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Upper airway obstruction induced by non-invasive ventilation using an oronasal interface

  • Neurology • Original Article
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Abstract

Background

On initiation of long-term non-invasive ventilation (NIV), intermittent upper airway obstruction has rarely been described as possibly treatment-induced. Inspiratory pressure effects and the use of an oronasal interface may promote obstructive events in some patients with neuromuscular disease (NMD) and amyotrophic lateral sclerosis (ALS) in particular.

Methods

We evaluated clinical data from 212 patients in whom NIV was initiated using an oronasal mask. Treatment-induced upper airway obstruction (TAO) was defined as an AHI > 5/h along with a relative increase of the AHI in the first treatment night compared to diagnostic sleep studies.

Results

Prevalence of TAO was 14.2% in the entire cohort, 17.0% in patients with NMD (n = 165), 20.4% in the ALS subgroup (n = 93), and 4.3% in non-NMD patients (n = 47). Fixed expiratory positive airway pressure (EPAP, n = 192) was significantly correlated with AHI reduction (r = 0.50; p < 0.001). The inspiratory-expiratory pressure interval (∆PAP, n = 191) showed inverse correlation with the AHI change achieved in the first treatment night (r = − 0.28; p < 0.001). However, ∆PAP and the effective pressure range between EPAP and the highest inspiratory PAP achieved were not predictive of TAO. In patients with ALS, TAO was associated with better bulbar function. Study results were limited by initial EPAP being significantly lower in NMD patients reflecting that sleep apnea was less frequent and severe in this subgroup.

Conclusions

Initiation of NIV using an oronasal interface may be associated with TAO in a subset of patients. Since both EPAP and ∆PAP appear to play a causative role, careful titration of ventilator settings is recommended.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Sleep Medicine and Neuromuscular Disorders, Münster University Hospital, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany

    Valentin Schellhas, Christian Glatz, Ingo Beecken, Angelika Okegwo, Anna Heidbreder, Peter Young & Matthias Boentert

Authors
  1. Valentin Schellhas
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  2. Christian Glatz
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  3. Ingo Beecken
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  4. Angelika Okegwo
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  5. Anna Heidbreder
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  6. Peter Young
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  7. Matthias Boentert
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Contributions

VS, CG, MB, AH, AO, and IB were responsible for data collection. MB and VS performed the statistical analyses. MB, VS, and PY prepared the manuscript.

Corresponding author

Correspondence to Matthias Boentert.

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Conflict of interest

PY has received speaker honoraria and financial research support from the Löwenstein Foundation, Bad Ems, Germany. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

This study was approved by the local ethics authority.

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Schellhas, V., Glatz, C., Beecken, I. et al. Upper airway obstruction induced by non-invasive ventilation using an oronasal interface. Sleep Breath 22, 781–788 (2018). https://doi.org/10.1007/s11325-018-1640-8

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  • DOI: https://doi.org/10.1007/s11325-018-1640-8

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