TY - JOUR
T1 - Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency
AU - Ambrogio, Cristina
AU - Lowman, Xazmin
AU - Kuo, Ming
AU - Malo, Joshua
AU - Prasad, Anil R.
AU - Parthasarathy, Sairam
N1 - Funding Information:
Conflict of interest Dr. Parthasarathy received research funding from Respironics, Inc. for the conduct of this study. None of the other authors have any existent or potential conflicts of interest, including specific financial interests that is relevant to the subject of this manuscript.
PY - 2009/2
Y1 - 2009/2
N2 - 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 VE in the same patients. Design: Single-blind, randomized, cross-over, prospective study. Setting: Academic institution. Patients and participants: Twenty-eight patients. Interventions: NIV-PS or AVAPS therapy. Measurements and 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). VE 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 VE during AVAPS than NIV-PS of unclear significance was observed. VE was determined by sleep-wakefulness state, body mass index, and mode of therapy.
AB - 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 VE in the same patients. Design: Single-blind, randomized, cross-over, prospective study. Setting: Academic institution. Patients and participants: Twenty-eight patients. Interventions: NIV-PS or AVAPS therapy. Measurements and 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). VE 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 VE during AVAPS than NIV-PS of unclear significance was observed. VE was determined by sleep-wakefulness state, body mass index, and mode of therapy.
KW - Artificial respiration
KW - Obesity hypoventilation syndrome
KW - Respiratory failure
KW - Respiratory insufficiency
KW - Sleep
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U2 - 10.1007/s00134-008-1276-4
DO - 10.1007/s00134-008-1276-4
M3 - Article
C2 - 18795255
AN - SCOPUS:59849107001
SN - 0342-4642
VL - 35
SP - 306
EP - 313
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 2
ER -