PT  - JOURNAL ARTICLE
AU  - Liam M. Hannan
AU  - Linda Rautela
AU  - David J. Berlowitz
AU  - Christine F. McDonald
AU  - Jennifer M. Cori
AU  - Nicole Sheers
AU  - Caroline Chao
AU  - Fergal J. O'Donoghue
AU  - Mark E. Howard
TI  - Randomised controlled trial of polysomnographic titration of noninvasive ventilation
AID  - 10.1183/13993003.02118-2018
DP  - 2019 May 01
TA  - European Respiratory Journal
PG  - 1802118
VI  - 53
IP  - 5
4099  - http://erj.ersjournals.com/content/53/5/1802118.short
4100  - http://erj.ersjournals.com/content/53/5/1802118.full
SO  - Eur Respir J2019 May 01; 53
AB  - Noninvasive ventilation (NIV) settings determined during wakefulness may produce patient–ventilator asynchrony (PVA) during sleep, causing sleep disruption and limiting tolerance. This study investigated whether NIV titrated with polysomnography (PSG) is associated with less PVA and sleep disruption than therapy titrated during daytime alone.Treatment-naive individuals referred for NIV were randomised to control (daytime titration followed by sham polysomnographic titration) or PSG (daytime titration followed by polysomnographic titration) groups. Primary outcomes were PVA and arousal indices on PSG at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life (HRQoL).In total, 60 participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. PVA events were less frequent in those undergoing polysomnographic titration (median (interquartile range (IQR)): PSG 25.7 (12–68) events·h−1 versus control 41.0 (28–182) events·h−1; p=0.046), but arousals were not significantly different (median (IQR): PSG 11.4 (9–19) arousals·h−1 versus control 14.6 (11–19) arousals·h−1; 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: PSG 95 (95% CI 29–161) min·day−1 versus control −23 (95% CI −86–39) min·day−1; p=0.01). Arterial carbon dioxide tension, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of HRQoL.NIV titrated with PSG is associated with less PVA but not less sleep disruption when compared with therapy titrated during daytime alone.In a cohort comprised mostly of individuals with neuromuscular disorders, nocturnal noninvasive ventilation was associated with less patient–ventilator asynchrony and adherence was better when treatment was titrated during polysomnography http://ow.ly/xibR30nY8c7