Overlap Syndrome Clinical Trial
Official title:
Initiation of Non- Invasive Ventilation at Home Versus Hospital Among Patients With Overlap Syndrome: Randomized Controlled Non-inferiority Study
The study is based on the assumption that in the Overlap Syndrome, the introduction at home of the NIV is as effective in terms of compliance and clinical and gazometric improvement, and life quality, that setting hospital start up. The investigators will study the initiation of NIV at home versus in hospital in two randomized Overlap Syndrome patient groups. The main objective of the study is to demonstrate the non-inferiority of the initiation of the NIV at home versus hospital in terms of compliance.
The Overlap Syndrome is defined by the coexistence of chronic obstructive pulmonary disease
(COPD) and an apnea - hypopnea syndrome obstructive sleep (SAHS). The interaction between
these two diseases is responsible for deepest nocturnal desaturation, decreased sensitivity
to CO2, more pronounced sleep alterations, more frequent daytime hypercapnia, a higher risk
of hypertension pulmonary and increased cardiovascular risk, compared to subjects with COPD
or isolated SAHS.
The Overlap Syndrome treatments are continuous positive airway pressure (CPAP) or
non-invasive ventilation (NIV), associated complemented or not by oxygen therapy during
sleep. The criteria for choosing the type of treatment are not well defined. Quality and
compliance of the NIV are very important in all diseases leading to chronic respiratory
failure whose Overlap Syndrome. The increase in the number of patients treated with NIV is
estimated at over 12% per year. The NIV startup is usually performed in a conventional
hospitalization but congestion healthcare pathways lead to increase waiting time before
treatment. Thus, to date, no study has validated a supported alternative to meet the
increase in the number of patients on NIV while maintaining quality service.
The HAS has defined good candidates for a NIV home based startup, on the following criteria:
patients with a recognized indication of NIV in the long term , with stable respiratory
failure, requiring only nocturnal ventilation, surrounded by caregivers mastering the use of
equipment and whose location allows rapid intervention. The study is based on the assumption
that in the Overlap Syndrome, the introduction at home of the NIV is as effective in terms
of compliance and clinical and gazometric improvement, and life quality, that setting
hospital start up. The investigators will study the initiation of NIV at home versus in
hospital in two randomized Overlap Syndrome patient groups. The main objective of the study
is to demonstrate the non-inferiority of the initiation of the NIV at home versus hospital
in terms of compliance.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
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