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Noninvasive ventilation in the treatment of sleep-related breathing disorders: concise clinical review

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  • Published:
Journal of Medicine and the Person

Abstract

Noninvasive mechanical ventilation (NIPPV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the past 30 years NIPPV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne–Stokes respiration). In this review we discuss the different types of NIPPV, the specific conditions in which they can be used and the indications, recommendations, and evidence supporting the efficacy of NIPPV. Obstructive sleep apnea syndrome (OSA) is characterized commonly by instability of upper airway during sleep, reduction or elimination of airflow, daytime hyper somnolence, and sleep disruption. It is a risk factor for cardiovascular and cerebrovascular disorders including hypertension, myocardial infarction and stroke. Optimizing patient acceptance and adherence to noninvasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determinated in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrea; these effects are related to reduced humidity of inspired gas. Humidification of delivered gas may improve these symptoms. Sleep specialists should review the results of objective testing with the patient and educate the patient concerning the nature of the disorder and treatment options. General education on the impact of weight loss, sleep position, alcohol avoidance, risk factor modification, and medication effects should be discussed. The patient should be counseled on the risks and management of drowsy driving. Patient education should optimally be delivered as a part of a multidisciplinary chronic disease management team.

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Acknowledgments

The authors thank Dr. Simona Colamartino and Dr. Adele Tasso for the help in conception of the paper and Paul Pilkington for his valuable help in revising the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Respiratory Diseases Unit, Hospital of Sestri Levante, Via Terzi 43, 16039, Sestri Levante, Italy

    Antonello Nicolini

  2. Neuromuscular Diseases Unit, Don Gnocchi Foundation, Milan, Italy

    Paolo Banfi & Agata Lax

  3. Department of Forensic Medicine, ASL4° Chiavarese, Chiavari, Italy

    Cornelius Barlascini

  4. Emergency Department, ASL4° Chiavarese, Chiavari, Italy

    Gianluca Ferraioli

  5. Rehabilitation Department, ASL4° Chiavarese, Chiavari, Italy

    Bruna Grecchi

Authors
  1. Antonello Nicolini
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  2. Paolo Banfi
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  3. Cornelius Barlascini
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  4. Gianluca Ferraioli
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  5. Agata Lax
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  6. Bruna Grecchi
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Corresponding author

Correspondence to Antonello Nicolini.

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Nicolini, A., Banfi, P., Barlascini, C. et al. Noninvasive ventilation in the treatment of sleep-related breathing disorders: concise clinical review. J Med Pers 12, 44–50 (2014). https://doi.org/10.1007/s12682-014-0176-3

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  • DOI: https://doi.org/10.1007/s12682-014-0176-3

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