PT - JOURNAL ARTICLE AU - Alexandra McCartney AU - Devin Phillips AU - Matthew James AU - Olivia Chan AU - J. Alberto Neder AU - Juan P. de-Torres AU - Nicolle J. Domnik AU - Sophie J. Crinion TI - Ventilatory neural drive in chronically hypercapnic patients with COPD: effects of sleep and nocturnal noninvasive ventilation AID - 10.1183/16000617.0069-2022 DP - 2022 Sep 30 TA - European Respiratory Review PG - 220069 VI - 31 IP - 165 4099 - http://err.ersjournals.com/content/31/165/220069.short 4100 - http://err.ersjournals.com/content/31/165/220069.full SO - EUROPEAN RESPIRATORY REVIEW2022 Sep 30; 31 AB - Sleep brings major challenges for the control of ventilation in humans, particularly the regulation of arterial carbon dioxide pressure (PaCO2). In patients with COPD, chronic hypercapnia is associated with increased mortality. Therefore, nocturnal high-level noninvasive positive-pressure ventilation (NIV) is recommended with the intention to reduce PaCO2 down to normocapnia. However, the long-term physiological consequences of PaCO2 “correction” on the mechanics of breathing, gas exchange efficiency and resulting symptoms (i.e. dyspnoea) remain poorly understood. Investigating the influence of sleep on the neural drive to breathe and its translation to the mechanical act of breathing is of foremost relevance to create a solid rationale for the use of nocturnal NIV. In this review, we critically discuss the mechanisms by which sleep influences ventilatory neural drive and mechanical consequences in healthy subjects and hypercapnic patients with advanced COPD. We then discuss the available literature on the effects of nocturnal NIV on ventilatory neural drive and respiratory mechanics, highlighting open avenues for further investigation.A review outlining our current understanding of the ventilatory neural drive in sleep and chronic hypercapnic respiratory failure in COPD as well as the effect of noninvasive ventilation. Important gaps in the literature are highlighted. https://bit.ly/3AlABJR