Source: Annual Congress 2008 - Progress and a new era for noninvasive mechanical ventilation
Disease area: Respiratory critical care, Sleep and breathing disorders

Abstract

Introduction: Long-term nocturnal noninvasive ventilation (NIV) is a key treatment for hypercapnic chronic respiratory failure. Asynchronies between patient‘s respiratory efforts and the ventilator triggerings may occur and contribute to NIV failure or discomfort. However, the impact of such patient-ventilator interactions on sleep quality remains unknown.
Methods: We analysed 12 polysomnographies from 6 OHS and 6 COPD patients hospitalized in our unit for routine non-invasive pressure support assessment. Ventilatory cycles and sleep architecture were manually analyzed by two experienced consultants. Three types of asynchronies were identified based on flow, airway pressure, and oesophageal pressure variations and were automatically quantified by a specific algorithm: ineffective triggering efforts (ITE), auto-triggerings and/or double triggerings (AT), delayed expiratory cycling (DEC).
Results: During sleep, ITE rate varied from 0 to 6.29%, AT from 0 to 4.19% and DEC from 0 to 0.49% without any relation with the underlying pulmonary disease. 84% of asynchronies occurred during non rapid eye movement sleep. 35% of all micro-arousals were preceded by an asynchrony but not associated with apnea or hypopnea. Asynchrony rate was correlated with the total number of sleep awakenings, micro-arousals and was inversely correlated with the percentage of rapid eye movement sleep.
Conclusion: Patient-ventilator asynchronies actually affect sleep quality, increase the number of awakenings and micro-arousals and decrease the quantity of rapid eye movement sleep.

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H. Rabarimanantsoa, U. S. Freitas, C. Letellier, L. Achour, L. C. Molano, F. Portier, E. Delagree, J. F. Muir, A. Cuvelier (Rouen, France). Does patient-ventilator asynchrony actually affect sleep during nocturnal noninvasive ventilation?. Eur Respir J 2008; 32: Suppl. 52, 364

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