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Original Research: Sleep Disorders |

Impact of Different Backup Respiratory Rates on the Efficacy of Noninvasive Positive Pressure Ventilation in Obesity Hypoventilation SyndromeOptimization of Noninvasive Ventilation Setting: A Randomized Trial

Olivier Contal, PhD, PT; Dan Adler, MD; Jean-Christian Borel, PhD; Fabrice Espa, RPSGT; Stephen Perrig, MD; Daniel Rodenstein, MD; Jean-Louis Pépin, MD; Jean-Paul Janssens, MD
Author and Funding Information

From the Division of Pulmonary Diseases (Drs Contal, Adler, and Janssens), and the Sleep Laboratory (Mr Espa and Drs Perrig and Pépin), Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; AGIR a dom (Dr Borel), Recherche et Développement, Meylan, France; Institut National de la Santé et de la Recherche Médical (Dr Pépin), University Hospital, Grenoble, France; and Service de pneumologie et Centre de médecine du sommeil (Drs Rodenstein and Pépin), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.Drs Rodenstein, Pépin, and Janssens are from the SomnoNIV group.

Correspondence to: Olivier Contal, PT, Division of Pulmonary Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 4, 1211 Geneva 14, Switzerland; e-mail: olivier.contal@hcuge.ch


For editorial comment see page 8

Funding/Support: This study was supported by an unrestricted grant from the Pulmonary League of Geneva (www.lpge.ch), the Swiss Society of Pulmonology, and the Lancardis Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):37-46. doi:10.1378/chest.11-2848
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Background:  Unintentional leaks, patient-ventilatory asynchrony, and obstructive or central events (either residual or induced by noninvasive positive pressure ventilation [NPPV]) occur in patients treated with NPPV, but the impact of ventilator settings on these disturbances has been little explored. The objective of this study was to investigate the impact of backup respiratory rate (BURR) settings on the efficacy of ventilation, sleep structure, subjective sleep quality, and respiratory events in a group of patients with obesity hypoventilation syndrome (OHS).

Methods:  Ten stable patients with OHS treated with long-term nocturnal NPPV underwent polysomnographic recordings and transcutaneous capnography on 3 consecutive nights with three different settings for BURR in random order: spontaneous (S) mode, low BURR, and high BURR. No other ventilator parameter was modified.

Results:  The S mode was associated with the occurrence of a highly significant increase in respiratory events, mainly of central and mixed origin, when compared with both spontaneous/timed (S/T) modes. Accordingly, the oxygen desaturation index was significantly higher in the S mode than in either of the S/T modes. The results of nocturnal transcutaneous Pco2 (Ptcco2) (mean value and time spent with Ptcco2 > 50 mm Hg) were similar over the three consecutive nocturnal recordings. The quality of sleep was perceived as slightly better, and the number of perceived arousals as lower with the low- vs high-BURR (S/T) mode.

Conclusions:  In a homogenous group of patients treated with long-term NPPV for obesity-hypoventilation, changing BURR from an S/T mode with a high or low BURR to an S mode was associated with the occurrence of a highly significant increase in respiratory events, of mainly central and mixed origin.

Trial registry:  ClinicalTrials.gov; No.: NCT01130090; URL: www.clinicaltrials.gov

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