Acute effects of noninvasive ventilation on sleep physiology in patients with moderate to severe stable chronic obstructive pulmonary disease: a pilot study

Changes in sleep architecture in patients with Chronic Obstructive Pulmonary Disease (COPD) can be explained by a combination of physiological changes in breathing during sleep, with impairment of respiratory mechanics and reduction of arterial oxygenation. This study aimed to evaluate the acute effects of noninvasive ventilation (NIV) – compared to spontaneous breathing – on sleep latency and stages, and on the occurrence of sleep-related respiratory events, nocturnal hypoxemia, and changes in heart rate (HR) in patients with moderate to severe stable COPD. Patients completed two polysomnography (PSG) studies: one during spontaneous breathing and one while receiving NIV in bilevel mode and with backup respiratory rate (RR.) setting. Sleepware G3 software was used for the analysis of PSG and pressure, volume, and ventilator flow curves × time. Participants were 10 female patients with a mean age of 68.1 ± 10.2 years. NIV during sleep decreased sleep onset latency (17 ± 18.8 min vs 46.8 ± 39.5 min; p = 0.02), increased REM sleep time (41.2 ± 24.7 min vs 19.7 ± 21.7 min; p = 0.03), and decreased the obstructive apnea index (OAI) (0 vs 8.7 ± 18.8; p = 0.01). Lower mean HR (66.6 ± 4.1 bpm vs 70.6 ± 5.9 bpm; p = 0.03) and lower maximum HR (84.1 ± 7.3 bpm vs 91.6 ± 7.8 bpm; p = 0.03) were observed in PSG with NIV. The use of NIV in patients with moderate to severe stable COPD while they were sleeping increased REM sleep time and decreased sleep onset latency, the number of obstructive respiratory events, and the mean and maximum HR. •Physiological changes during sleep have a greater impact on individuals with COPD.•Compared to spontaneous breathing, nocturnal NIV increased REM sleep time.•Polysomnography is an important tool to determine the optimal NIV settings.