Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency

Objective Noninvasive ventilation with pressure support (NIV-PS) therapy can augment ventilation; however, such therapy is fixed and may not adapt to varied patient needs. We tested the hypothesis that in patients with chronic respiratory insufficiency, a newer mode of ventilation [averaged volume assured pressure support (AVAPS)] and lateral decubitus position were associated with better sleep efficiency than NIV-PS and supine position. Our secondary aim was to assess the effect of mode of ventilation, body position, and sleep–wakefulness state on minute ventilation in the same patients. Design Single-blind, randomized, cross-over, prospective study. Setting Academic institution. Patients and participants Twenty-eight patients. Interventions NIV-PS or AVAPS therapy. Measurements and results Three sleep studies were performed in each patient; prescription validation night, AVAPS or NIV-PS, and crossover to alternate mode. Sleep was not different between AVAPS and NIV-PS. Supine body position was associated with worse sleep efficiency than lateral decubitus position (77.9 ± 22.9 and 85.2 ± 10.5%; P = 0.04). was lower during stage 2 NREM and REM sleep than during wakefulness ( P