This is a summary of the presentation on novel methods of ambulatory physiologic monitoring in patients with neuromuscular disease, presented as part of the program on pulmonary management of pediatric patients with neuromuscular disorders at the 30th annual Carrell-Krusen Neuromuscular Symposium on February 20, 2008. Pediatrics 2009123:S250-S252 R ECENTLY, CONSENSUS GUIDELINES were published for the respiratory care of patients with Duchenne muscular dystrophy and spinal muscular atrophy. These were practice-based guidelines, because the ability to generate evidence-based guidelines is limited because of the relatively rare nature of these diseases. The respiratory care guidelines provide precise recommendations for the timing and extent of respiratory examinations and care, from initial diagnosis through end-oflife directives. The process that produced these guidelines and the recent anesthesia and sedation guidelines, reviewed by Birnkrant in this conference, serves as a model for developing consensus practice parameters thataddress the multisystem involvement seen for many of the muscular dystrophies. [1][2][3][4][5] In the context of continuous quality improvement, they provided an AIM statement and a clear guide to muscle disorders clinics of the role of pediatric pulmonary evaluation and management (Table 1 www.pediatrics.org/content/vol123/ Supplement_4).The welcome shift from hospital ventilation to home ventilation, the emergence of technologic and biomedical advancements, and maximizing the benefits of therapies through appropriate timing have brought about a search for pulmonary outcome measures. Respiratory disease accounts for ϳ80% of the mortalities of patients with Duchenne muscular dystrophy. Our current measures consist of spirometry (forced vital capacity, forced expiratory volume at 1 second, oxygen saturation awake and asleep, and peak inspiratory and peak expiratory pressure) and rates of pneumonia, hospitalization, and respiratory failure. [6][7][8] The routine evaluation of sleep has been hindered by the expense associated with technician-monitored studies geared at screening for the justification of expensive home therapies for adults with obstructive sleep apnea syndrome, lack of pediatric sleep laboratories (with the insufficiency made more difficult by the increased recommendations for evaluation of primary snoring with inadequate infrastructure in place), variability in interpretation, and inadequately developed standards of "normal." 9 Home sleep monitoring has been hindered by the frequent need for restudy, which has resulted in the denial of development of a payment structure to foster a business case for innovation. 10 The reliance by private payers on Center for Medicare and Medicaid Services approval led to a reevaluation being released in March 2008, spurred by the deluge of obesity-related obstructive sleep apnea in adults with inadequate infrastructure for evaluation before initiation of home continuous positive airway pressure intervention.In the face of these d...