Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular dis
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular disorders Anna Christina Meyer 1 & Jens Spiesshoefer 1,2,9 & Nina Christina Siebers 1 & Anna Heidbreder 1,3 & Christian Thiedemann 1 & Hartmut Schneider 4 & Andrew T. Braun 5 & Winfried Randerath 6,7 & Peter Young 8 & Michael Dreher 9 & Matthias Boentert 1,10 Received: 17 June 2020 / Revised: 24 October 2020 / Accepted: 24 November 2020 # The Author(s) 2020
Abstract Purpose In neuromuscular disorders (NMD), inspiratory muscle weakness may cause sleep-related hypoventilation requiring non-invasive ventilation (NIV). Alternatively, nasal high flow therapy (NHF) may ameliorate mild nocturnal hypercapnia (NH) through washout of anatomical dead space and generation of positive airway pressure. Ventilatory support by NIV or NHF might have favourable short-term effects on sympathovagal balance (SVB). This study comparatively investigated the effects of NHF and NIV on sleep-related breathing and SVB in NMD patients with evolving NH. Methods Transcutaneous CO2 (ptcCO2), peripheral oxygen saturation (SpO2), sleep outcomes and SVB (spectral analysis of heart rate, diastolic blood pressure variability) along with haemodynamic measures (cardiac index, total peripheral resistance index) were evaluated overnight in 17 patients. Polysomnographies (PSG) were randomly split into equal parts with no treatment, NIV and NHF at different flow rates (20 l/min vs. 50 l/min). In-depth analysis of SVB and haemodynamics was performed on 10min segments of stable N2 sleep taken from each intervention. Results Compared with no treatment, NHF20 and NHF50 did not significantly change ptcCO2, SpO2 or the apnea hypopnea index (AHI). NHF50 was poorly tolerated. In contrast, NIV significantly improved both gas exchange and AHI without adversely affecting sleep. During daytime, NHF20 and NHF50 had neutral effects on ventilation and oxygenation whereas NIV improved ptcCO2 and SpO2. Effects of NIV and NHF on SVB and haemodynamics were neutral during both night and daytime. Conclusions NHF does not correct sleep-disordered breathing in NMD patients with NH. Both NHF and NIV exert no immediate effects on SVB. Keywords Nasal high flow therapy . Hypercapnia . Translational respiratory physiology . Neuromuscular disorders . Sympathetic drive
Anna Christina Meyer and Jens Spiesshoefer contributed equally to this work. * Matthias Boentert [email protected] 1
Department of Neurology with Institute for Translational Neurology, Münster University Hospital, Munster, Germany
5
Sleep Disorders Center, Bayview Hospital, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
6
Bethanien Hospital gGmbH Solingen, Solingen, Germany
7
Institute for Pneumology at the University of Cologne, Solingen, Germany
2
Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
8
3
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
Medi
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