Previously it was shown that Passy-Muir speaking valve is safe to use during sleep in children. However it continues to be contraindicated for use while asleep. A small prospective study done on 10 tracheostomized adult patients with a mean age of 70 years showed that the use of the speaking valve for one night in seriously ill patients was not associated with apneas or significant desaturations. A cohort study of 32 tracheostomized patients showed that 14 patients were able to tolerate speaking valve for 24 hours; even during sleep.