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Title: Randomised controlled trial of polysomnographic titration of non-invasive ventilation.
Austin Authors: Hannan, Liam M ;Rautela, Linda ;Berlowitz, David J ;McDonald, Christine F ;Cori, Jennifer M ;Sheers, Nicole ;Chao, Caroline ;O'Donoghue, Fergal J ;Howard, Mark E 
Affiliation: Respiratory and Sleep Medicine
Institute for Breathing and Sleep
Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
Issue Date: May-2019
Date: 2019-05-23
Publication information: The European Respiratory Journal 2019; 53(5): 1802118
Abstract: Non-invasive ventilation settings determined during wakefulness may produce patient-ventilator asynchrony during sleep, causing sleep disruption and limiting tolerance. This study investigated whether non-invasive ventilation titrated with polysomnography is associated with less patient-ventilator asynchrony and sleep disruption than therapy titrated during wakefulness alone.Treatment naïve individuals referred for non-invasive ventilation were randomised to Control (daytime titration followed by sham polysomnographic titration) or Polysomnography (daytime titration followed by polysomnographic titration) groups. Primary outcomes were patient-ventilator asynchrony and arousal indices on polysomnography at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life.Sixty participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. Patient-ventilator asynchrony events were less frequent in those undergoing polysomnographic titration ([median (interquartile range)]: Polysomnography 25.7/hr (12-68) versus Control 41.0/hr (28-182), p=0.046) but arousals were not significantly different ([median (interquartile range)]: Polysomnography 11.4/hr (9-19) versus Control 14.6/hr (11-19), p=0.258). Overall adherence was not different except in those with poor early adherence (<4 h·day-1) who increased their use after polysomnographic titration (mean difference (95% CI); Polysomnography +95 min·day-1 (29 to 161)  versus Control -23 min·day-1 (-86 to 39), p=0.01). PaCO2, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of health-related quality of life.Non-invasive ventilation titrated with polysomnography is associated with less patient-ventilator asynchrony but not less sleep disruption when compared to therapy titrated during daytime alone.
DOI: 10.1183/13993003.02118-2018
ORCID: 0000-0003-1847-4266
Journal: The European Respiratory Journal
PubMed URL: 30880286
Type: Journal Article
Appears in Collections:Journal articles

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