title: Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Non-invasive positive pressure ventilation (NIPPV) is effective in treating acute exacerbations of chronic obstructive pulmonary disease (COPD). Nocturnal non-invasive positive pressure ventilation (nocturnal-NIPPV) has been proposed as an intervention for stable hypercapnic patients with COPD.
  
  
  OBJECTIVE
  To assess the effects of nocturnal-NIPPV at home via nasal mask or face mask in people with COPD by using a meta-analysis based on individual patient data (IPD).
  
  
  METHODS
  We searched the Cochrane Airways Group Specialised Register. We performed the latest search in August 2012.
  
  
  METHODS
  Randomised controlled trials in people with stable COPD that compared nocturnal-NIPPV at home for at least five hours per night, for at least three consecutive weeks plus standard therapy with standard therapy alone.
  
  
  METHODS
  IPD were collected and two review authors assessed risk of bias independently.
  
  
  RESULTS
  This update of the systematic review on nocturnal-NIPPV in COPD (Wijkstra 2002), has led to the inclusion of three new studies, leading to seven included studies on 245 people. We obtained IPD for all participants in all included studies. The 95% confidence interval (CI) of all outcomes included zero. These included partial pressure of CO2 and O2 in arterial blood, six-minute walking distance (6MWD), health-related quality of life (HRQoL), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), maximal inspiratory pressure (PImax) and sleep efficiency. The mean effect on 6MWD was small at 27.7 m and not statistically significant. Given the width of the 95% CI (-28.1 to 66.3 m), the real effect of NIPPV on 6MWD is uncertain and we cannot exclude an effect that is clinically significant (considering that the minimal clinically difference on 6MWD is around 26 m).
  
  
  CONCLUSIONS
  Nocturnal-NIPPV at home for at least three months in hypercapnic patients with stable COPD had no consistent clinically or statistically significant effect on gas exchange, exercise tolerance, HRQoL, lung function, respiratory muscle strength or sleep efficiency. Meta-analysis of the two new long-term studies did not show significant improvements in blood gases, HRQoL or lung function after 12 months of NIPPV. However, the small sample sizes of these studies preclude a definite conclusion regarding the effects of NIPPV in COPD.
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen,Netherlands.
authors.forename: Fransien M
authors.initials: FM
authors.lastname: Struik
authors.forename: Yves
authors.initials: Y
authors.lastname: Lacasse
authors.forename: Roger
authors.initials: R
authors.lastname: Goldstein
authors.forename: Huib M
authors.initials: HM
authors.lastname: Kerstjens
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Wijkstra
mesh_terms: D003964:Diaphragm / Q000503:physiopathology; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010313:Partial Pressure; D011175:Positive-Pressure Respiration / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D011788:Quality of Life; D012890:Sleep / Q000502:physiology; D013997:Time Factors; D016138:Walking