Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency.
OBJECTIVE
Noninvasive ventilation with pressure support (NIV-PS) therapy can augment ventilation; however, such therapy is fixed and may not adapt to varied patient needs. We tested the hypothesis that in patients with chronic respiratory insufficiency, a newer mode of ventilation [averaged volume assured pressure support (AVAPS)] and lateral decubitus position were associated with better sleep efficiency than NIV-PS and supine position. Our secondary aim was to assess the effect of mode of ventilation, body position, and sleep-wakefulness state on minute ventilation (V(E)) in the same patients.


METHODS
Single-blind, randomized, cross-over, prospective study.


METHODS
Academic institution.


METHODS
Twenty-eight patients.


METHODS
NIV-PS or AVAPS therapy.


RESULTS
Three sleep studies were performed in each patient; prescription validation night, AVAPS or NIV-PS, and crossover to alternate mode. Sleep was not different between AVAPS and NIV-PS. Supine body position was associated with worse sleep efficiency than lateral decubitus position (77.9 +/- 22.9 and 85.2 +/- 10.5%; P = 0.04). V(E) was lower during stage 2 NREM and REM sleep than during wakefulness (P < 0.0001); was lower during NIV-PS than AVAPS (P = 0.029); tended to be lower with greater body mass index (P = 0.07), but was not influenced by body position.


CONCLUSIONS
In patients with chronic respiratory insufficiency, supine position was associated with worse sleep efficiency than the lateral decubitus position. AVAPS was comparable to NIV-PS therapy with regard to sleep, but statistically greater V(E) during AVAPS than NIV-PS of unclear significance was observed. V(E) was determined by sleep-wakefulness state, body mass index, and mode of therapy.
Ambrogio
Cristina
C
University of Torino, Turin, Italy.
Lowman
Xazmin
X
Kuo
Ming
M
Malo
Joshua
J
Prasad
Anil R
AR
Parthasarathy
Sairam
S
D015992:Body Mass Index; D002908:Chronic Disease; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007040:Hypoventilation / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods*; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy*; D012890:Sleep; D012913:Snoring / Q000175:diagnosis / Q000453:epidemiology
Gerontology. 1996;42(1):46-53
8641601
J Physiol. 2004 Sep 1;559(Pt 2):663-73
15235077
J Appl Physiol (1985). 1996 May;80(5):1475-84
8727529
Am J Respir Crit Care Med. 2001 Jan;163(1):129-34
11208637
Am J Respir Crit Care Med. 2001 Feb;163(2):540-77
11179136
Am J Respir Crit Care Med. 1995 Apr;151(4):945-51
7697271
Am J Respir Crit Care Med. 2002 Dec 1;166(11):1423-9
12406837
Am J Respir Crit Care Med. 2005 Sep 1;172(5):619-24
15961699
Am J Respir Crit Care Med. 2003 Sep 15;168(6):645-58
12773321
Chest. 2002 Aug;122(2):479-88
12171820
Am Rev Respir Dis. 1981 Sep;124(3):260-8
7025715
Am J Respir Crit Care Med. 2002 May 1;165(9):1260-4
11991875
Sleep Breath. 2005 Dec;9(4):167-75
16273421
Can Respir J. 2006 May-Jun;13(4):203-10
16779465
Eur Respir J. 1999 Sep;14(3):517-22
10543269
Am J Respir Crit Care Med. 1999 Jan;159(1):112-8
9872827
Chest. 2006 Sep;130(3):815-21
16963680
Respir Care. 2004 Jan;49(1):39-51; discussion 51-2
14733621
Am J Respir Crit Care Med. 1996 Jan;153(1):266-71
8542127
J Appl Physiol (1985). 1998 Nov;85(5):1929-40
9804601
Chest. 1990 Aug;98(2):317-24
2198134