Effect of non-invasive mechanical ventilation on sleep andnocturnal ventilation in patients with chronic respiratory failure

摘要

BACKGROUND—Chronic respiratory failure (CRF) is associated with nocturnal hypoventilation. Due to the interaction of sleep and breathing, sleep quality is reduced during nocturnal hypoventilation. Non-invasive mechanical ventilation (NMV), usually performed overnight, relieves symptoms of hypoventilation and improves daytime blood gas tensions in patients with CRF. The time course of the long term effect of NMV on sleep and breathing during both spontaneous ventilation (withdrawing the intervention) and NMV was investigated in patients with CRF due to thoracic restriction.
METHODS—Fifteen consecutive patients (13 women) of mean (SD) age 57.9 (12.0) years with CRF due to thoracic restriction were included in the study. During the one year observation period four polysomnographic studies were performed: three during spontaneous breathing without NMV—before initiation of NMV (T0) and after withdrawing NMV for one night at six months (T6) and 12 months (T12-)—and the fourth during NMV after 12 months (T12+). Daytime blood gas tensions and lung function were also measured.
RESULTS—Spontaneous ventilation (in terms of mean oxygen saturation) progressively improved (from T0 to T12-) during both REM sleep (24.8%, 95% CI 12.9 to 36.9) and NREM sleep (21.5%, 95% CI 12.4to 30.6). Sleep quality during spontaneous ventilation also improved in terms of increased total sleeptime (26.8%, 95% CI 11.6 to 42.0) and sleep efficiency (17.5%, 95%CI 5.4 to 29.6) and decreased awakenings (54.0%, 95% CI 70.3 to37.7). Accordingly, REM and NREM sleep stages 3 and 4 significantlyimproved. However, the most significant improvements in both nocturnalventilation and sleep quality were seen during NMV at 12months.
CONCLUSIONS—After longterm NMV both spontaneous ventilation duringsleep and sleep quality in patients with CRF due to thoracicrestriction showed evidence of progressive improvement compared withbaseline after withdrawal of NMV for a single night at six and 12 months. However, the greatest improvements in nocturnal ventilation and sleep were achieved during NMV at 12months.