Polysomnography in stable COPD under non-invasive ventilation to reduce patient-ventilator asynchrony and morning breathlessness
Open accessAbstract
BACKGROUND: Stable severe chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure treated by nocturnal bi-level positive pressure non-invasive ventilation (NIV) may experience severe morning deventilation dyspnea. We hypothesised that in these patients, progressive hyperinflation, resulting from inappropriate ventilator settings, leads to patient-ventilator asynchrony (PVA) with a high rate of unrewarded inspiratory efforts and morning discomfort. METHODS: Polysomnography (PSG), diaphragm electromyogram and transcutaneous capnography (PtcCO(2)) under NIV during two consecutive nights using baseline ventilator settings on the first night, then, during the second night, adjustment of ventilator parameters under PSG with assessment of impact of settings changes on sleep, patient-ventilator synchronisation, morning arterial blood gases and morning dyspnea. RESULTS: Eight patients (61 ± 8 years, FEV(1) 30 ± 8% predicted, residual volume 210 ± 30% predicted) were included. In all patients, pressure support was decreased during setting adjustments, as well as tidal volume, while respiratory rate increased without any deleterious effect on nocturnal PtcCO(2) or morning PaCO(2). PVA index, initially high (40 ± 30%) during the baseline night, decreased significantly after adjusting ventilator settings (p = 0.0009), as well as subjective perception of PVA leaks, and morning dyspnea while quality of sleep improved. CONCLUSION: The subgroup of COPD patients treated by home NIV, who present marked deventilation dyspnea and unrewarded efforts may benefit from adjustment of ventilator settings under PSG or polygraphy.
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Only a few studies have paid attention to adherence to NIV in COPD people, and most focused only on early NIV failure or quantification of adherence.
“Nevertheless, only a few studies have paid attention to adherence to NIV in COPD people, and most of them have focused only on early NIV failure (33,34) or on the quantification of adherence (35).”
From Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. (2022) · cites this paper as [34]
The Methods (Ventilator built-in software) say compliance was downloaded, and the Results report nightly ventilator-use hours in patients with COPD. But the study’s stated focus was patient–ventilator asynchrony and morning breathlessness, not only quantifying adherence; its Introduction does not establish that few studies have examined adherence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredVentilator settings are not easy to adjust and they influence sleep quality, which has spill-over effects on daytime life.
“Ventilator settings are not easy to adjust and they influence sleep quality, which has spill-over effects on daytime life [34, 35].”
From A psychological intervention to promote acceptance and adherence to non-invasive ventilation in people with chronic obstructive pulmonary disease: study protocol of a randomised controlled trial. (2017) · cites this paper as [35]
The Methods describe a monitored, step-by-step process for adjusting ventilator settings, and the Results (Subjective assessment; page unavailable) report improved perceived sleep quality and reduced morning breathlessness after adjustment. The Discussion suggests these improvements may affect quality of life, but it does not establish that changes in sleep quality itself cause broader effects on daytime life. (LLM, conf=0.84)
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- Authors
- Adler, D., Perrig, S., Takahashi, H., Espa, F., Rodenstein, D., Pépin, J. L., & Janssens, J.-P.
- Affiliations
- University Hospital of Geneva (CH)
- Cliniques Universitaires Saint-Luc (BE)
- Inserm (FR)
- Corresponding author
- Adler, Dan
- Venue
- Sleep and Breathing
- Published
- 2011-11-04
- Volume
- 16
- Issue
- 4
- Pages
- 1081-1090
- ISSN
- 1520-9512 (ISSN-L)
- 1522-1709
- PMC
- PMC3497941
- OpenAlex
- W2034389724
- Cited by
- 104
- References
- 36
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 7 · 2020: 8 · 2019: 10 · 2018: 14 · 2017: 6 · 2016: 2 · 2015: 8 · 2014: 10 · 2013: 5 · 2012: 2
- FWCI
- 4.62
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Sleep And Breathing (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Digital Access to Libraries (submittedVersion, other-oa)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- chronic obstructive pulmonary disease, non-invasive ventilation, patient-ventilator asynchrony, hypercapnic respiratory failure, pressure support ventilation, diaphragm electromyography, sleep quality, hyperinflation
- MeSH terms
- Aged, Blood Gas Monitoring, Transcutaneous, Circadian Rhythm, Dyspnea, Equipment Failure, Female, Humans, Male, Middle Aged, Oxygen, Software, Switzerland, Therapy, Computer-Assisted, Wakefulness, Polysomnography, Pulmonary Disease, Chronic Obstructive, Continuous Positive Airway Pressure
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