Abstract
Introduction: Current recommendation is to use PSG for setup of NIV in COPD-OSA.
Aim: To assess the clinical effectiveness at 3 month of a limited monitoring for NIV setup in COPD-OSA overlap compared of PSG.
Methods: Prospective randomised controlled trial including patients with COPD-OSA overlap with a BMI>30kg/m2 and daytime PaCO2>6kPa. Patients were randomised 1:1 to have NIV setup using oximetry-capnography or PSG. Primary outcome was change in daytime PaCO2 at 3 month. Secondary outcome were NIV adherence , changes in quality of life measures and in neural respiratory drive (NRD).
Results: Twelve patients were included. Baseline data were comparable between the 2 groups [age 62±9 years, BMI 36±5kg/m2, smoking history 49±29 pack-year, FEV1 1±0.9L, 4% ODI 35±20/h, Epworth sleepiness scale (ESS) 10.6±4, Pittsburgh Sleep Quality Index (PSQI) 11±3 and Severe Respiratory Insufficiency (SRI) 47±15]. At discharge, NIV settings were similar with trend to higher EPAP in PSG group At three month, mean change in PaCO2 was -0.85kPa in the limited monitoring group and -0.33kPa in the PSG group (p:0.38). NIV adherence did not differ significantly: 4.4h/day in limited group vs. 2.7h/day in PSG group (p:0.11). NRD reduction on NIV was correlated to NIV adherence (rho:-0.608, p:0.021). Improvements in ESS, PQSI and SRI were similar in both groups and were: -1.8±3, -4±4, 10.5±15 respectively.
| Limited monitoring group | PSG group | |
| IPAP | 25.7 (±3.5) | 26.0 (±2.3) |
| EPAP | 9.1 (±2) | 10.9 (±1.6) |
| BUR | 15.1 (±1) | 16.3 (±2.1) |
| Ti | 1.1 (±0.1) | 1.1 (±0.1) |
NIV settings after initiation
Conclusion: Limited monitoring is sufficient to successfully setup NIV in COPD-OSA patients. Measurement of NRD may aid in setup.
- Copyright ©the authors 2016
