Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular disorders

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 10-min 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.

The quality and quantity of sleep on dexmedetomidine during high-flow nasal cannula oxygen therapy in critically ill patients

“…However, patients in the non-DEX group showed a median sleep efficiency during the study period of only 22%. Meyer et al reported that HFNC did not correct the sleep quality or quantity compared with no treatment or NPPV for sleep-related disorder breathing in patients with neuromuscular disease (8). In their study, the median sleep efficiency was 55.9%, and the 91% TST was predominantly occupied by shallow sleep of stage N1 and N2 at an HFNC flow rate of 50 L / min.…”

“…In their study, the median sleep efficiency was 55.9%, and the 91% TST was predominantly occupied by shallow sleep of stage N1 and N2 at an HFNC flow rate of 50 L / min. In addition, HFNC at a high flow rate of 40 to 60 L / min was poorly tolerated (8,26,27). Anxiety and discomfort associated with nasal cannula, a high flow and high temperature of humid gases, noise exposure, and condensation that accumulated in the nasal prong and spraying into patient's nostril may all disrupt a patient's sleep (9)(10)(11)(12).…”

“…Therefore, HFNC has been expected to achieve a high sleep quality and quantity in ICU patients. However, previous studies have reported that sleep in patients receiving HFNC in a critical care setting may be impaired due to severe fragmentation of sleep periods by nursing interventions, significant reduction in deep sleep, and the predominance of shallow sleep (8,9). Anxiety or discomfort associated with nasal cannula, high temperatures and humid gases, noise exposure, and condensation in the nasal prong might be the main causes of sleep disorder in patients treated with HFNC (9)(10)(11)(12).…”

Effects of nasal high flow on sympathovagal balance, sleep, and sleep-related breathing in patients with precapillary pulmonary hypertension

“…However, as the segments were only 2 h long, it was extremely difficult to find distinct 10 min recordings of constant stable N2 with no artifacts and comparable respiratory rates. Furthermore, in a nighttime setting, it would not have been possible to additionally adjust for respiratory rate as previously established by our group [ 53 , 54 ].…”

The Safety of a High-Flow Nasal Cannula in Neuromuscular Disease Patients with Acute Respiratory Failure: A Retrospective Case-Series Study

“…Moreover, HFNC appeared to be better tolerated than NIV in a patient with ARF consequent to immune-related myasthenia gravis [ 14 ]. By contrast, nighttime provision of HFNC at 20 and 50 L/min (without additional O 2 supplementation) was found to be poorly tolerated in a group of 17 clinically stable patients with genetically proven NMD [ 15 ].…”