Which noninvasive intervention is often required to manage sleep-disordered breathing in advanced DMD?

• A. Invasive ventilation
• B. Supplemental oxygen alone
• C. Chest physiotherapy
• D. Noninvasive ventilation

Answer: (D)

When DMD progresses, weakness of the breathing muscles, especially the diaphragm, leads to nocturnal hypoventilation and sleep-disordered breathing. The best noninvasive approach to manage this is noninvasive ventilation, which delivers positive airway pressure through a mask or similar interface to assist breathing during sleep. This support increases tidal volumes, improves overnight gas exchange, reduces carbon dioxide buildup, and often enhances daytime energy and quality of life, all without needing an artificial airway. Supplemental oxygen alone won’t correct the underlying hypoventilation and can even worsen CO2 retention in a ventilatory failure. Chest physiotherapy helps clear secretions but doesn’t provide ventilation during sleep. Invasive ventilation involves an airway through a tube and is not the noninvasive option described here.