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Polysomnography in stable COPD under non-invasive ventilation to reduce patient-ventilator asynchrony and morning breathlessness

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Adler, Dan Perrig, Stephen Takahashi, Hiromitsu Espa, Fabrice Rodenstein, Daniel [UCL] Janssens, Jean-Paul

Background: Stable severe chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure treated by nocturnal bi-level positive pressure non-invasive ventilation (NIV) may experience severe morning deventilation dyspnea. We hypothesised that in these patients, progressive hyperinflation, resulting from inappropriate ventilator settings, leads to patient-ventilator asynchrony (PVA) with a high rate of unrewarded inspiratory efforts and morning discomfort. Methods: Polysomnography (PSG), diaphragm electromyogram and transcutaneous capnography (PtcCO2) under NIV during two consecutive nights using baseline ventilator settings on the first night, then, during the second night, adjustment of ventilator parameters under PSG with assessment of impact of settings changes on sleep, patient-ventilator synchronisation, morning arterial blood gases and morning dyspnea. Results: Eight patients (61 ± 8 years, FEV1 30 ± 8% predicted, residual volume 210 ± 30% predicted) were included. In all patients, pressure support was decreased during setting adjustments, as well as tidal volume, while respiratory rate increased without any deleterious effect on nocturnal PtcCO2 or morning PaCO 2. PVA index, initially high (40 ± 30%) during the baseline night, decreased significantly after adjusting ventilator settings (p = 0.0009), as well as subjective perception of PVA leaks, and morning dyspnea while quality of sleep improved. Conclusion: The subgroup of COPD patients treated by home NIV, who present marked deventilation dyspnea and unrewarded efforts may benefit from adjustment of ventilator settings under PSG or polygraphy

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2012
Language Anglais
Journal information "Sleep and Breathing : international journal of the science and practice of sleep medicine" - Vol. 16, no.4, p. 1081-1090 (2011)
Peer reviewed yes
Publisher Springer ((Germany) Heidelberg)
issn 1520-9512
e-issn 1522-1709
Publication status Publié
Affiliations UCL - SSS/IREC/LUNS - Pôle pneumologie, ORL (airways) et dermatologie (skin)
UCL - (SLuc) Service de pneumologie
MESH Subject Aged ; Middle Aged ; Oxygen ; Polysomnography ; Pulmonary Disease, Chronic Obstructive ; Software ; Switzerland ; Therapy, Computer-Assisted ; Wakefulness ; Blood Gas Monitoring, Transcutaneous ; Circadian Rhythm ; Continuous Positive Airway Pressure ; Dyspnea ; Equipment Failure ; Female ; Humans ; Male
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Bibliographic reference Adler, Dan ; Perrig, Stephen ; Takahashi, Hiromitsu ; Espa, Fabrice ; Rodenstein, Daniel ; et. al. Polysomnography in stable COPD under non-invasive ventilation to reduce patient-ventilator asynchrony and morning breathlessness. In: Sleep and Breathing : international journal of the science and practice of sleep medicine, Vol. 16, no.4, p. 1081-1090 (2011)
Permanent URL http://hdl.handle.net/2078.1/158616