Peripheral neuropathy is ascribed when peripheral nerves are damaged. This condition is associated with impaired motor, sensory, and/or autonomic nerve dysfunction, and may be either inherited such as in Charcot-Marie-Tooth (CMT) disease or acquired. Acquired neuropathies are commonly caused by leprosy (most common world-wide), other diseases (diabetes mellitus, autoimmune disorders, toxins such as alcohol or heavy metals) or nutritional deficiencies (B12 or thiamine).
The prevalence of OSA in patients with peripheral neuropathy is unknown. This, in part, may be influenced by the underlying cause of disorder such as diabetes mellitus. In a group of nonobese diabetic patients, 30% demonstrated OSA (61). Patients with peripheral neuropathies such as CMT and familial dysautonomia are also predisposed to OSA (62,63). Sleep apnea may in itself pose a risk to the peripheral nervous system. Chronic hypoxemia is a known risk factor for polyneu-ropathy (64). OSA was shown to be associated with transient but severe peripheral vasoconstriction (65). Patients with OSA had clinical signs of polyneuropathy including axonal damage (66). Phrenic nerve dysfunction was documented in Guillain-Barre syndrome (GBS), CMT, ALS, and diabetes mellitus. Phrenic nerve dysfunction particularly avails the patient to hypoventilation and hypoxemia during REM sleep.
Polysomnographic investigation for most of these patients should be routine. Patients should be considered for hypoventilation syndromes and as such end tidal CO2 measurements may be helpful. Patients must be observed in REM sleep for a complete evaluation. Esophageal reflux can also cause some of the apneic episodes in patients with autonomic nervous system dysfunction (67). Severe patients may require significant assistance with some activities of daily living.
Treatment of OSA in patients with peripheral neuropathy is similar to those in the general population and typically utilizes pressure support. Constant or bilevel pressure support can be used effectively. Patients need to be assessed for fine motor skills since distal extremities are typically involved with most peripheral neuropathies. Thus manipulation of these devices may require creative assistive devices such as large loops for quick-release straps or less intrusive delivery devices.
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