title: Sleep in hypercapnic critical care patients under noninvasive ventilation: conventional versus dedicated ventilators.
abstract: OBJECTIVE
  To compare sleep quality between two types of ventilators commonly used for noninvasive ventilation: conventional ICU ventilators and dedicated noninvasive ventilators; and to evaluate sleep during and between noninvasive ventilation sessions in critically ill patients.
  
  
  METHODS
  Physiological sleep study with a randomized assessment of the ventilator type.
  
  
  METHODS
  Medical ICU in a university hospital.
  
  
  METHODS
  Twenty-four patients admitted for acute hypercapnic respiratory failure requiring noninvasive ventilation.
  
  
  METHODS
  Patients were randomly assigned to receive noninvasive ventilation with either an ICU ventilators (n = 12) or a dedicated noninvasive ventilators (n = 12), and their sleep and respiratory parameters were recorded by polysomnography from 4 PM to 9 AM on the second, third, or fourth day after noninvasive ventilation initiation.
  
  
  RESULTS
  Sleep architecture was similar between ventilator groups, including sleep fragmentation (number of arousals and awakenings/hr), but the dedicated noninvasive ventilators group showed a higher patient-ventilator asynchrony-related fragmentation (28% [17-44] vs. 14% [7.0-22]; p = 0.02), whereas the ICU ventilators group exhibited a higher noise-related fragmentation. Ineffective efforts were more frequent in the dedicated noninvasive ventilators group than in the ICU ventilators group (34 ineffective efforts/hr of sleep [15-125] vs. two [0-13]; p < 0.01), possibly as a result of a higher tidal volume (7.2 mL/kg [6.7-8.8] vs. 5.8 [5.1-6.8]; p = 0.04). More sleep time occurred and sleep quality was better during noninvasive ventilation sessions than during spontaneous breathing periods (p < 0.05) as a result of greater slow wave and rapid eye movement sleep and lower fragmentation.
  
  
  CONCLUSIONS
  There were no observed differences in sleep quality corresponding to the type of ventilator used despite slight differences in patient-ventilator asynchrony. Noninvasive ventilation sessions did not prevent patients from sleeping; on the contrary, they seem to aid sleep when compared with unassisted breathing.
authors.affiliation: Réanimation Médicale, AP-HP, Groupe Hospitalier Albert Chenevier-Henri Mondor, Créteil, France. anacordobaizquierdo@hotmail.com
authors.forename: Ana
authors.initials: A
authors.lastname: Córdoba-Izquierdo
authors.forename: Xavier
authors.initials: X
authors.lastname: Drouot
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.forename: Fabrice
authors.initials: F
authors.lastname: Galia
authors.forename: Ferran
authors.initials: F
authors.lastname: Roche-Campo
authors.forename: Frédérique
authors.initials: F
authors.lastname: Schortgen
authors.forename: Enric
authors.initials: E
authors.lastname: Prats-Soro
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000628:therapy*; D007362:Intensive Care Units; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000295:instrumentation*; D017286:Polysomnography; D012890:Sleep; D012893:Sleep Wake Disorders / Q000209:etiology / Q000517:prevention & control*