The latest edition of The International Classification of Sleep Disorders: Diagnostic and Coding Manual subsumes a broad range of disorders under the heading “Sleep Related Hypoventilation / Hypoxemic Syndromes.” Some are quite common, such as COPD with worsening gas exchange during sleep; while some are exceedingly rare, such as congenital central hypoventilation syndrome.

All share the attribute of abnormal gas exchange that worsens, or may only be present, during sleep. The sleep state, the sleeping posture, and the circadian rhythm driving sleep all may affect respiration by altering control of breathing and/or pulmonary mechanics. These changes are largely inconsequential in the normal individual but interact with respiratory, neurologic, or neuromuscular disease to manifest as the sleep-related hypoventilation / hypoxemic syndromes.

In addition to optimal treatment of the underlying disorder (when known and when possible), treatment usually involves nocturnal ventilatory support that is now most commonly provided by noninvasive positive pressure ventilation.

Key Words: chest wall disease • control of breathing • hypercapnia • hypoventilation • hypoxemia • hypoxia • neuromuscular disease

Kenneth R. Casey, MD, MPH, FCCP; Kathia Ortiz Cantillo, MD and Lee K. Brown, MD, FCCP

Correspondence to: Lee K. Brown MD, FCCP, Professor of Medicine and Pediatrics, and Vice Chair, Clinical Program Development, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Ave NE, Building 2, Albuquerque, NM 87102;

American College of Chest Physicians

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