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March 7, 2026

Severe sleep-related hypoventilation in antibody-positive and antibody-negative autoimmune encephalitis: an emergency

Puntos clave

This research investigates the prevalence of sleep-disordered breathing in autoimmune encephalitis patients, focusing on hypoventilation.
Conducted a cohort study in a tertiary center over 4.5 years.
Performed overnight video-polysomnography with capnography on participants.
Assessed sleep-related breathing disorders including hypoventilation and apnoea-hypopnoea syndrome.
56.5% of participants exhibited sleep-disordered breathing.
41.3% had moderate to severe apnoea-hypopnoea syndrome.
36% of cases showed hypoventilation based on capnography.
43% of subjects required respiratory support, including non-invasive ventilation.

Resumen

Background and objectives Although sleep disorders of neurological origin have been extensively documented in cases of autoimmune encephalitis, the impact and clinical significance of sleep-disordered breathing remain underexplored. We aimed at determining the prevalence of sleep-disordered breathing in autoimmune encephalitis. Methods A cohort study of consecutive patients with autoimmune encephalitis referred to a tertiary center for sleep pathology was conducted over a period of four and a half years. Patients underwent an overnight video-polysomnography with capnography. We investigated the presence of sleep-related breathing disorders, including sleep-related hypoventilation, sleep apnoea-hypopnoea syndrome, central hyperventilation, irregular breathing and excessive sighing. Results Forty-six participants with autoimmune encephalitis were included, with a median age of 60 Quartiles 1,3: 40, 69 years, of whom three were previously treated with non-invasive ventilation after acute respiratory failure and three were previously treated with positive airway pressure. A total of 26/46 (56.5%) participants had sleep-disordered breathing, including 19/46 (41.3%) participants with moderate to severe apnoea-hypopnoea syndrome. Capnography revealed sleep-related hypoventilation in 12/33 (36%) cases, including 4/5 (80%) anti-IgLON5, 1/4 (25%) anti-GAD65, 1/4 (25%) anti-CASPR2, and 6/14 (42.8%) antibody-negative cases. Nocturnal stridor was observed in 2/5 (40%) anti-IgLON5 cases. Overall, 20/46 (43%) subjects required respiratory support, including positive airway pressure (n=13) and non-invasive ventilation (n=7). Conclusion More than one third of participants with autoimmune encephalitis required nocturnal mechanical ventilation. Particular attention should be paid to sleep-related hypoventilation (assessed by nocturnal capnography) in patients with autoimmune encephalitis to guide timely respiratory support and reduce morbidity and mortality.

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