Intensive Care Medicine

, Volume 39, Issue 4, pp 739–746 | Cite as

Polygraphic respiratory events during sleep with noninvasive ventilation in children: description, prevalence, and clinical consequences

  • Valeria Caldarelli
  • Jean Christian Borel
  • Sonia Khirani
  • Adriana Ramirez
  • Renato Cutrera
  • Jean-Louis Pépin
  • Brigitte Fauroux
Pediatric Original

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Polygraphy Sleep Noninvasive positive pressure ventilation Patient–ventilator asynchrony Arousal Desaturation 

Notes

Acknowledgments

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.

Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Valeria Caldarelli
    • 1
    • 2
  • Jean Christian Borel
    • 3
    • 4
  • Sonia Khirani
    • 1
    • 5
  • Adriana Ramirez
    • 1
    • 6
  • Renato Cutrera
    • 2
  • Jean-Louis Pépin
    • 3
  • Brigitte Fauroux
    • 1
    • 7
    • 8
  1. 1.AP-HP, Hôpital Armand Trousseau, Pediatric Pulmonary DepartmentParisFrance
  2. 2.UOC Broncopneumologia, Ospedale Pediatrico Bambino Gesù, IRCCSRomeItaly
  3. 3.HP2 Laboratory, Faculté de MédecineUniversité Joseph Fourier, INSERM U 1042GrenobleFrance
  4. 4.AGIRadom, Research and Development DepartmentMeylanFrance
  5. 5.S2A SantéIvry sur SeineFrance
  6. 6.ADEP AssistanceSuresnesFrance
  7. 7.UMPC, Paris VI UniversityParisFrance
  8. 8.XII University, INSERM U 955ParisFrance

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