title: Impact of intelligent volume-assured pressure support on sleep quality in stable hypercapnic chronic obstructive pulmonary disease patients: a randomized, crossover study.
abstract: BACKGROUND
  Noninvasive positive-pressure ventilation (NPPV) using intelligent volume-assured pressure support (iVAPS) combines volume- and pressure-preset NPPV and therefore uses a variation of inspiratory positive airway pressures.
  
  
  OBJECTIVE
  The effect of iVAPS on sleep quality in stable hypercapnic patients with chronic obstructive pulmonary disease (COPD) has not been determined.
  
  
  METHODS
  In this randomized, open-label, two-treatment, two-period, crossover study, patients were randomized to receive high-intensity (HI)-NPPV and then iVAPS or iVAPS and then HI-NPPV. Patients were studied in hospital for 2 consecutive nights, employing full polysomnography (PSG), transcutaneous partial pressure of CO2 (PtcCO2) monitoring, blood gas analysis and a visual analog scale (VAS)-based sleep questionnaire. After discharge, patients used HI-NPPV and iVAPS at home, each for 6 weeks. They had to answer a VAS question concerning sleep every morning, and were telephoned weekly and asked additional questions. At the end of each treatment period, they were visited at home for the determination of blood gases and treatment adherence, and to change the NPPV mode.
  
  
  RESULTS
  Fourteen patients were enrolled. In-hospital PSG measurements showed no difference in sleep quality between iVAPS and HI-NPPV. At home, patients reported more restful sleep during iVAPS than HI-NPPV (p = 0.04). Blood gases during spontaneous breathing at home did not differ with iVAPS and HI-NPPV, and there was a greater decrease in PtcCO2 during iVAPS than during HI-NPPV (p = 0.003).
  
  
  CONCLUSIONS
  Although sleep quality in hospital was not different between iVAPS and HI-NPPV, COPD patients with chronic hypercapnic respiratory failure reported a trend towards more restful sleep at home with iVAPS. In addition, nocturnal hypercapnia was effectively treated with iVAPS.
authors.affiliation: Department of Pneumology, University Hospital, Freiburg, Germany.
authors.forename: Emelie
authors.initials: E
authors.lastname: Ekkernkamp
authors.forename: Jan H
authors.initials: JH
authors.lastname: Storre
authors.forename: Wolfram
authors.initials: W
authors.lastname: Windisch
authors.forename: Michael
authors.initials: M
authors.lastname: Dreher
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis / Q000379:methods; D002245:Carbon Dioxide / Q000097:blood*; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000209:etiology / Q000628:therapy; D059725:Interactive Ventilatory Support / Q000379:methods*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods; D017286:Polysomnography / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D012129:Respiratory Function Tests / Q000379:methods; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000628:therapy; D012890:Sleep / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide