ArticleJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2026
Establishing polysomnographic criteria for initiation of non-invasive ventilation in children with neuromuscular diseases.
Article in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.
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1 citing paper in PubMed.
- Methodological and clinical considerations for polysomnographic criteria guiding non-invasive ventilation initiation in pediatric neuromuscular diseases.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
objectivesThis study aims to (1) assess agreement for polysomnography (PSG)-based criteria for non-invasive ventilation (NIV) initiation between the American College of Chest Physicians (CHEST) neuromuscular guidelines, American Academy of Sleep Medicine (AASM) definitions for nocturnal hypoventilation and pediatric obstructive sleep apnea (OSA), and authors' proposed rapid eye movement (REM)-related criteria and (2) compare clinical outcomes and NIV adherence within 12 months in children with neuromuscular disorders (NMD).
methodsMulticenter retrospective study of children with NMD recommended NIV between 2010 and 2023. We classified participants in 3 groups based on described criteria. Kappa and Wilcoxon signed-rank were used to assess agreement and compare groups.
resultsOf 115 participants (88 male, median age 11.8 years [IQR 7-15]), 71% met at least one NIV initiation criterion across all groups. Twenty-five percent had nocturnal hypoventilation by CHEST guidelines, 16% by REM-related criteria and 9% AASM-based criteria. Nocturnal hypoxemia was diagnosed in 22% (CHEST) and 19% (REM-related). Overall agreement was moderate between REM-related and CHEST criteria (k = 0.71; CI95% 0.47-0.95; p < 0.001). Apnea-hypopnea index agreement was strong between CHEST and AASM-based criteria (k = 0.86, CI95% 0.74-0.98; p < 0.001). Nocturnal hypoxemia agreement was moderate between CHEST and REM-related criteria (k = 0.69, CI95% 0.49-0.89; p < 0.001). From the 96% (n = 111) of children that started NIV, 73% (n = 84) maintained its use for 6-12 months, with no differences in adherence or clinical outcomes across groups.
conclusionsFindings support new CHEST guidelines integrate disease and REM-specific criteria to enhance timely NIV initiation for early signs of nocturnal hypoventilation or hypoxemia in children with NMD. CURRENT KNOWLEDGE/STUDY RATIONALE: The American College of Chest Physicians (CHEST) guidelines recommend starting non-invasive ventilation (NIV) before advanced sleep-disordered breathing (SDB) develops. However, it remains unclear whether these criteria fully capture the progressive nature of SDB in children and youth with neuromuscular disorders (NMD), which often begins in rapid eye movement (REM) sleep and later affects all stages. STUDY IMPACT: Our study demonstrated that CHEST and REM-related criteria detect more children with early sleep-disordered breathing (SDB), especially those with CO
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