Polygraphic respiratory events during sleep with noninvasive ventilation in children: description, prevalence, and clinical consequences.
Summary of "Polygraphic respiratory events during sleep with noninvasive ventilation in children: description, prevalence, and clinical consequences."
The optimal monitoring during sleep with noninvasive positive pressure ventilation (NPPV) has not been validated in children. The aim of the study was to describe on polygraphic (PG) recordings the respiratory events and associated autonomic arousals (AA) and/or 3 % desaturations (DS3%) during nocturnal NPPV.
This was a prospective descriptive study performed in the pulmonology unit of a pediatric university hospital. Consecutive patients admitted for routine follow-up of long-term NPPV were enrolled. Nocturnal PG during sleep with NPPV was performed. A second PG was performed after adjustment of the ventilatory settings when a respiratory event occurred more than 50 times/h.
The PG tracings of 39 patients (age range 1-18 years) were analyzed. Underlying diagnoses included neuromuscular disease (n = 13), obstructive sleep apnea (n = 15), and lung disease (n = 11). Unintentional leaks, patient-ventilator asynchronies, decrease in ventilatory drive, upper airway obstruction with or without reduction of ventilatory drive, and mixed events were observed in 27, 33, 10, 11, 12, and 3 % of the patients, respectively. A predominant respiratory event was observed in all patients. The mean duration spent with respiratory events was 32 ± 30 % (range 3-96 %) of total recording time. Unintentional leaks were the most frequently associated with AA, whereas patient-ventilator asynchronies were rarely associated with AA or DS3%. In eight re-evaluated patients, a decrease in the main event was observed (p = 0.005).
Respiratory events during sleep with NPPV are common in children treated with long-term NPPV. Consequences of respiratory events vary according to the type of event with unintentional leaks being associated preferentially with AA.
AP-HP, Hôpital Armand Trousseau, Pediatric Pulmonary Department, 28 avenue du Docteur Arnold Netter, 75012, Paris, France.
This article was published in the following journal.
Name: Intensive care medicine
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/23344829
- DOI: http://dx.doi.org/10.1007/s00134-012-2806-7
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Medical and Biotech [MESH] Definitions
Abnormal behavioral or physiologic events that are associated with REM sleep, including REM SLEEP BEHAVIOR DISORDER.
Respiratory support system used primarily with rates of about 100 to 200/min with volumes of from about one to three times predicted anatomic dead space. Used to treat respiratory failure and maintain ventilation under severe circumstances.
The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder.
Techniques for effecting the transition of the respiratory-failure patient from mechanical ventilation to spontaneous ventilation, while meeting the criteria that tidal volume be above a given threshold (greater than 5 ml/kg), respiratory frequency be below a given count (less than 30 breaths/min), and oxygen partial pressure be above a given threshold (PaO2 greater than 50mm Hg). Weaning studies focus on finding methods to monitor and predict the outcome of mechanical ventilator weaning as well as finding ventilatory support techniques which will facilitate successful weaning. Present methods include intermittent mandatory ventilation, intermittent positive pressure ventilation, and mandatory minute volume ventilation.
A disorder characterized by recurrent apneas during sleep despite persistent respiratory efforts. It is due to upper airway obstruction. The respiratory pauses may induce HYPERCAPNIA or HYPOXIA. Cardiac arrhythmias and elevation of systemic and pulmonary arterial pressures may occur. Frequent partial arousals occur throughout sleep, resulting in relative SLEEP DEPRIVATION and daytime tiredness. Associated conditions include OBESITY; ACROMEGALY; MYXEDEMA; micrognathia; MYOTONIC DYSTROPHY; adenotonsilar dystrophy; and NEUROMUSCULAR DISEASES. (From Adams et al., Principles of Neurology, 6th ed, p395)