Long-term effects of nasal intermittent positive-pressure ventilation on pulmonary function and sleep architecture in patients with neuromuscular diseases.
OBJECTIVE
This article evaluates the long-term clinical and physiologic effects of nocturnal nasal intermittent positive-pressure ventilation (NIPPV) in patients with neuromuscular disease.


METHODS
Before and after 18 +/- 2 months of NIPPV, we measured during the daytime arterial blood gases, lung mechanics, and respiratory muscle strength in 8 patients (51 +/- 5 years; mean +/- SEM). Sleep parameters were also evaluated at 10 +/- 2 months.


RESULTS
All patients tolerated NIPPV and none required hospitalization during follow-up. After NIPPV, daytime arterial PO2 increased (71 +/- 4 to 81 +/- 2 mm Hg; p < 0.05) and arterial PCO2 decreased (46 +/- 3 to 41 +/- 1 mm Hg; p < 0.05). The change of PaO2 after NIPPV was related to its baseline value (r2 = 0.78, p < 0.05). Vital capacity (50 +/- 6% predicted), total lung capacity (63 +/- 4% predicted), alveolar-arterial oxygen gradient (20 +/- 3 mm Hg), and maximal inspiratory (39 +/- 9% predicted) or expiratory (32 +/- 5% predicted) pressures did not change after NIPPV. The apnea-hypopnea index fell from 22 +/- 6 to 1 +/- 1 (p < 0.05), and both sleep architecture and sleep efficiency (from 59 +/- 8% to 83 +/- 5%; p < 0.05) were enhanced. The time spent with an arterial oxygen saturation (SaO2) value below 90% decreased from 160 +/- 53 min to 8 +/- 4 min (p < 0.05). Mean (88 +/- 3 to 95 +/- 1%; p < 0.05) and minimal nocturnal SaO2 (67 +/- 5 to 89 +/- 1%; p < 0.001) improved after NIPPV.


CONCLUSIONS
In patients with neuromuscular disease, long-term NIPPV is well tolerated and easy to implement clinically. In these patients, long-term NIPPV improves daytime arterial blood gas values and sleep-disordered breathing. However, it does not modify lung mechanics or respiratory muscle strength.
Barbé
F
F
Servei Pneumología, Hospital Son Dureta, University of Illes Balers, Palma de Mallorca, Spain.
Quera-Salva
M A
MA
de Lattre
J
J
Gajdos
P
P
Agustí
A G
AG
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D002940:Circadian Rhythm; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D009468:Neuromuscular Diseases / Q000503:physiopathology*; D009666:Nose; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011312:Pressure; D011653:Pulmonary Diffusing Capacity / Q000502:physiology; D012123:Pulmonary Ventilation / Q000502:physiology; D015656:Respiratory Mechanics / Q000502:physiology; D012132:Respiratory Muscles / Q000503:physiopathology; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000517:prevention & control; D014109:Total Lung Capacity / Q000502:physiology; D014797:Vital Capacity / Q000502:physiology
D002245:Carbon Dioxide; D010100:Oxygen