Impact of home mechanical ventilation on sleep quality

Factors Associated With Change in S3-NIV Score Over Time in People With Chronic Respiratory Failure Treated With Long-Term Home Noninvasive Ventilation

INTRODUCTION

Monitoring changes in symptoms over time during long-term nocturnal home non-invasive ventilation (NIV) using patient-reported outcome measures is crucial. This study aimed to identify factors associated with changes in the S3-NIV total score, its two domains ("respiratory symptoms" and "sleep and NIV-related side effects") and individual item responses.

METHODS

We conducted a retrospective, longitudinal data analysis of a cohort of adults with chronic respiratory failure treated with NIV. Data were obtained from a French homecare provider. Multivariate linear and multinomial ordinal mixed effect models were used to identify factors associated with changes in S3-NIV scores over time.

RESULTS

Median follow-up was 2 years for 2135 participants. Each participant completed a median of five S3-NIV questionnaires; totaling 11,359 analyzed questionnaires. Type of respiratory condition, sex, age and time since NIV initiation were associated with change in S3-NIV score over time. NIV adherence was not associated with total S3-NIV score but high adherence was associated with more severe respiratory symptoms and an improvement in sleep and NIV-related side effects during the follow-up. Intensity of pressure support was associated with a lower total S3-NIV score and more side effects. Face masks and supplemental oxygen were associated with a lower S3-NIV total score.

CONCLUSION

Changes in S3-NIV scores over time are associated with the individual's characteristics and NIV settings. Analysis of the two domains and individual items of the S3-NIV could increase understanding of the difficulties experienced by people on NIV.

The Impact of Non-Invasive Ventilation on Sleep Quality in COPD Patients

Background: Non-invasive ventilation (NIV) has been shown to be the most appropriate therapy for COPD patients with chronic respiratory failure. While physiological parameters and long-term outcome frequently serve as primary outcomes, very few studies have primarily addressed the impact of NIV initiation on sleep quality in COPD. Methods: This single-center prospective cohort study comprised NIV-naïve patients with COPD. All patients underwent polysomnographic evaluation both at baseline and at 3 months follow-up, accompanied by the assessment of health-related quality of life (HRQL) using the Severe Respiratory Insufficiency Questionnaire (SRI) and the Epworth Sleepiness Scale (ESS). A subgroup evaluation was performed to address the impact of comorbid obstructive sleep apnea syndrome (OSAS). Results: Forty-six patients were enrolled and twenty-five patients completed the follow-up period (66.7 ± 7.4 years). NIV resulted in an increase in slow-wave sleep (+2% (−3.5/7.5), p = 0.465) and rapid eye movement sleep (+2.2% (−1.0/5.4), p = 0.174), although no statistical significance could be detected. ESS (−1.7(−3.6/0.1), p = 0.066) also showed a positive trend. Significant improvements in the Respiratory Disturbance Index (RDI) (−12.6(−23.7/−1.5), p = 0.027), lung function parameters, transcutaneous PCO₂ and the SRI summary scale (4.5(0.9/8), p = 0.016) were observed. Conclusion: NIV therapy does not decrease sleep quality and is even capable of improving HRQL, transcutaneous PaCO₂, daytime sleepiness and RDI, and the latter especially holds true for patients with comorbid OSAS.

Acute effects of noninvasive ventilation on sleep physiology in patients with moderate to severe stable chronic obstructive pulmonary disease: a pilot study

OBJECTIVE/BACKGROUND

Changes in sleep architecture in patients with Chronic Obstructive Pulmonary Disease (COPD) can be explained by a combination of physiological changes in breathing during sleep, with impairment of respiratory mechanics and reduction of arterial oxygenation. This study aimed to evaluate the acute effects of noninvasive ventilation (NIV) - compared to spontaneous breathing - on sleep latency and stages, and on the occurrence of sleep-related respiratory events, nocturnal hypoxemia, and changes in heart rate (HR) in patients with moderate to severe stable COPD.

PATIENTS/METHODS

Patients completed two polysomnography (PSG) studies: one during spontaneous breathing and one while receiving NIV in bilevel mode and with backup respiratory rate (RR.) setting. Sleepware G3 software was used for the analysis of PSG and pressure, volume, and ventilator flow curves × time.

RESULTS

Participants were 10 female patients with a mean age of 68.1 ± 10.2 years. NIV during sleep decreased sleep onset latency (17 ± 18.8 min vs 46.8 ± 39.5 min; p = 0.02), increased REM sleep time (41.2 ± 24.7 min vs 19.7 ± 21.7 min; p = 0.03), and decreased the obstructive apnea index (OAI) (0 vs 8.7 ± 18.8; p = 0.01). Lower mean HR (66.6 ± 4.1 bpm vs 70.6 ± 5.9 bpm; p = 0.03) and lower maximum HR (84.1 ± 7.3 bpm vs 91.6 ± 7.8 bpm; p = 0.03) were observed in PSG with NIV.

CONCLUSIONS

The use of NIV in patients with moderate to severe stable COPD while they were sleeping increased REM sleep time and decreased sleep onset latency, the number of obstructive respiratory events, and the mean and maximum HR.

[Quality of Care for People with Home Mechanical Ventilation in Germany: A Scoping Review]

Hintergrund Die außerklinische Intensivversorgung von Menschen mit Langzeitbeatmung ist ein stark anwachsender Bereich mit vielseitigen Versorgungsbedarfen. Ziel dieses Scoping Reviews ist es, den aktuellen Forschungsstand zur Qualität der Versorgung beatmeter Menschen in der außerstationären Intensivpflege in Deutschland darzustellen und Forschungslücken aufzudecken.

Methode Anhand definierter Einschlusskriterien wurden 4 Datenbanken nach Publikationen zur Versorgung von außerklinisch beatmeten Menschen in Deutschland durchsucht. Datenextraktion und Synthese erfolgten nach der Methode der „data driven thematic analysis“. Eine Differenzierung zwischen Forschung und Expertenmeinung fand statt.

Ergebnisse Die Suche ergab 493 Treffer, von denen insgesamt 68 Publikationen eingeschlossen wurden, darunter 2 Leitlinien (3%), 45 (66%) Forschungsarbeiten und 21 (31%) Expertenmeinungen. Inhaltlich konnten folgende Themenfelder identifiziert werden: Organisation und Steuerung der Beatmung (n=43; 63%), pflegerische (n=23; 34%), medizinische (n=39; 57%), therapeutische (n=7; 10%) und Hilfsmittelversorgung (n=24; 35%), sowie die Sicht beatmeter Personen und deren Angehörigen (n=33; 49%) und weitere Themen (n=13; 19%).

Schlussfolgerung Obwohl der Qualitätsdiskurs zur Versorgung beatmeter Personen in der außerklinischen Intensivpflege breit geführt wird, fehlen Studien zur Bedarfsgerechtigkeit von Versorgungsleistungen, zu Selbstbestimmung und Teilhabe in Abhängigkeit der Wohnform oder zur Rolle einzelner ‚Health Professionals‘ im interprofessionellen Team.

Noninvasive ventilation in stable hypercapnic COPD: what is the evidence?

Long-term noninvasive ventilation (NIV) to treat chronic hypercapnic respiratory failure is still controversial in severe chronic obstructive pulmonary disease (COPD) patients. However, with the introduction of high-intensity NIV, important benefits from this therapy have also been shown in COPD. In this review, the focus will be on the arguments for long-term NIV at home in patients with COPD. The rise of (high-intensity) NIV in COPD and the randomised controlled trials showing positive effects with this mode of ventilation will be discussed. Finally, the challenges that might be encountered (both in clinical practice and in research) in further optimising this therapy, monitoring and following patients, and selecting the patients who might benefit most will be reviewed.