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Alveolar Hypoventilation and Non-invasive Ventilation in COPD

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Complex Sleep Breathing Disorders

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Abstract

The adoption of non-invasive ventilation in the home setting for patients with chronic obstructive pulmonary disease (COPD) has been slow, due to concern that adherence would be low and that quality of life may be compromised. However, home non-invasive ventilation can be effective in COPD with persistent hypercapnia (PaCO2 > 52 mmHg) while in a stable state. Device settings are equally important, as recent randomized trials have found significant advantages with settings that attempt to reduce the PaCO2 (inspiratory positive airway pressure (IPAP) 19–24 cmH2O and expiratory positive airway pressure (EPAP) 4–6 cmH2O), with benefits including a reduced risk of readmission, improved survival, and improvement in health-related quality of life and in adherence to the device. Although some studies have also recommended a high back-up rate to maximize PaCO2 reduction, adherence may not particularly improve with the selection of a back-up rate option. Future studies may need to address the potential confounding by sleep apnea in patients with the overlap syndrome of COPD and sleep apnea, the role of a back-up rate, and further refine the recommended device settings including the role of higher EPAP to address the potential threshold load from intrinsic positive end-expiratory pressure (PEEP).

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Authors and Affiliations

  1. Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Loutfi S. Aboussouan & Umur Hatipoǧlu

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  1. Loutfi S. Aboussouan
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  2. Umur Hatipoǧlu
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Correspondence to Loutfi S. Aboussouan .

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Editors and Affiliations

  1. Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA

    Christine Won

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Aboussouan, L.S., Hatipoǧlu, U. (2021). Alveolar Hypoventilation and Non-invasive Ventilation in COPD. In: Won, C. (eds) Complex Sleep Breathing Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-57942-5_13

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  • DOI: https://doi.org/10.1007/978-3-030-57942-5_13

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