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State of the art review
Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure
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  • Published on: 15 February 2024
    Continuous positive airway pressure in chronic hypercapnic respiratory failure

    Dear editor,
    I read with interest the state-of-the-art review article by Shah et al1. on the effects of non-invasive ventilation (NIV) on sleep in chronic hypercapnic respiratory failure. However, I wish to delve deeper into the topic of Continuous Positive Airway Pressure (CPAP) especially in patients with Chronic Obstructive Pulmonary Disease-Obstructive Sleep Apnea (COPD-OSA) overlap syndrome and obesity hypoventilation syndrome (OHS).
    COPD-OSA overlap syndrome was first described by Professor Flenley2, which is associated with an increased frequency and severity of COPD exacerbations3, hospitalizations3, and mortality4. Current data indicates that CPAP improves these outcomes5.
    Similarly, in OHS, OSA is highly prevalent, affecting an estimated 90% of patients with OHS6. CPAP has been demonstrated to offer similar benefits to NIV6 7 and is recommended as the initial treatment for stable OHS patients8. CPAP therapy enhances outcomes by improving ventilation, reducing air-trapping, enhancing diaphragmatic function, improving hypercapnic response, and decreasing CO2 production resulting from excessive respiratory muscle work9. Given its advantages and cost-effectiveness compared to NIV, CPAP devices should be considered the initial treatment option7 for both disease before NIV.

    Reference
    1. Shah NM, Steier J, Hart N, Kaltsakas G. Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure. Thorax 2023 doi: 10.1136...

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    Conflict of Interest:
    None declared.