Polysomnography versus limited respiratory monitoring and nurse-led titration to optimise non-invasive ventilation set-up: a pilot randomised clinical trial.

Patout, Maxime; Arbane, Gill; Cuvelier, Antoine; Muir, Jean Francois; Hart, Nicholas; Murphy, Patrick Brian · Thorax · 2019

rct · Level II

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Abstract

Polysomnography (PSG) is recommended for non-invasive ventilation (NIV) set-up in patients with chronic respiratory failure. In this pilot randomised clinical trial, we compared the physiological effectiveness of NIV set-up guided by PSG to limited respiratory monitoring (LRM) and nurse-led titration in patients with COPD-obstructive sleep apnoea (OSA) overlap. The principal outcome of interest was change in daytime arterial partial pressure of carbon dioxide (PaCO<sub>2</sub>) at 3 months. Fourteen patients with daytime PaCO<sub>2</sub> >6 kPa and body mass index >30 kg/m<sup>2</sup> were recruited. At 3 months, PaCO<sub>2</sub> was reduced by -0.88 kPa (95% CI -1.52 to -0.24 kPa) in the LRM group and by -0.36 kPa (95% CI -0.96 to 0.24 kPa) in the PSG group. These pilot data provide support to undertake a clinical trial investigating the clinical effectiveness of attended limited respiratory monitoring and PSG to establish NIV in patients with COPD-OSA overlap. TRIAL NUMBER: Results, NCT02444806.

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