1040 Improved Care in Neuromuscular Multidisciplinary Clinic with Sleep Medicine Incorporation

Abstract Introduction Neuromuscular multidisciplinary clinical care models are becoming common in the management of the neuromuscular disease. Updated clinical practice guidelines emphasize the role of polysomnography (PSG) in determining the need for early non-invasive ventilation (NIV) in these patients to improve quality of life and disease course. Despite this and the high prevalence of comorbid sleep disorders, sleep medicine is not included in the standard model for these clinics. We sought to (1) define and improve the rate of PSG acquisition, and (2) improve detection of sleep-related comorbidities in this high acuity population with the addition of sleep medicine to an established neuromuscular multidisciplinary clinic. Methods Sleep medicine physicians joined a pre-established multidisciplinary clinic aimed to treat neuromuscular disease and related comorbidities. The multidisciplinary clinic was attended monthly from January to December 2023. Patients were evaluated for sleep disorders using clinical interviews and standardized sleep questionnaires. Patients were referred to the sleep disorders center to obtain diagnostic in lab video PSG with carbon dioxide monitoring. When sleep disordered breathing was detected, patients were offered therapy and followed clinically. Results A total of 12 neuromuscular patients (6 male (50%), average age 52) were evaluated, with75% (n=9) having no prior sleep medicine encounter. Only 50% had completed a PSG prior to sleep medicine evaluation. After sleep medicine evaluation, PSG acquisition rate improved to 100%. Obstructive sleep apnea (OSA) was detected in 83.3% (n=10, average AHI 26.6) of patients, with 8 meeting criteria for moderate-severe OSA, and 2 having nocturnal hypoventilation despite normal pulmonary function testing. The average sleep efficiency was 70%. The average Insomnia Severity Index was 8.25 and 58.3% (n=7) were diagnosed with chronic insomnia disorder. The average Epworth Sleepiness Scale was 7.6, with 41.6% (n=5) reporting excessive sleepiness. Conclusion Acquisition of clinically recommended PSG improved to 100% from our intervention. The detection of previously undiagnosed OSA, insomnia, and nocturnal hypoventilation is clinically meaningful. Sleep medicine incorporation into the neuromuscular multidisciplinary clinical care model contributes to improved patient care. Support (if any)