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

Abstract

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 (V(E)) in the same patients. Single-blind, randomized, cross-over, prospective study. Academic institution. Twenty-eight patients. NIV-PS or AVAPS therapy. 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). V(E) 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. 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 V(E) during AVAPS than NIV-PS of unclear significance was observed. V(E) was determined by sleep-wakefulness state, body mass index, and mode of therapy.