BACKGROUND: Noninvasive positive-pressure ventilation may benefit patients with amyotrophic lateral sclerosis and respiratory insufficiency. OBJECTIVE: To determine 1) whether patients tolerant of noninvasive positive-pressure ventilation have better survival than intolerant patients and 2) whether bulbar symptoms account for intolerance of noninvasive positive-pressure ventilation. DESIGN: Observational cohort study. SETTING: Tertiary care referral center. PATIENTS: 39 patients with amyotrophic lateral sclerosis who were treated with noninvasive positive-pressure ventilation. INTERVENTION: Noninvasive positive-pressure ventilation was started for patients with new orthopnea, new hypercapnia, or both. Patients were divided into two groups: those tolerant of and those intolerant of noninvasive positive-pressure ventilation. RESULTS: The risk for death from onset of respiratory insufficiency was higher for intolerant patients than for tolerant patients (relative risk, 3.1 [95% CI, 1.8 to 9.6]). Moderate or severe bulbar symptoms were more prevalent among intolerant patients than among tolerant patients (67% compared with 33%; P = 0.04). CONCLUSIONS: Among patients with amyotrophic lateral sclerosis, those who are tolerant of noninvasive positive-pressure ventilation have better survival than do those who are intolerant. Bulbar symptoms partially account for intolerance of noninvasive positive-pressure ventilation.
BACKGROUND: Noninvasive positive-pressure ventilation may benefit patients with amyotrophic lateral sclerosis and respiratory insufficiency. OBJECTIVE: To determine 1) whether patients tolerant of noninvasive positive-pressure ventilation have better survival than intolerant patients and 2) whether bulbar symptoms account for intolerance of noninvasive positive-pressure ventilation. DESIGN: Observational cohort study. SETTING: Tertiary care referral center. PATIENTS: 39 patients with amyotrophic lateral sclerosis who were treated with noninvasive positive-pressure ventilation. INTERVENTION: Noninvasive positive-pressure ventilation was started for patients with new orthopnea, new hypercapnia, or both. Patients were divided into two groups: those tolerant of and those intolerant of noninvasive positive-pressure ventilation. RESULTS: The risk for death from onset of respiratory insufficiency was higher for intolerant patients than for tolerant patients (relative risk, 3.1 [95% CI, 1.8 to 9.6]). Moderate or severe bulbar symptoms were more prevalent among intolerant patients than among tolerant patients (67% compared with 33%; P = 0.04). CONCLUSIONS: Among patients with amyotrophic lateral sclerosis, those who are tolerant of noninvasive positive-pressure ventilation have better survival than do those who are intolerant. Bulbar symptoms partially account for intolerance of noninvasive positive-pressure ventilation.
Authors: P N Leigh; S Abrahams; A Al-Chalabi; M-A Ampong; L H Goldstein; J Johnson; R Lyall; J Moxham; N Mustfa; A Rio; C Shaw; E Willey Journal: J Neurol Neurosurg Psychiatry Date: 2003-12 Impact factor: 10.154
Authors: Hans D Katzberg; Adam Selegiman; Lee Guion; Nancy Yuan; Sungho C Cho; Jonathan S Katz; Robert G Miller; Yuen T So Journal: J Clin Sleep Med Date: 2013-04-15 Impact factor: 4.062