Patterns:

• Significant breathing problems that can result from muscle weakness of the diaphragm, abdominal and intercostal muscles and myotonia of these muscles.

• Low blood oxygen and elevated blood carbon dioxide levels.

• Chronic respiratory impairment is the primary cause of mortality and morbidity in DM1.

Symptoms:

• Excessive daytime sleepiness (EDS).

• Insufficient air flow during sleep.

• Weakness of the breathing and swallowing muscles.

• Aspiration of food and drink, saliva, nasal secretions and stomach fluids.

• General anesthesia and pain medications, especially opiates, often cause respiratory failure.

• Ineffective cough.

• Recurrent chest infections.

• Morning headaches, apnea, snoring.

Diagnosis:

• Discuss the following tests with your doctor.

• Forced vital capacity (FVC) and forced expiratory volume.

• Respiratory muscle strength evaluation.

• Sleep study.

• Clearance capacity.

Treatment:

• Careful perioperative management.

• Vaccinations for influenza and pneumonia if no contraindications.

• Respiratory cough assistance and mechanical ventilation (as needed).

• Consultations from respiratory therapy and pulmonary medicine groups as needed.

• Airway clearance and lung volume recruitment techniques (e.g., breath stacking, abdominal thrust, the vest and the mechanical insufflator/exsufflator).

• Noninvasive positive-pressure ventilation (NIV) for respiratory insufficiency.

• Emergency medical alert devices.