A model to predict ventilator requirement in myotonic dystrophy type 1

Muscle Nerve. 2019 Jun;59(6):683-687. doi: 10.1002/mus.26471. Epub 2019 Apr 2.

Abstract

Introduction: Respiratory failure is one of the most common causes of mortality in myotonic dystrophy type 1 (DM1). The variation in the DM1 phenotype causes difficulty in clinically predicting the severity of respiratory involvement, and variables such as daytime somnolence are insensitive for identifying patients who require continuous or bilevel nocturnal positive airway pressure (NPAP).

Methods: We retrospectively analyzed a cohort of 126 adult onset patients with DM1 at the point of their first respiratory assessment to identify significant factors in predicting ventilator requirement.

Results: Triplet repeat years score and Muscle Impairment Rating Scale were significantly linearly related to NPAP and, thus, formed the model.

Discussion: We devised a simple model to aid clinicians in predicting at first visit those patients with DM1 who are likely to require NPAP. We also describe the causes of failure to tolerate NPAP in DM1. Muscle Nerve 59:683-687, 2019.

Keywords: daytime somnolescence; muscle impairment rating scale; myotonic dystrophy; nocturnal positive airway pressure; obstructive sleep apnea; repeat expansion.

MeSH terms

  • Adult
  • Aged
  • Continuous Positive Airway Pressure / statistics & numerical data*
  • Female
  • Humans
  • Hypoventilation / etiology
  • Hypoventilation / therapy*
  • Male
  • Middle Aged
  • Myotonic Dystrophy / complications
  • Myotonic Dystrophy / physiopathology
  • Myotonic Dystrophy / therapy*
  • Phenotype
  • Respiration, Artificial
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*
  • Retrospective Studies
  • Sleep Apnea, Obstructive / etiology
  • Sleep Apnea, Obstructive / therapy*
  • Vital Capacity
  • Young Adult