Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency
Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency
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DOI：
10.1007/s00134-008-1276-4
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发表时间：
2009-02-01
影响因子：
38.9
通讯作者：
Parthasarathy, Sairam
中科院分区：
文献类型：
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作者：
Ambrogio, Cristina;Lowman, Xazmin;Parthasarathy, Sairam
目的：无创通气压力支持（NIV-PS）疗法可以增强通气；然而，这种疗法是固定的，可能无法适应不同患者的需求。我们测试了这样的假设：在慢性呼吸功能不全的患者中，较新的通气模式 [平均容量保证压力支持 (AVAPS)] 和侧卧位与 NIV-PS 和仰卧位相比具有更好的睡眠效率。我们的次要目的是评估同一患者通气模式、体位和睡眠觉醒状态对每分钟通气量 (V) 与点通气量 (E) 的影响。设计：单盲、随机、交叉、前瞻性研究。背景：学术机构。患者和参与者：二十八名患者。干预措施：NIV-PS 或 AVAPS 治疗。测量和结果：对每位患者进行三项睡眠研究；夜间处方验证、AVAPS 或 NIV-PS，以及交叉到备用模式。 AVAPS 和 NIV-PS 之间的睡眠没有差异。仰卧位与侧卧位相比睡眠效率较差（77.9 +/- 22.9 和 85.2 +/- 10.5%；P = 0.04）。 (V) 第 2 阶段 NREM 和 REM 睡眠期间的 over dot(E) 低于清醒期间 (P < 0.0001)； NIV-PS 期间低于 AVAPS (P = 0.029)；体重指数越高，则越低（P = 0.07），但不受身体位置的影响。结论：在慢性呼吸功能不全患者中，仰卧位的睡眠效率比侧卧位差。在睡眠方面，AVAPS 与 NIV-PS 治疗相当，但在统计学上观察到 AVAPS 期间的 V-E 高于 NIV-PS，但意义不明确。 (V)超过点(E)由睡眠-觉醒状态、体重指数和治疗方式确定。
Objective: Noninvasive ventilation with pressure support (NIV-PS) therapy can augment ventilation; however, such therapy is fixed and may not adapt to varied patient needs. We tested the hypothesis that in patients with chronic respiratory insufficiency, a newer mode of ventilation [averaged volume assured pressure support (AVAPS)] and lateral decubitus position were associated with better sleep efficiency than NIV-PS and supine position. Our secondary aim was to assess the effect of mode of ventilation, body position, and sleep wakefulness state on minute ventilation (V) over dot(E) in the same patients. Design: Single-blind, randomized, cross-over, prospective study. Setting: Academic institution. Patients and participants: Twenty-eight patients. Interventions: NIV-PS or AVAPS therapy. Measurements and results: Three sleep studies were performed in each patient; prescription validation night, AVAPS or NIV-PS, and crossover to alternate mode. Sleep was not different between AVAPS and NIV-PS. Supine body position was associated with worse sleep efficiency than lateral decubitus position (77.9 +/- 22.9 and 85.2 +/- 10.5%; P = 0.04). (V) over dot(E) was lower during stage 2 NREM and REM sleep than during wakefulness (P < 0.0001); was lower during NIV-PS than AVAPS (P = 0.029); tended to be lower with greater body mass index (P = 0.07), but was not influenced by body position. Conclusions: In patients with chronic respiratory insufficiency, supine position was associated with worse sleep efficiency than the lateral decubitus position. AVAPS was comparable to NIV-PS therapy with regard to sleep, but statistically greater V-E during AVAPS than NIV-PS of unclear significance was observed. (V) over dot(E) was determined by sleep-wakefulness state, body mass index, and mode of therapy.