0
Original Research: CRITICAL CARE |

Noninvasive Ventilation in COPDNoninvasive Ventilation and Sleep Quality in COPD: Impact of Inspiratory Pressure Levels on Sleep Quality

Michael Dreher, MD; Emelie Ekkernkamp, MD; Stephan Walterspacher, MD; David Walker, MD; Claudia Schmoor, PhD; Jan H. Storre, MD; Wolfram Windisch, MD
Author and Funding Information

From the Department of Pneumology (Drs Dreher, Ekkernkamp, Walterspacher, Walker, Storre, and Windisch), and the Clinical Trials Unit (Dr Schmoor), University Medical Center, Freiburg, Germany.

Correspondence to: Michael Dreher, MD, Department of Pneumology, University Medical Center Freiburg, Killianstrasse 5, Freiburg, D-79106, Germany; e-mail: michael.dreher@uniklinik-freiburg.de


Drs Storre and Windisch contributed equally to this work.

Funding/Support: The study was supported by the German Interdisciplinary Society of Home Mechanical Ventilation (Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, DIGAB). The study group received an open research grant from Breas Medical AB (Molnlycke, Sweden), Respironics Inc (Pittsburgh, PA), and ResMed GmbH and Co KG (Germany).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):939-945. doi:10.1378/chest.11-0253
Text Size: A A A
Published online

Background:  Although high-intensity noninvasive positive pressure ventilation (HI-NPPV) is superior to low-intensity noninvasive positive pressure ventilation (LI-NPPV) in controlling nocturnal hypoventilation in stable hypercapnic patients with COPD, it produces higher amounts of air leakage, which, in turn, could impair sleep quality. Therefore, the present study assessed the difference in sleep quality during HI-NPPV and LI-NPPV.

Methods:  A randomized, controlled, crossover trial comparing sleep quality during HI-NPPV (mean inspiratory positive airway pressure 29 ± 4 mbar) and LI-NPPV (mean inspiratory positive airway pressure 14 mbar) was performed in 17 stable hypercapnic patients with COPD who were already familiar with HI-NPPV.

Results:  Thirteen patients (mean FEV1 27% ± 11% predicted) completed the trial; four patients refused to sleep under LI-NPPV. There was no significant difference in sleep quality between the treatment groups (all P > .05), with a mean difference of −3.0% (95% CI, −10.0 to 3.9; P = .36) in the primary outcome, namely non-rapid eye movement sleep stages 3 and 4. However, nocturnal Paco2 was lower during HI-NPPV compared with LI-NPPV, with a mean difference of −6.4 mm Hg (95% CI, −10.9 to −1.8; P = .01).

Conclusions:  In patients with COPD, high inspiratory pressures used with long-term HI-NPPV produce acceptable sleep quality that is no worse than that produced by lower inspiratory pressures, which are more traditionally applied in conjunction with LI-NPPV. In addition, higher pressures are more successful in maintaining sufficient alveolar ventilation compared with low pressures. Thus, HI-NPPV is a very promising new approach, but still requires large, longer-term trials to determine the impact on outcomes such as exacerbation rates and longevity.

Trial registry:  German Clinical Trials Register (DRKS); No.: DRKS00000520; URL: www.drks.de

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543