In patients under bi-level pressure support ventilation for obesity hypoventilation syndrome, this study aims to determine if it is better, in terms of efficacy and patient-ventilator synchronisation to use * Spontaneous mode (S) * Spontaneous/Timed mode (ST) with an intermediate back-up rate, slightly below the respiratory rate of the patient * Timed mode (T), with a ventilator respiratory rate above that of the patient. This issue has to our knowledge only been marginally studied without any consensus.
Eligibility: patients under home bi-level pressure support ventilation for obesity hypoventilation in a stable clinical condition, aged over 18 Methods: Three consecutive sleep studies in a randomised sequence with usual parameters Inspiratory Positive Airway Pressure(IPAP), Expiratory Positive Airway Pressure (EPAP) and change of only back up respiratory rate (RR): one night in a spontaneous mode, one with an intermediate RR, and one with a RR above that of the patient Endpoints: Quality of sleep and sleep structure (polysomnography), patient-ventilator synchronisation and respiratory events under NIV, efficacy of ventilation: oxygen saturation measured by pulse oxymetry (SaO2); transcutaneous capnography (PtcCO2), and comfort.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
10
3 consecutive nights in randomized order, in either "S" (Spontaneous) mode, "ST" (Spontaneous/Timed) mode with a back-up rate under spontaneous respiratory rate of the patient, or in "ST" (Spontaneous/Timed) mode with a back-up rate at least 2 cycles/minute above spontaneous nocturnal respiratory rate. Each assessment will include complete polysomnographic recording (sleep study) as well as SpO2, PtcCO2, pneumotachograph (flow), mask pressure, quantitative assessment of patient-ventilator synchronisation, central or obstructive apnea and hypopnea, data of built-in software, and rating of patient comfort
Geneva University hospital - Sleep laboratory
Geneva, Switzerland
Sleep structure
Quantification of quality of sleep assessed by polysomnography (sleep stages, arousals)
Time frame: Night 1
Sleep structure
Quantification of quality of sleep assessed by polysomnography (sleep stages, arousals)
Time frame: Night 2
Sleep structure
Quantification of quality of sleep assessed by polysomnography (sleep stages, arousals)
Time frame: Night 3
Transcutaneous capnography (PtcCO2)
Mean PtcCO2 during Night 1
Time frame: Night 1
Transcutaneous capnography (PtcCO2)
Mean PtcCO2 during night 2
Time frame: Night 2
Transcutaneous capnography (PtcCO2)
Mean PtcCO2 during night 3
Time frame: Night 3
Correlation between microarousal index and autonomic arousal index
Correlation between microarousal index (assessed by EEG) and autonomic arousal index under NIV (assessed by pulse plethysmography)
Time frame: Night 1
Correlation between microarousal index and autonomic arousal index
Correlation between microarousal index (measured by EEG) and autonomic arousal index (measured by pulse plethysmography)
Time frame: Night 2
Correlation between microarousal index and autonomic arousal index
Correlation between microarousal index (measured by EEG) and autonomic arousal index (measured by pulse plethysmography)
Time frame: Night 3
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