{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T20:10:23Z","timestamp":1793304623500,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction\/Aims<\/jats:title><jats:p>Respiratory failure from hypoventilation is the most common cause of death in amyotrophic lateral sclerosis (ALS). However, ALS care rarely assesses hypercapnia, a physiologic measure of hypoventilation. We investigated the prevalence and clinical significance of daytime hypercapnia measured by transcutaneous carbon dioxide (tcCO<jats:sub>2<\/jats:sub>) monitoring in patients with ALS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included patients seen at two ALS clinics in the United States between 2012 and 2024 who had tcCO<jats:sub>2<\/jats:sub> measured concurrently with pulmonary function tests (PFTs), which included forced vital capacity (FVC) and, at one site, maximum inspiratory pressure (MIP). We assessed the prevalence of hypercapnia (tcCO<jats:sub>2<\/jats:sub>\u2009&gt;\u200945\u2009mmHg), the sensitivity and specificity of patient symptoms and PFTs for hypercapnia, and the relationship between hypercapnia and survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Daytime hypercapnia was present in 33\/328 (10%) patients at baseline. Hypercapnia was associated with an increased rate of death (aHR 2.1, 95% CI 1.4\u20133.3). Orthopnea or dyspnea was 70% sensitive for hypercapnia (95% CI 51%\u201384%). Absolute value of MIP (|MIP|)\u2009&lt;\u200960\u2009cmH<jats:sub>2<\/jats:sub>O was 95% sensitive (95% CI 74%\u2013100%) and 22% specific (95% CI 16%\u201330%), FVC\u2009&lt;\u200950% predicted was 33% sensitive (95% CI 18%\u201352%) and 82% specific (95% CI 78%\u201387%), and FVC\u2009&lt;\u200980% predicted was 85% sensitive (95% CI 68%\u201395%) and 31% specific (95% CI 26%\u201336%) for hypercapnia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>TcCO<jats:sub>2<\/jats:sub> monitoring identified strengths and weaknesses of PFTs in identifying hypercapnia in ALS. We found high sensitivity of |MIP|\u2009&lt;\u200960\u2009cmH<jats:sub>2<\/jats:sub>O and FVC\u2009&lt;\u200980% predicted and high specificity of FVC\u2009&lt;\u200950% predicted. Prospective studies should investigate the optimal clinical role for tcCO<jats:sub>2<\/jats:sub>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.28366","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T09:18:21Z","timestamp":1739351901000},"page":"611-619","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Identifying Daytime Hypercapnia Using Transcutaneous Carbon Dioxide Monitoring in Patients With Amyotrophic Lateral Sclerosis"],"prefix":"10.1002","volume":"71","author":[{"given":"Alexander H.","family":"Morrison","sequence":"first","affiliation":[{"name":"Department of Neurology, The Neuroscience Research Institute, College of Medicine The Ohio State University Wexner Medical Center  Columbus Ohio USA"},{"name":"Department of Neurology, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania 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of Pulmonary, and Critical Care and Sleep Medicine, Department of Medicine NYU Grossman School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4379-1255","authenticated-orcid":false,"given":"Jason","family":"Ackrivo","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, and Critical Care Division, Department of Medicine Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/17482968.2011.572979"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.2009.01290.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(05)70326-4"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3233\/JND-221658"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26875"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/17482960701262392"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202002-169OC"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.116.2.521"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181bc0141"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27779"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03501.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2023.03.011"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16316"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2020-323810"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2016.01.017"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2015.09.014"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3109\/17482968.2012.688836"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2017-211466"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27457"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/146608200300079536"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(99)00210-5"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2005.072660"},{"key":"e_1_2_10_24_1","first-page":"1428","article-title":"Amyotrophic 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