent satisfaction for home polysomnography was high.

CONCLUSIONS

This is the first study to measure transcutaneous CO2 during type 2 home polysomnography in children with neuromuscular disorders. Results suggest better sleep quality at home during testing. Current sensitivity of home polysomnography for the diagnosis of sleep-disordered breathing is too low for clinical use; however, the feasibility of transcutaneous CO2 measurement in the home and high satisfaction justify further research to improve accuracy of home polysomnography in this population.

CITATION: Withers A, Pettigrew G, Filmer K, Lam J, Downs J, Wilson A. Comparing home polysomnography with transcutaneous CO2 monitoring to laboratory polysomnography in children with neuromuscular disorders. J Clin Sleep Med. 2025;21(4):639-648.