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Neuromuscular nocturnal hypoventilation — SCE Respiratory MCQ

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HardVentilationNeuromuscular nocturnal hypoventilationSCE Respiratory

A 63-year-old man with motor neurone disease has morning headaches and orthopnoea. Upright FVC is 68% predicted and supine FVC falls to 42% predicted; overnight oximetry shows recurrent desaturation with transcutaneous CO2 rise. What is the most appropriate ventilation strategy?

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Correct answer: B — Initiate nocturnal non-invasive ventilation after specialist assessment

A marked supine FVC fall with nocturnal hypoventilation in motor neurone disease supports nocturnal NIV. Oxygen alone can worsen hypercapnia and does not correct ventilatory pump failure. CPAP treats upper airway obstruction, while tracheostomy or high-flow therapy is not first-line for this presentation.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/