P041 Feasibility and accuracy of home polysomnography with transcutaneous carbon dioxide monitoring in children with neuromuscular disorders

Abstract Objectives clinical utility of home polysomnography is limited in children with neuromuscular disorders as CO2 is not measured and hypoventilation cannot be identified. This study performed home polysomnography with a Type 2 portable monitoring device and a portable transcutaneous CO2 monitor in children with neuromuscular disorders. Methods feasibility was defined as adequate data recorded from both devices to allow identification of sleep disordered breathing. Results of laboratory and home polysomnography were compared with Mann-Whitney U test and random intercept regression models. Results nineteen paired polysomnograms were performed for thirteen participants, including ten males, six with Duchenne Muscular Dystrophy. Median age was nine years. Feasibility was 68%, with adequate transcutaneous CO2 data in 89%. Statistically significant differences in sleep architecture were higher total sleep time, lower awake time and less N1 sleep during home polysomnography. No significant differences were seen in gas exchange parameters or apnoea hypopnoea indices. Home polysomnography had a sensitivity of 50% for diagnosis of hypoventilation and 78% for obstructive sleep apnoea. There was a concordant diagnosis of obstructive sleep apnoea in 7/9 home polysomnograms (78%), with an under-estimation of severity in three cases. Discussion This is the first study in children with neuromuscular disorders that demonstrates feasibility of transcutaneous CO2 monitoring during home polysomnography and directly compares Type 2 home and laboratory polysomnography. Differences in sleep architecture imply better sleep quality during home polysomnography. Although results indicate that home polysomnography is not sensitive enough to reliably identify sleep disordered breathing, our results are novel and show promise.