Asynchronies and sleep disruption in neuromuscular patients under home noninvasive ventilation

Background: Noninvasive ventilation (NIV) may improve quality of sleep but patient-ventilator asynchronies (PVA) may affect sleep structure. Possible changes in ventilation quality after hospital discharge are poorly known.

Objective: To analyse the impact of different kinds of PVA on sleep disruption in chronically ventilated neuromuscular patients after in-hospital optimization of ventilator setting with nocturnal polygraphy, and to compare home and hospital PVA occurrence.

Methods: Eighteen patients were included in the study. PVA during hospital polygraphic monitoring and during successive home polysomnography were analysed. The relationships between PVA and air leaks, sleep stages, and arousals or awakenings recorded during polysomnography were investigated.

Results: Overall, PVA had a low rate of occurrence (4.32 events/h, IQR 1.75-6.25), but their number was higher during home polysomnographies than in hospital (p = 0.0039): their increase was correlated to an increase in air leaks with respect to hospital monitorings (p = 0.020). Autotriggerings were the most common asynchronies, followed by ineffective efforts (IE) and prolonged insufflations (PI). All asynchronies occurred more often in NREM than in REM sleep. Autotriggerings and IE were more often associated with arousals than PI (p < 0.05). PVA rate was correlated with arousals and awakenings rate (r = 0.49, p = 0.03), but, due to the low PVA rate, only 12.69% of arousals and awakenings were associated with PVA.

Conclusions: Most kinds of PVA are often associated with arousals. Polygraphic monitoring may help to improve ventilator setting. However, air leaks and autotriggerings may increase in unassisted environments. Therefore, it may be useful to extend control of NIV effects at home.