Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency

Cristina Ambrogio, Xazmin Lowman, Ming Kuo, Joshua Malo, Anil R. Prasad, Sairam Parthasarathy

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)306-313
Number of pages8
JournalIntensive Care Medicine
Volume35
Issue number2
DOIs
StatePublished - Feb 2009

Keywords

  • Artificial respiration
  • Obesity hypoventilation syndrome
  • Respiratory failure
  • Respiratory insufficiency
  • Sleep

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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