RT Journal Article
SR Electronic
T1 Randomised controlled trial of polysomnographic titration of non-invasive ventilation
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1802118
DO 10.1183/13993003.02118-2018
A1 Liam M. Hannan
A1 Linda Rautela
A1 David J. Berlowitz
A1 Christine F. McDonald
A1 Jennifer M. Cori
A1 Nicole Sheers
A1 Caroline Chao
A1 Fergal J. O'Donoghue
A1 Mark E. Howard
YR 2019
UL http://erj.ersjournals.com/content/early/2019/03/06/13993003.02118-2018.abstract
AB Non-invasive ventilation settings determined during wakefulness may produce patient-ventilator asynchrony during sleep, causing sleep disruption and limiting tolerance. This study investigated whether non-invasive ventilation titrated with polysomnography is associated with less patient-ventilator asynchrony and sleep disruption than therapy titrated during wakefulness alone.Treatment naïve individuals referred for non-invasive ventilation were randomised to Control (daytime titration followed by sham polysomnographic titration) or Polysomnography (daytime titration followed by polysomnographic titration) groups. Primary outcomes were patient-ventilator asynchrony and arousal indices on polysomnography at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life.Sixty participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. Patient-ventilator asynchrony events were less frequent in those undergoing polysomnographic titration ([median (interquartile range)]: Polysomnography 25.7/hr (12–68) versus Control 41.0/hr (28–182), p=0.046) but arousals were not significantly different ([median (interquartile range)]: Polysomnography 11.4/hr (9–19) versus Control 14.6/hr (11–19), p=0.258). Overall adherence was not different except in those with poor early adherence (<4 h·day−1) who increased their use after polysomnographic titration (mean difference (95% CI); Polysomnography +95 min·day−1 (29 to 161)  versus Control -23 min·day−1 (-86 to 39), p=0.01). PaCO2, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of health-related quality of life.Non-invasive ventilation titrated with polysomnography is associated with less patient-ventilator asynchrony but not less sleep disruption when compared to therapy titrated during daytime alone.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Hannan reports grants from National Health and Medical Research Council (Australia), during the conduct of the study.Conflict of interest: Ms Rautela has nothing to disclose.Conflict of interest: Dr. Berlowitz has nothing to disclose.Conflict of interest: Dr. McDonald has nothing to disclose.Conflict of interest: Dr. Cori has nothing to disclose.Conflict of interest: Ms Sheers has nothing to disclose.Conflict of interest: Ms Chao has nothing to disclose.Conflict of interest: Dr. Howard has nothing to disclose.Conflict of interest: Dr. O'Donoghue has nothing to disclose.