Abstract
Introduction: Our sleep disordered breathing service manages 750 patients, with 55 of these on domiciliary NIV.
Aim: Review rationale for initiating NIV and clinical outcomes.
Results: 20 females (mean age 59 years, range 36-75 years) and 35 males (mean age 61, range 18-83) are managed on home NIV, most having a diagnosis of OSAHS/obesity hypoventilation (44, 80%). Other diagnosis are COPD (3 patients, 4%), neuromuscular (3 patients, 4%) and kyphoscoliosis (5, 9%). 14 commenced therapy during an acute admission with ventilatory failure, the rest electively via the sleep medicine service. The mean duration of therapy is 37 months (range 1 to 130 months). The mean BMI for patients on home NIV for OSA/obesity hypoventilation is 45.3 (range 31-63).
Blood gas analysis pre and on treatment was available for 50 patients; 46 of these showing improvement in both PaCO2 and HCO3, with 3 having recently commenced NIV and yet to be clinically reviewed. There was insufficient information for 2 patients on treatment.
In terms of compliance, 45 of 55 patients had good compliance with therapy, 4 had variable compliance and 3 are poorly compliant with infrequent clinic attendance. 3 had only recently commenced therapy. 11 of 55 patients have had respiratory-related admissions whilst on home NIV, most commonly LRTI, with a mean of 2 admissions each - one patient has had 7 admissions and the others 1 or 2. However 44 patients have had no respiratory related admissions since commencing nocturnal home NIV.
Conclusion: The majority commenced nocturnal NIV for OSAHS/obesity-related hypoventilation, and our review suggests good compliance with treatment benefit, and with a low admission rate following initiation of intervention.
- © 2014 ERS