PT  - JOURNAL ARTICLE
AU  - Michelle Ramsay
AU  - Swapna Mandal
AU  - Eui-Sik Suh
AU  - Joerg Steier
AU  - Anita Simonds
AU  - Nicholas Hart
TI  - Impact of patient ventilator asynchrony (PVA) on the sleep quality of patients using home mechanical ventilation (HMV)
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P4708
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/P4708.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/P4708.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - Introduction: During HMV, PVA is reported to adversely affect gas exchange, respiratory muscle unloading and patient comfort. The impact of PVAs on sleep disruption is less clear.Methods: Patients attending a tertiary referral centre for initiation of HMV were enrolled in the study. HMV was titrated using transcutaneous capnography and oximetry. PVAs were scored from a 2 minute epoch every 10 minutes overnight using standard definitions and expressed as percentage of breaths or events per hour in sleep and wake. Polysomnography recordings were scored by an expert technician blinded to PVA assessment. We investigated the relationship between PVA at initiation of HMV (HMVi), 3 months post therapy (HMV3) and arousals.Results: 10 patients (3 female) were enrolled, 4 chronic obstructive disease, 2 obesity hypoventilation syndrome and 4 neuromuscular/ chest wall disease. PVA was most commonly observed during wake periods. During sleep, PVA was most frequent in light sleep (stage1&2) and preceded almost half of all arousals at both HMVi and HMV3.Conclusion: These data suggest that PVA is a common phenomenon and a majority do not lead to sleep disruption. However, half of arousals were preceded by PVA. Focusing on predicting those PVA that lead to sleep disruption and mechanisms to improve on patient ventilator synchronisation may lead to further enhancement of sleep quality in patients using HMV.