25648901
BACKGROUND	Amyotrophic lateral sclerosis patients have significant respiratory abnormalities with incomplete understanding of respiratory control .
BACKGROUND	This study analyzes electromyography ( EMG ) of the diaphragm ( dEMG ) using implanted diaphragm pacing ( DP ) electrodes .
METHODS	Retrospective analysis of dEMG data were obtained during Institutional Review Board and US Food and Drug Administration approved trials .
METHODS	The electrodes were used to analyze epochs of dEMG during multiple respiratory cycles .
RESULTS	Fifty-three patients were implanted .
RESULTS	Thirty-six had bilateral dEMG assessments , 18 had continuous overnight readings with pulse oximetry , and 19 had serial analysis .
RESULTS	Several findings revealed an alteration in the central respiratory drive including central apnea , hypoventilation , and hypercarbia .
RESULTS	The electrodes showed unilateral dysfunction and demonstrated noninvasive ventilation suppression of diaphragm activity .
RESULTS	DP can be used for serial monitoring , to decrease hypercarbia , improve sleep , and decrease atrophy .
CONCLUSIONS	Multiple abnormalities of respiratory control can be seen in amyotrophic lateral sclerosis patients using dEMG through therapeutic DP electrodes .
CONCLUSIONS	DP is used to overcome instability of respiratory control when there are intact diaphragm motor units leading to improved survival .

