Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Patient-Ventilator Interactions During Sleep Under Non-Invasive Ventilation in Severe Stable COPD
Non-invasive ventilation (NIV) in severe hypercapnic Chronic Obstructive Pulmonary Diseases
(COPD) may be associated - during sleep - with recurrent episodes of patient ventilatory
asynchrony, which in turn may affect quality of sleep, efficacy of ventilation and comfort
of nocturnal NIV.Polysomnography (PSG) under NIV is necessary to detect these events.
Adjusting ventilator settings according to respiratory events detected by PSG with NIV may
improve quality of sleep, efficacy of ventilation and comfort of nocturnal NIV.
Patients under NIV for hypercapnic COPD have several reasons to develop patient-ventilatory
asynchrony: delayed cycling, and insufficient expiratory time may induce progressive dynamic
hyperinflation, and increase intrinsic positive end-expiratory pressure (PEEPi); too high
levels of pressure support may also contribute to dynamic hyperinflation. Increase in PEEPi
is associated with two respiratory events: unrewarded inspiratory efforts, and
auto-triggering.
Our hypotheses are: 1/that these events occur frequently in COPD under NIV and that they are
not detected by medical history or usual monitoring tools (SpO2; PtcCO2); 2/ that they can
be easily detected by polysomnography; 3/ that simple adjustments of ventilator parameters
aiming to reduce dynamic hyperinflation and unrewarded inspiratory efforts may improve
efficacy of ventilation, quality of sleep and comfort of treatment.
The present study compares the results of two consecutive sleep studies: 1.PSG under NIV in
severe stable COPD under "usual ventilator settings" with 2.PSG under NIV after adapting
ventilator settings to results of initial PSG.
;
Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Supportive Care
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