Chest
Volume 110, Issue 5, November 1996, Pages 1179-1183
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Sleep: Clinical Investigations
Long-term Effects of Nasal Intermittent Positive-Pressure Ventilation on Pulmonary Function and Sleep Architecture in Patients With Neuromuscular Diseases

https://doi.org/10.1378/chest.110.5.1179Get rights and content

Study objective

This article evaluates the long-term clinical and physiologic effects of nocturnal nasal intermittent positive-pressure ventilation (NIPPV) in patients with neuromuscular disease.

Methods

Before and after 18±2 months of NIPPV, we measured during the daytime arterial blood gases, lung mechanics, and respiratory muscle strength in 8 patients (51±5 years; mean±SEM). Sleep parameters were also evaluated at 10±2 months.

Results

All patients tolerated NIPPV and none required hospitalization during follow-up. After NIPPV, daytime arterial Po2 increased (71±4 to 81±2 mm Hg; p<0.05) and arterial Pco2 decreased (46±3 to 41±1 mm Hg; p<0.05). The change of PaO2 after NIPPV was related to its baseline value (r2=0.78, p<0.05). Vital capacity (50±6% predicted), total lung capacity (63±4% predicted), alveolar-arterial oxygen gradient (20±3 mm Hg), and maximal inspiratory (39±9% predicted) or expiratory (32±5% predicted) pressures did not change after NIPPV. The apnea-hypopnea index fell from 22±6 to 1±1 (p<0.05), and both sleep architecture and sleep efficiency (from 59±8% to 83±5%; p<0.05) were enhanced. The time spent with an arterial oxygen saturation (SaO2) value below 90% decreased from 160±53 min to 8±4 min (p<0.05). Mean (88±3 to 95±1%; p<0.05) and minimal nocturnal SaO2 (67±5 to 89±1%; p<0.001) improved after NIPPV.

Conclusions

In patients with neuromuscular disease, long-term NIPPV is well tolerated and easy to implement clinically. In these patients, long-term NIPPV improves daytime arterial blood gas values and sleep-disordered breathing. However, it does not modify lung mechanics or respiratory muscle strength.

Section snippets

Patients

Eight consecutive patients with neuromuscular diseases, receiving NIPPV for at least 1 year, were evaluated prospectively. Table 1 presents the main anthropometric characteristics and clinical diagnoses of the 8 patients studied. There were two men and six women. Ages ranged from 22 to 70 years, with a mean value of 51±5 years. Four patients had myasthenia gravis, three had limb-girdle muscular dystrophy, and one had Scotland myopathy (Table 1). All patients were in clinically stable condition

Baseline Data

Diurnal somnolence was the most common symptom, followed by insomnia and morning headache. Two patients (patients 3 and 4) were heavy snorers. Table 2 shows the actual and percent predicted values of pulmonary function. Before NIPPV, all patients showed moderate to severe ventilatory restriction (Table 2). Average vital capacity was 50±6% of predicted, ranging from 21 to 70%. Total lung capacity was also reduced (63±4% of predicted), ranging from 45 to 74%. Awake arterial blood gas values

DISCUSSION

This study evaluates the clinical and physiologic effects of long-term (18±2 months) NIPPV in 8 patients with lone neuromuscular disease (Table 1). It shows that in these patients, NIPPV is easy to implement and well tolerated. Further, long-term NIPPV normalizes daytime arterial blood gas values, corrects previous sleep respiratory disturbances (when the patient is receiving NIPPV), and improves sleep quality. However, it fails to modify the efficiency of the lung as a gas exchanger, the

ACKNOWLEDGMENTS

We thank Dr. R. Estopà (Hospital Bellvitge, Spain) for his advice and encouragement.

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  • Cited by (0)

    Supported, in part, by Garches Foundation, Colegio Médicos de Baleares and ABEMAR.

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