Study Objectives:

In patients treated with noninvasive ventilation, sleep-related breathing changes can modify patient-ventilator interactions which could reduce its effectiveness. The aim of this prospective observational study was to determine the impact of sleep/wake state on leaks, upper airway obstructive events, and asynchronies, in patients treated by long-term noninvasive ventilation.

Methods:

Stable patients adapted to noninvasive ventilation were considered for nocturnal polysomnography. Unintentional leaks, upper airway obstructive events, and asynchronies were compared between sleep and awake periods.

Results:

Twenty-eight patients were enrolled. Underlying diagnoses were neuromuscular disease (n=11), chest wall disease (n=8) and obesity-hypoventilation (n=9). Leaks were more frequent in sleep than in awake periods, with a median of 10% (IQR 0-75%) versus 1% (IQR 0-9%) of time (p<0.001), respectively. During sleep, asynchronies with and without associated leak affected 27% of breaths (IQR 16-39%), compared to non-leak-related asynchronies that were recorded in 8% (IQR 3-25%) of breaths (p<0.001). Asynchronies affecting more than 10% of total breaths were more frequent in sleep (25 patients, 89%) than in awake time (8 patients, 29%; p=0.25). Eleven patients (39%) presented 5 or more upper airway obstructive events without reduction of ventilatory drive per hour of sleep.

Conclusions:

In patients adapted to home noninvasive ventilation, leaks, asynchronies and upper airway obstructive events are frequent during the night and are concentrated in sleep periods. Asynchronies are often associated with leaks. These findings may have clinical implications considering that in patients with low sleep efficiency respiratory events could be underestimated if sleep is not evaluated.

中文翻译：

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睡眠会增加家庭无创通气期间的漏气和不同步：一项多导睡眠图研究

学习目标：

在接受无创通气治疗的患者中，与睡眠相关的呼吸变化会改变患者与呼吸机的相互作用，从而降低其有效性。这项前瞻性观察研究的目的是确定睡眠/清醒状态对长期无创通气治疗患者的漏气、上气道阻塞事件和不同步的影响。

方法：

适应无创通气的稳定患者被考虑进行夜间多导睡眠监测。比较睡眠和清醒期间的意外漏气、上呼吸道阻塞事件和不同步。

结果：

招募了 28 名患者。基础诊断为神经肌肉疾病 (n=11)、胸壁疾病 (n=8) 和肥胖-通气不足 (n=9)。泄漏在睡眠期间比在清醒期间更频繁，时间的中位数分别为 10% (IQR 0-75%)和1% (IQR 0-9%) (p<0.001)。在睡眠期间，有和没有相关漏气的不同步影响了 27% (IQR 16-39%) 的呼吸，相比之下，非漏气相关的不同步影响了 8% (IQR 3-25%) 的呼吸 (p<0.001) . 影响超过 10% 的总呼吸的不同步在睡眠时（25 名患者，89%）比清醒时更频繁（8 名患者，29%；p=0.25）。11 名患者 (39%) 表现出 5 次或更多次上呼吸道阻塞事件，但每小时睡眠时通气驱动没有减少。

结论：

在适应家庭无创通气的患者中，漏气、不同步和上气道阻塞事件在夜间频繁发生，并集中在睡眠期间。异步通常与泄漏有关。考虑到如果不评估睡眠，睡眠效率低的患者可能会低估呼吸事件，这些发现可能具有临床意义。