Faut-il s'intéresser au sommeil des patients polyhandicapés ?

Far from superfluous, sleep recording is useful for diagnosing mechanical respiratory disorders such as Sleep Apneas. Those have an important impact on diurnal quality of life for patients with multiple disabilities: behaviour disorders, sleepiness, increased difficulty of concentration. Directed clinical examination and questioning are useful to decide whether to continue or not further investigations. Nocturnal pulse oxymetry recording is a good approach to the diagnosis. Confirmation can be achieved by sleep polygraphy. Only when doubt remains will polysomnography be considered. For the set-up of a ventilatory treatment, noninvasive PCO2 monitoring is useful to differentiate pure OSA from global alveolar hypoventilation-associated OSA. Before setting-up a ventilatory treatment, a risk-benefit evaluation should be done: the OSA or alveolar hypoventilation treatment must improve enough quality of life sufficiently to balance the constraint of being ventilated every night.