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NIV in clinical practice: view from the frontline
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P1 NON-INVASIVE VENTILATION IN MOTOR NEURONE DISEASE: THE UTILITY OF THE EPWORTH SLEEPINESS SCALE AS AN OUTCOME MEASURE

1L. H. Piggin, 1E. W. Thornton, 2R. M. Angus, 2B. Chakrabarti, 3C. A. Young. 1School of Psychology, University of Liverpool, Liverpool, UK, 2Aintree Chest Centre, University Hospital Aintree, Liverpool, UK, 3Walton Centre for Neurology and Neurosurgery, Liverpool, UK

Introduction: The Epworth Sleepiness Scale (ESS) is used to quantify changes in daytime somnolence. It is not known whether quantitative changes in ESS scores accurately reflect qualitative experiences of patients with motor neurone disease (MND) following initiation of non-invasive ventilation (NIV) in terms of perceived changes in sleep quality, fatigue and daytime somnolence.

Methods: This study, comprising both quantitative and qualitative methods, assessed 7 MND patients (6 men; mean age 66 years) immediately prior to NIV commencement and again 3 months post NIV initiation. Each assessment included overnight pulse oximetry, the ESS and one semi-structured interview. Interviews underwent thematic analysis before comparison with quantitative data.

Results: Pre-NIV, 3 patients scored ⩾10 on ESS (range 2–17; M = 8.0). Pre-NIV ESS scores correlated significantly with percentage time <90% saturation in pre-NIV oximetry (M = 21.22%, SD = 22.06; r = 0.786, p = 0.036). However, ESS scores did not appear to correspond to individual qualitative experiences, underestimating symptom severity. The majority experienced disturbed sleep, fatigue and daytime somnolence that often caused low mood and negative illness perception. Post-NIV, ESS scores (range 1–12; M = 6.29) did not differ significantly from pre-NIV scores (t (6) = 0.61, p = 0.56) and did not correlate with any post-NIV oximetry markers. The trend in ESS scores towards decreased sleepiness (M = 0.29, SD = 7.65) following NIV initiation did significantly correlate with the change in percentage time spent <90% saturation (M = 16.8, SD = 13.24; r = 0.841, p = 0.018). Qualitatively, patients reported substantial improvement in sleep quality and reductions in daytime somnolence beyond those suggested by change in ESS scores. For the majority, qualitative changes following NIV initiation were significant enough to improve …

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