title: [Nocturnal monitoring of home non-invasive ventilation: Contribution of simple tools such as pulse-oximetry, capnography, built-in ventilator software and autonomic markers of sleep fragmentation].
abstract: Complex respiratory events, which may have a detrimental effect on both quality of sleep and control of nocturnal hypoventilation, occur during sleep in patients treated by non-invasive ventilation (NIV). Among these events are patient-ventilator asynchrony, increases in upper airway resistance with or without increased respiratory drive, and leaks. Detection of these events is important in order to select the most appropriate ventilator settings and interface. Simple tools can provide important information when monitoring NIV. Pulse-oximetry is important to ensure that an adequate SpO2 is provided, and to detect either prolonged or short and recurrent desaturations. However, the specificity of pulse-oximetry tracings under NIV is low. Transcutaneous capnography discriminates between hypoxemia related to V/Q mismatch and hypoventilation, documents correction of nocturnal hypoventilation, and may detect ventilator-induced hyperventilation, a possible cause for central apnea/hypopnea and glottic closure. Data provided by ventilator software helps the clinician by estimating ventilation, tidal volume, leaks, rate of inspiratory or expiratory triggering by the patient, although further validation of these signals by independent studies is indicated. Finally, autonomic markers of sympathetic tone using signals such as pulse wave amplitude of the pulse-oximetry signal can provide reliable information of sleep fragmentation.
authors.affiliation: Centre antituberculeux, division of pulmonary diseases, Geneva university hospital, rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Suisse. Electronic address: jean-paul.janssens@hcuge.ch.
authors.forename: J-P
authors.initials: JP
authors.lastname: Janssens
authors.affiliation: Laboratoire du sommeil, CHU de Grenoble, BP 217X, 38043 Grenoble cedex, France; Association médico-technique Agir à dom, 29-31, boulevard des Alpes, 38240 Meylan, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Borel
authors.affiliation: Laboratoire du sommeil, CHU de Grenoble, BP 217X, 38043 Grenoble cedex, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Pépin
mesh_terms: D017776:Autonomic Pathways; D015415:Biomarkers / Q000032:analysis*; D019296:Capnography / Q000295:instrumentation / Q000379:methods; D002940:Circadian Rhythm; D006801:Humans; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D063087:Noninvasive Ventilation / Q000295:instrumentation / Q000379:methods; D010092:Oximetry / Q000295:instrumentation / Q000379:methods; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy*; D012890:Sleep / Q000502:physiology; D012892:Sleep Deprivation / Q000150:complications / Q000175:diagnosis*; D012984:Software; D012122:Ventilators, Mechanical
chemical_list: D015415:Biomarkers
keywords: Autonomic markers; Capnographie; Capnography; Marqueurs autonomiques; Monitorage; Monitoring; Non-invasive ventilation; Oxymétrie; Pulsoximetry; Ventilation non invasive