Sigurd Aarrestad1, Magnus Qvarfort2, Anne Louise Kleiven2, Elin Tollefsen3, Ole Henning Skjønsberg4, Jean-Paul Janssens5. 1. Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway; University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Long Term Mechanical Ventilation, Haukeland University Hospital, Norway. Electronic address: UXSIRR@ous-hf.no. 2. Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway. 3. Department of Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway. 4. Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway; University of Oslo, Oslo, Norway. 5. Division of Pulmonary Diseases, Geneva University Hospitals, Switzerland.
Abstract
OBJECTIVES: To evaluate the sensitivity and specificity of a screening test panel for nocturnal hypoventilation (NH) and other sleep related respiratory events during monitoring of patients with chronic hypercapnic respiratory failure (CRF) treated with NIV. METHODS: We performed a prospective study at Oslo University Hospital. Eligible for inclusion were consecutive adults with CRF due to neuromuscular diseases or chest wall disorders treated with NIV scheduled for a follow-up visit. All patients underwent the screening test panel (clinical evaluation, daytime arterial blood gas (ABG), nocturnal pulse oximetry (SpO2) and data from ventilator software) and the reference tests; sleep polygraphy and nocturnal transcutaneous CO2. RESULTS: Of 67 patients included, NH was confirmed in 23-50 according to the 3 definitions used for NH, apnea-hypopnea index (AHIpolygraphy) ≥ 10 was confirmed in 16 and patient-ventilator asynchrony (PVA) ≥ 10% of total recording time in 14. Sensitivity of the combined screening test panel for NH was 87% (95% confidence interval 66-97), 84% (66-95) and 80% (66-90), for abnormal AHIpolygraphy 91% (59-100) and for PVA 71% (42-92). Sensitivity for NH of SpO2 was 48% (27-69), 39% (22-58) and 38% (24-53) and of daytime ABG 74% (52-90), 74% (55-88) and 68% (53-80). Sensitivity and specificity of AHIsoftware for AHIpolygraphy ≥ 10 was 93% (68-100) and 92% (81-98) respectively. DISCUSSION: In patients treated with long term NIV, screening test panel, nocturnal SpO2 and daytime ABG all failed to accurately detect NH, underlining the importance of nocturnal monitoring of CO2. AHIsoftware accurately identified obstructive events and can be used to modify NIV settings. TRIAL REGISTRATION: N° NCT01845233.
OBJECTIVES: To evaluate the sensitivity and specificity of a screening test panel for nocturnal hypoventilation (NH) and other sleep related respiratory events during monitoring of patients with chronic hypercapnic respiratory failure (CRF) treated with NIV. METHODS: We performed a prospective study at Oslo University Hospital. Eligible for inclusion were consecutive adults with CRF due to neuromuscular diseases or chest wall disorders treated with NIV scheduled for a follow-up visit. All patients underwent the screening test panel (clinical evaluation, daytime arterial blood gas (ABG), nocturnal pulse oximetry (SpO2) and data from ventilator software) and the reference tests; sleep polygraphy and nocturnal transcutaneous CO2. RESULTS: Of 67 patients included, NH was confirmed in 23-50 according to the 3 definitions used for NH, apnea-hypopnea index (AHIpolygraphy) ≥ 10 was confirmed in 16 and patient-ventilator asynchrony (PVA) ≥ 10% of total recording time in 14. Sensitivity of the combined screening test panel for NH was 87% (95% confidence interval 66-97), 84% (66-95) and 80% (66-90), for abnormal AHIpolygraphy 91% (59-100) and for PVA 71% (42-92). Sensitivity for NH of SpO2 was 48% (27-69), 39% (22-58) and 38% (24-53) and of daytime ABG 74% (52-90), 74% (55-88) and 68% (53-80). Sensitivity and specificity of AHIsoftware for AHIpolygraphy ≥ 10 was 93% (68-100) and 92% (81-98) respectively. DISCUSSION: In patients treated with long term NIV, screening test panel, nocturnal SpO2 and daytime ABG all failed to accurately detect NH, underlining the importance of nocturnal monitoring of CO2. AHIsoftware accurately identified obstructive events and can be used to modify NIV settings. TRIAL REGISTRATION: N° NCT01845233.
Authors: Vishnu Jeganathan; Linda Rautela; Simon Conti; Krisha Saravanan; Alyssa Rigoni; Marnie Graco; Liam M Hannan; Mark E Howard; David J Berlowitz Journal: BMJ Open Respir Res Date: 2021-03
Authors: Madalina Macrea; Simon Oczkowski; Bram Rochwerg; Richard D Branson; Bartolome Celli; John M Coleman; Dean R Hess; Shandra Lee Knight; Jill A Ohar; Jeremy E Orr; Amanda J Piper; Naresh M Punjabi; Shilpa Rahangdale; Peter J Wijkstra; Susie Yim-Yeh; M Bradley Drummond; Robert L Owens Journal: Am J Respir Crit Care Med Date: 2020-08-15 Impact factor: 21.405