Assessment of pulmonary function in amyotrophic lateral sclerosis: When can polygraphy help evaluate the need for non-invasive ventilation?

Tino Prell*, Thomas M. Ringer, Kara Wullenkord, Philipp Garrison, Anne Gunkel, Beatrice Stubendorff, Otto W. Witte, Julian Grosskreutz

*Corresponding author for this work
31 Citations (Scopus)

Abstract

Background Non-invasive positive-pressure ventilation (NPPV) is an established, effective, long-term treatment for patients with amyotrophic lateral sclerosis (ALS), but the correct indicators for the establishment of NPPV have not been defined. Methods In this retrospective study, records (spirometry, nocturnal polygraphy, nocturnal blood gases) of 131 patients with ALS were reviewed in order to evaluate the role of polygraphy for prediction of respiratory failure in ALS. Results The patient group reporting with versus without dyspnoea had significantly lower values on the revised ALS-Functional Rating Scale (ALSFRS-R), vital capacity (VC), forced VC (FVC), arterial oxygen saturation and arterial oxygen tension readings, including a higher apnoea-hypopnoea index. 23 patients, who did not report about dyspnoea, had an FVC of <75%. Nocturnal hypoventilation was observed in 67% of the patients with ALS independent of their ALSFRS-R. The patient group with nocturnal hypoventilation was characterised by a significantly lower VC, FVC and maximal static inspiratory pressure compared with the group without nocturnal hypoventilation. However, also in the absence of nocturnal hypoventilation, 8 patients had a VC <50% as predicted. Discussion Our study shows that in patients not reporting dyspnoea and having an FVC of >75%, nocturnal hypoventilation was observed in nearly every second patient. Therefore, for the question of whether NPPV should be initiated, polygraphy does not provide useful additional information if the FVC is already <75% as predicted. However, in patients with more or less normal lung function parameters or where lung spirometry cannot perform adequately (eg, bulbar ALS), it can provide sufficient evidence for the need of NPPV.

Original languageEnglish
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume87
Issue number9
Pages (from-to)1022-1026
Number of pages5
ISSN0022-3050
DOIs
Publication statusPublished - 01.09.2016
Externally publishedYes

Research Areas and Centers

  • Centers: Center for Neuromuscular Diseases

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