UNIGE document Scientific Article
previous document  unige:1169  next document
add to browser collection
Title

Impact of volume targeting on efficacy of bi-level non-invasive ventilation and sleep in obesity-hypoventilation

Authors
Metzger, Marie
Published in Respiratory medicine. 2009, vol. 103, no. 2, p. 165-72
Abstract BACKGROUND: Volume targeting by bi-level positive pressure ventilation (BPPV) has recently been made available by several manufacturers for home care ventilators. Although it may improve nocturnal ventilation, we hypothesized that increased pressure swings related to volume targeting may have a deleterious effect on sleep structure and patient comfort. METHODS: Patients in stable clinical condition (n=12) treated by BPPV for obesity-hypoventilation (BMI: 44+/-8 kg/m(2)) for a median of 30 months (range: 2-138), underwent nocturnal polysomnography with transcutaneous capnography on 2 consecutive nights with either BPPV and usual ventilator settings or BPPV with volume targeting, in randomized sequence. Subjective quality of sleep (St. Mary's Hospital Questionnaire) and comfort of ventilation (VAS scales) were also assessed. RESULTS: Mean IPAP, mean tidal volume, and total ventilation increased significantly with volume targeting. Control of nocturnal hypoventilation was slightly improved with volume targeting (nocturnal TcPCO(2): 42+/-9 vs. 45+/-5 mmHg, p=0.04). However, total sleep time and stage 2 sleep were greater without volume targeting, and wake after sleep onset and awakenings >20s increased with volume targeting. Subjectively, patients described a lighter sleep, of lesser quality and more frequent awakenings with volume targeting; ventilation was perceived as less comfortable, with an increased perception of leaks and of "too much air". CONCLUSION: In stable patients treated by BPPV for obesity-hypoventilation, volume targeting improved control of nocturnal hypoventilation at the expense of a slight decrease in objective and subjective sleep quality, and comfort of ventilation.
Keywords Capnography/methodsCarbon Dioxide/physiologyFemaleHumansMaleObesity Hypoventilation Syndrome/physiopathology/therapyOximetry/methodsPatient SatisfactionPolysomnographyPositive-Pressure Respiration/instrumentation/methodsSleep/physiologyTreatment Outcome
Stable URL http://archive-ouverte.unige.ch/unige:1169
Full text
Article (Author postprint) (264 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Identifiers
PMID: 18579368
Structures

144 hits

2 downloads

Update

Deposited on : 2009-03-19

Export document
Format :
Citation style :