Hypoventilation

About: Hypoventilation is a research topic. Over the lifetime, 1772 publications have been published within this topic receiving 40799 citations. The topic is also known as: respiratory depression.

Treatment of central sleep apnoea in congestive heart failure with nasal ventilation.

Abstract: Cheyne-Stokes respiration (CSR) is common in patients with congestive heart failure (CHF).1 This characteristic crescendo-decrescendo pattern of breathing is often seen during sleep in patients with CHF and is a form of central sleep apnoea.2 Disordered nocturnal breathing leads to oxygen desaturation, poor sleep quality, and altered sleep architecture.3 These features may lead to complaints of daytime somnolence, fatigue, insomnia, and many of the symptoms typical of sleep disordered breathing. It has been proposed that CSR during sleep in patients with heart failure is an indicator of a poor prognosis.4 5 The likely adverse effects of CSR on daytime performance and myocardial function have resulted in the introduction and evaluation of a range of treatments aimed at reducing CSR. These include low flow oxygen,6 theophylline,7 and nasal continuous positive airways pressure (nCPAP).8 In one controlled study nCPAP was shown to improve both sleep quality and daytime myocardial function.8 Other groups have found nCPAP to be ineffective in controlling CSR.9-11 Nocturnal nasal intermittent positive pressure ventilation (nIPPV) is the accepted treatment for patients with chronic respiratory failure due to hypoventilation during sleep.12 13 We hypothesised that nIPPV may also effectively treat central sleep apnoea in heart failure by controlling ventilation and carbon dioxide in patients whose disordered breathing has been linked to fluctuating carbon dioxide levels, relative hyperventilation, and hypocapnia.14 15Nasal IPPV was administered in an attempt to mechanically ventilate the patient through the apnoeic portion of the Cheyne-Stokes cycle, thereby preventing fluctuations in carbon dioxide levels and consequently abolishing CSR. This study describes the use of nocturnal nIPPV in a group of patients with heart failure and Cheyne-Stokes respiration during sleep. The effects of this therapy on respiratory disturbance and sleep quality following an in-hospital acclimatisation period are …

Obesity hypoventilation syndrome treated with non-invasive ventilation: Is a switch to CPAP therapy feasible?

Abstract: Background and objective Obesity hypoventilation syndrome (OHS) can be treated with either continuous positive airway pressure (CPAP) or non-invasive ventilation (NIV) therapy; the device choice has important economic and operational implications. Methods This multicentre interventional trial investigated the safety and short-term efficacy of switching stable OHS patients who were on successful NIV therapy for ≥3 months to CPAP therapy. Patients underwent an autotitrating CPAP night under polysomnography (PSG); if the ensuing parameters were acceptable, they were sent home on a fixed CPAP for a 4-6-week period. It was hypothesized that blood gas analysis, PSG parameters and lung function tests would remain unchanged. Results A total of 42 OHS patients were recruited, of whom 37 patients were switched to CPAP therapy. All patients had a history of severe obstructive sleep apnoea syndrome; chronic obstructive pulmonary disease (COPD) (Global Initiative for Obstructive Lung Disease (GOLD) I/II) was present in 52%. Regarding the primary outcome, 30 of 42 patients (71%, 95% CI: 55-84%) maintained daytime partial pressure of carbon dioxide (PaCO2 ) levels ≤45 mm Hg after the home CPAP period. There was no further impairment in quality of life, sleep parameters or lung function. Interestingly, 24 patients (65%) preferred CPAP as their long-term therapy, despite the high pressure levels used (mean: 13.8 ± 1.8 mbar). After the CPAP period, 7 of 37 patients were categorized as CPAP failure, albeit only due to mild hypercapnia (mean: 47.9 ± 2.7 mm Hg). Conclusion It is feasible to switch most stable OHS patients from NIV to CPAP therapy, a step that could significantly reduce health-related costs. The auto-adjusted CPAP device, used in combination with the analysis of the PSG and capnometry, is a valid titration method in OHS patients.

Treatment of complex sleep apnea syndrome

Abstract: Patients with complex sleep apnea syndrome (CompSAS) present with features of obstructive sleep apnea syndrome but demonstrate not only instability of upper airway tone (leading to classic obstructive apneas and hypopneas) but also unstable, chemosensitive ventilatory control leading to repetitive central apneas or periodic breathing during sleep. The central apneas often become most apparent after application of continuous positive airway pressure (CPAP) to alleviate upper airway obstruction; patients continue to have fragmented sleep and repetitive desaturations as a result of central apneas and hypopneas. In some patients, central apneas appear to abate over time as a result of some form of adaptation to CPAP. How often this occurs is uncertain, however, and many patients with CompSAS require treatment that combines stabilization of the upper airway obstruction with treatment of respiratory center dysfunction. Adaptive servo-ventilation, which provides both a minimum pressure to hold the airway open and a precisely calculated ventilatory assist to minimize cyclic hypoventilation and hyperventilation, has emerged as a leading treatment. Noninvasive ventilation using bilevel positive airway pressure in the spontaneous-timed mode also may regulate ventilation in some patients with CompSAS. There is anecdotal evidence that CompSAS may be successfully treated using combined PAP therapy with oxygen, carbon dioxide, or the addition of dead space, but data are not sufficient to routinely recommend these methods.