Thorax 1988;43:75-77 Bilateral diaphragm paralysis and sleep apnoea without diurnal respiratory failure

This is a case history of a patient with isolated bilateral diaphragm paralysis. It is presented because it offers insight into possible mechanisms of the respiratory failure which usually develops in this condition. Case report The patient, now 40 years old, presented in 1973 with mesangiocapillary glomerulonephritis (hypocompliment-aemic with C3 nephritic factor) and subsequently developed progressive renal failure. In 1978 classical neuralgic amyotro-phy (brachial neuritis) occurred in both arms and remitted over the next three months, his sister having had similar episodes some years before. Four months later he underwent a successful cadaver renal transplant. Subsequently the patient had several episodes of rejection and suffered from recurrent chest infections during the first year. One year afte