Skip to main content
Log in

Subjective Sleep Quality During Average Volume Assured Pressure Support (AVAPS) Ventilation in Patients with Hypercapnic COPD: A Physiological Pilot Study

  • Published:
Lung Aims and scope Submit manuscript

An Erratum to this article was published on 30 October 2009

Abstract

The aim of this short-term, single-blind, randomized, crossover study was to evaluate night-time efficacy of and compliance and physiological responses to Average Volume Assured Pressure Support (AVAPS) versus Pressure Support (PS) ventilation. AVAPS or PS ventilation was delivered to nine stable hypercapnic COPD patients via a mask over two 5-day periods during consecutive weeks. The Synchrony® ventilator was used to deliver mask ventilation as follows: 8 ml/kg of ideal body weight (as the targeted inspiratory tidal volume) with IPAP ranging from EPAP up to 30 cmH2O for AVAPS, and the patient’s highest tolerated IPAP level for PS. EPAP was set at the minimum level for both modalities and oxygen was added at a fixed inspiratory fraction to maintain SaO2 above 90%. Arterial blood gases, comfort (by VAS), and perceived sleep efficiency (SE by questionnaire) were measured at baseline (T0) and after three (T1) and five (T2) nights over the two periods. Compliance to ventilation, as measured by mean usage (hours/night), was also recorded. Measurements were similar between the two treatment periods at baseline. PaCO2 and comfort VAS similarly improved for both modalities, whereas the SE score significantly improved at T2 with AVAPS (from 5.1 ± 2.0 to 4.1 ± 2.2, P = 0.001) but not with PS (from 5.1 ± 1.7 to 4.7 ± 1.3, P = 0.219). No difference in mean usage was found between the two modalities. Mask AVAPS is as comfortable and effective as PS at reducing respiratory acidosis but produces better perceived sleep efficiency in stable hypercapnic COPD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. American College of Chest Physicians (1999) Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation: a consensus conference report. Chest 116:521–534

    Article  Google Scholar 

  2. Dìaz O, Bégin P, Torrealba B, Jover E, Lisboa C (2002) Effects of noninvasive ventilation on lung hyperinflation in stable hypercapnic COPD. Eur Respir J 20:1490–1498

    Article  PubMed  Google Scholar 

  3. Nava S, Fanfulla F, Frigerio P, Navalesi P (2001) Physiologic evaluation of 4 weeks of nocturnal nasal positive pressure ventilation in stable hypercapnic patients with chronic obstructive pulmonary disease. Respiration 68:573–583

    Article  CAS  PubMed  Google Scholar 

  4. Elliott MW, Mulvey DA, Moxham J, Green M, Branthwaite MA (1991) Domiciliary nocturnal nasal intermittent positive pressure ventilation in COPD: mechanisms underlying changes in arterial blood gas tensions. Eur Respir J 4:1044–1052

    CAS  PubMed  Google Scholar 

  5. Clini E, Sturani C, Porta R, Scarduelli C, Galavotti V, Vitacca M, Ambrosino N (1998) Outcome of COPD patients performing nocturnal non-invasive mechanical ventilation. Respir Med 92(10):1215–1222

    Article  CAS  PubMed  Google Scholar 

  6. Clini E, Sturani C, Rossi A, Viaggi S, Corrado A, Donner CF, Ambrosino N, on behalf of the Rehabilitation, Chronic Care Study Group of AIPO (2002) The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. Eur Respir J 20:529–538

    Article  CAS  PubMed  Google Scholar 

  7. Windisch W, Kostić S, Dreher M, Virchow JC Jr, Sorichter S (2005) Outcome of patients with stable COPD receiving controlled noninvasive positive pressure ventilation aimed at a maximal reduction of Pa(CO2). Chest 128:657–662

    Article  PubMed  Google Scholar 

  8. Meecham Jones DJ, Paul EA, Jones PW, Wedzicha JA (1995) Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD. Am J Respir Crit Care Med 152:538–544

    CAS  PubMed  Google Scholar 

  9. Krachman SL, Quaranta AJ, Berger TJ, Criner GJ (1997) Effects of noninvasive positive pressure ventilation on gas exchange and sleep in COPD patients. Chest 112(3):623–628

    Article  CAS  PubMed  Google Scholar 

  10. Elliott MW, Simonds AK, Carroll MP, Wedzicha JA, Branthwaite MA (1992) Domiciliary nocturnal nasal intermittent positive pressure ventilation in hypercapnic respiratory failure due to chronic obstructive lung disease: effects on sleep and quality of life. Thorax 47(5):342–348

    Article  CAS  PubMed  Google Scholar 

  11. Strumpf DA, Millman RP, Carlisle CC, Grattan LM, Ryan SM, Erickson AD, Hill NS (1991) Nocturnal positive-pressure ventilation via nasal mask in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 144(6):1234–1239

    CAS  PubMed  Google Scholar 

  12. Gay PC, Hubmayr RD, Stroetz RW (1996) Efficacy of nocturnal nasal ventilation in stable, severe chronic obstructive pulmonary disease during a 3-month controlled trial. Mayo Clin Proc 71(6):533–542

    Article  CAS  PubMed  Google Scholar 

  13. Wijkstra PJ, Lacasse Y, Guyatt GH, Casanova C, Gay PC, Meecham Jones J, Goldstein RS (2003) A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD. Chest 124(1):337–343

    Article  PubMed  Google Scholar 

  14. Criner GJ, Brennan K, Travaline JM, Kreimer D (1999) Efficacy and compliance with noninvasive positive pressure ventilation in patients with chronic respiratory failure. Chest 116(3):667–675

    Article  CAS  PubMed  Google Scholar 

  15. Amato MB, Barbas CS, Bonassa J, Saldiva PH, Zin WA, de Carvalho CR (1992) Volume-assured pressure support ventilation (VAPSV): a new approach for reducing muscle workload during acute respiratory failure. Chest 102:1225–1234

    Article  CAS  PubMed  Google Scholar 

  16. Storre JH, Seuthe B, Fiechter R, Milioglou S, Dreher M, Sorichter S, Windisch W (2006) Average volume-assured pressure support in obesity hypoventilation: a randomized crossover trial. Chest 130(3):815–821

    Article  PubMed  Google Scholar 

  17. Ambrogio C, Lowman X, Kuo M, Malo J, Prasad AR, Parthasarathy S (2009) Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency. Intensive Care Med 35(2):306–313

    Article  PubMed  Google Scholar 

  18. Global Initiative for Chronic Obstructive Pulmonary Disease. Global Strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease: NHLBI/WHO workshop report, NIH Publication 2701. Bethesda, MD: National Institutes of Health, April 2001 (updated November 2006). Available at http://www.goldcopd.com/

  19. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows: report of Working Party Standardization of Lung Function Tests, European Community for Steel and Coal; official statement of the European Respiratory Society. Eur Respir J Suppl 16:5–40

    CAS  PubMed  Google Scholar 

  20. Black LF, Hyatt RE (1969) Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis 99:696–702

    CAS  PubMed  Google Scholar 

  21. Meurice JC, Dore P, Paquereau J, Neau JP, Ingrand P, Chavagnat JJ, Patte F (1994) Predictive factors of long-term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome. Chest 105:429–433

    Article  CAS  PubMed  Google Scholar 

  22. Aitken RC (1969) Measurement of feelings using visual analogue scales. Proc R Soc Med 62:989–993

    CAS  PubMed  Google Scholar 

  23. Glantz SG (2005) Primer of Biostatistics 6/e Valuepack, 6th edn. McGraw-Hill, New York

    Google Scholar 

  24. Windisch W, Storre JH, Sorichter S, Virchow JC Jr (2005) Comparison of volume- and pressure-limited NPPV at night: a prospective randomized cross-over trial. Respir Med 99(1):52–59

    Article  PubMed  Google Scholar 

  25. Schonhofer B, Sonneborn M, Haidl P, Böhrer H, Köhler D (1997) Comparison of two different modes for noninvasive mechanical ventilation in chronic respiratory failure: volume versus pressure controlled device. Eur Respir J 10:184–191

    Article  CAS  PubMed  Google Scholar 

  26. Marrone O, Salvaggio A, Insalaco G (2006) Respiratory disorders during sleep in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 1(4):363–372

    PubMed  Google Scholar 

  27. ODonoghue FJ, Catcheside PG, Ellis EE, Grunstein RR, Pierce RJ, Rowland LS, Collins ER, Rochford SE, McEvoy RD (2003) Australian trial of noninvasive ventilation in chronic airflow limitation investigators. Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors. Eur Respir J 21:977–984

    Article  CAS  Google Scholar 

  28. Janssens JP, Metzger M, Sforza E (2009) Impact of volume targeting on efficacy of bi-level non-invasive ventilation and sleep in obesity-hypoventilation. Respir Med 103:165–172

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by an unrestricted grant from Philips-Respironics Inc. We thank Mr. Steven Coughlin, PhD (Clinical Research Manager, EAME International Group), Mr. Bill Gaussa (Director Global Product Manager, Home Respiratory Care Division), and Mrs. Delphine Leboulanger (Prodict Manager, International Division) for their support by granting our proposal and approving the study in its final version.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Enrico M. Clini.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00408-009-9194-y

Rights and permissions

Reprints and permissions

About this article

Cite this article

Crisafulli, E., Manni, G., Kidonias, M. et al. Subjective Sleep Quality During Average Volume Assured Pressure Support (AVAPS) Ventilation in Patients with Hypercapnic COPD: A Physiological Pilot Study. Lung 187, 299–305 (2009). https://doi.org/10.1007/s00408-009-9167-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-009-9167-1

Keywords

Navigation