The study aims to compare 2 different strategies used to setup non-invasive ventilation in patients with OCPD-OSA overlap.
With limited comparative data to support the different strategies, there is substantial variation across Europe and the United States in the methods used by clinicians to set up home non-invasive ventilation (NIV) for patients with chronic respiratory failure as a consequence of sleep disordered breathing. Indeed with few data to support the practice, many centres employ full montage polysomnography, which is not only a significant physical burden to the patient but also a financial burden to the healthcare provider in terms of the facilities required, staff training and equipment. The investigators propose to undertake a randomised controlled trial to compare the clinical effectiveness, in terms of the change in daytime arterial partial pressure of carbon dioxide (PaCO2) at 3 months, of limited respiratory polygraphy and full polysomnography to set up NIV in patients with COPD-OSA overlap. Secondary outcome measures at 3 months will include overnight control of gas exchange, subjective sleep quality, health related quality of life and ventilator adherence. COPD-OSA overlap are a patient group that have a rising prevalence with limited data currently available detailing NIV set up, which wholly supports the rationale of using this increasingly important group as a target population for this trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
14
Full sleep and respiratory monitoring with EEG
Limited monitoring with nurse observation and continuous oximetry-capnography overnight for NIV titration.
PaCO2 (Arterial blood gas analysis)
Arterial blood gas analysis
Time frame: 3 months
Health related quality of life (CAT, SRI)
CAT, SRI
Time frame: 3 months
Spirometry (FEV1, FVC)
FEV1, FVC
Time frame: 3 months
Subjective sleep comfort (VAS)
VAS
Time frame: 3 months
Objective sleep comfort (Actigraphy)
Actigraphy
Time frame: 3 months
Respiratory mechanics (to include, work of breathing, PEEPdyn, Cdyn, EMGdi, EMGpara)
Invasive respiratory mechanics performed on discharge NIV settings to include, work of breathing, PEEPdyn, Cdyn, EMGdi, EMGpara
Time frame: Day 1
NIV compliance (machine recorded)
NIV machine recorded compliance
Time frame: 3 months
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