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.
KeywordsPolygraphy Sleep Noninvasive positive pressure ventilation Patient–ventilator asynchrony Arousal Desaturation
The authors gratefully thank the “Scientific Council Agiradom” for their support. The research of Brigitte Fauroux is supported by the Association Française contre les Myopathies (AFM), Vaincre la Mucoviscidose (VLM), Assistance Publique-Hôpitaux de Paris, Inserm, ADEP Assistance, and Université Pierre et Marie Curie-Paris 6. V. Caldarelli is a recipient of a fellowship Fondazione Fornasini di Poggio Renatico.
Conflicts of interest
None of the authors has any conflict of interest to disclose.
- 1.Adler D, Perrig S, Takahashi H, Espa F, Rodenstein D, Pépin JL, Janssens JP (2012) Polysomnography in stable COPD under non-invasive ventilation to reduce patient-ventilator asynchrony and morning breathlessness. Sleep Breath 16:1081–1090Google Scholar
- 2.Pépin JL, Borel JC, Janssens JP, Tamisier R, Levy P (2008) Sleep and NIV: monitoring of the patient under home ventilation. Eur Respir Monogr 41:350–366Google Scholar
- 3.Gonzalez-Bermejo J, Perrin C, Janssens JP, Pepin JL, Mroue G, Léger P, Langevin B, Rouault S, Rabec C, Rodenstein D, SomnoNIV Group (2012) Proposal for a systematic analysis of polygraphy or polysomnography for identifying and scoring abnormal events occurring during non-invasive ventilation. Thorax 67:546–552PubMedCrossRefGoogle Scholar
- 4.Finder JD et al (2004) Respiratory care of the patient with Duchenne muscular dystrophy: ATS consensus statement. Am J Respir Crit Care Med 170:456–465Google Scholar
- 6.Ramirez A, Khirani S, Delord V, Aubertin G, Pépin JL, Fauroux B (2012) Assessment of sleep quality by pulse wave amplitude and actigraphy in children with sleep-disordered breathing: evaluation at diagnosis and under non-invasive ventilation. Sleep Breath. doi: 10.1007/s11325-012-0771-6
- 12.Iber C, Ancoli-Israel S, Chesson AL, Quan SF, AAoS (2007) The AASM manual for the scoring of sleep and associated events. American Academy of Sleep Medicine, WestchesterGoogle Scholar
- 18.Morgenthaler TI, Lee-Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B, Brown T, Chesson ALJ, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ, Zak R (2007) Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep 30:1445–1459PubMedGoogle Scholar
- 19.Gaultier C, Boulé M, Allaire Y, Clément A, Burry A, Girard F (1978) Determination of capillary oxygen tension in infants and children: assessment of methodology and normal values during growth. Bull Eur Physiopath Resp 14:287–294Google Scholar
- 23.Nardi J, Prigent H, Adala A, Bohic M, Lebargy F, Quera-Salva MA, Orlikowski D, Lofaso F (2012) Nocturnal oximetry and transcutaneous carbon dioxide in home-ventilated neuromuscular patients. Respir Care ;57:1425–1430Google Scholar
- 27.Janssens JP, Borel JC, Pépin JL, SomnoNIV Group (2011) Nocturnal monitoring of home non-invasive ventilation: the contribution of simple tools such as pulse oximetry, capnography, built-in ventilator software and autonomic markers of sleep fragmentation. Thorax 66:438–445PubMedCrossRefGoogle Scholar