Noninvasive Ventilation Improves Sleep in Amyotrophic Lateral Sclerosis: A Prospective Polysomnographic Study

Vrijsen, Bart; Buyse, Bertien; Belge, Catharina; Robberecht, Wim; Damme, Philip Van; Decramer, Marc; Testelmans, Dries

doi:10.5664/jcsm.4704

Cited by 79 publications

(76 citation statements)

References 35 publications

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“…Non-invasive ventilation (NIV) has been shown to improve nocturnal respiration and quality of life in patients with non-bulbar and bulbar ALS [7,12,18,20,21]. In bulbar ALS, successful implementation of NIV appears to be more difficult and therapeutic effects may be smaller [23]. Survival is significantly improved by NIV in patients with non-bulbar disease, rendering NIV more effective in prolonging life span than any other medical treatment for ALS [7].…”

Section: Introductionmentioning

confidence: 98%

Effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with amyotrophic lateral sclerosis

et al. 2015

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In amyotrophic lateral sclerosis (ALS), non-invasive ventilation (NIV) is indicated if sleep-disordered breathing (SDB), daytime hypercapnia, or significant diaphragmatic weakness is present. We investigated both short-term and long-term effects of NIV on objective measures of sleep and nocturnal respiration in patients with ALS. Polysomnography (PSG) and transcutaneous capnography were conducted for diagnosis of SDB (T0), for treatment initiation (T1), and follow-up 3, 9, and 15 months later (T2, T3, and T4, respectively). Records from 65 patients were retrospectively analyzed at T0 and T1. At subsequent timepoints, the number of full data sets decreased since follow-up sleep studies frequently included polygraphy rather than PSG (T2, 38 patients, T3, 17 patients, T4, 11 patients). At T0, mean age was 63.2 years, 29 patients were female, and 22 patients had bulbar ALS. Immediate sequelae of NIV initiation included significant increases of slow wave sleep, rapid eye movement sleep, and oxygen saturation. Mean apnea-hypopnea index, respiratory rate, and the maximum transcutaneous carbon dioxide tension were reduced. At T2-T4, normoxia and normocapnia were preserved. Sleep quality measures showed no alteration as diurnal use of NIV gradually increased reflecting disease progression. In contrast to previous reports, improvement of sleep and respiratory outcomes was found in both non-bulbar and bulbar patients. NIV significantly improves objective sleep quality and SDB in the first night of treatment in patients with bulbar and non-bulbar ALS. NIV warrants nocturnal normoventilation without deterioration of sleep quality in the long run with only minor changes to ventilator settings.

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Section: Introductionmentioning

confidence: 98%

Effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with amyotrophic lateral sclerosis

et al. 2015

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“…A recent study in which NIV was titrated by in-hospital PSG with incorporation of transcutaneous CO 2 measurement showed an improved sleep efficiency, sleep architecture, and arousal-awakening index in subjects without or with mild bulbar involvement. 32 The effects of leaks and bulbar involvement on sleep quality and patient-ventilator asynchrony should be examined in future studies. Finally, the impact of reduced patient-ventilator asynchrony and enhanced sleep quality on clinical outcomes, including survival, should be evaluated.…”

Section: Niv and Sleepmentioning

confidence: 99%

Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

et al. 2015

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During the last few decades, attention has increasingly focused on noninvasive ventilation (NIV) in the treatment of chronic respiratory failure. The University of Leuven and the University Hospitals Leuven therefore chose this topic for a 2-day working group session during their International Symposium on Sleep-Disordered Breathing. Numerous European experts took part in this session and discussed (1) NIV in amyotrophic lateral sclerosis (when to start NIV, NIV and sleep, secretion management, and what to do when NIV fails), (2) recent insights in NIV and COPD (high-intensity NIV, NIV in addition to exercise training, and NIV during exercise training), (3) monitoring of NIV (monitoring devices, built-in ventilator software, leaks, and asynchronies) and identifying events during NIV; and (4) recent and future developments in NIV (target-volume NIV, electromyography-triggered NIV, and autoregulating algorithms)

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“…2 A comment on this article was written by Fanfulla and Carratù, in which they raised the question whether our full polysomnography titration procedure should be the gold standard for NIV titration in patients with ALS. 3 Rabec et al, on behalf of the SomnoNIV group, replied rather negatively.…”

mentioning

confidence: 99%

“…[4][5][6] Patients with ALS complain of a subjective decrease in sleep quality, and deterioration in sleep structure has also been objectified. 2,7,8 Therefore, it is of great importance to improve sleep architecture and sleep quality in this rapidly progressive disease. Until our data were presented, studies dealing with NIV in patients with ALS did not show an improvement in sleep architecture.…”

mentioning

confidence: 99%

And the Doctor Continues: “…But I Have to Choose My Gear Wisely”

Vrijsen

Buyse

Testelmans

2016

Journal of Clinical Sleep Medicine

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Noninvasive Ventilation Improves Sleep in Amyotrophic Lateral Sclerosis: A Prospective Polysomnographic Study

Cited by 79 publications

References 35 publications

Effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with amyotrophic lateral sclerosis

Effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with amyotrophic lateral sclerosis

Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

And the Doctor Continues: “…But I Have to Choose My Gear Wisely”

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