• Respiratory medicine · Dec 2013

    Pulse wave amplitude reduction: a surrogate marker of micro-arousals associated with respiratory events occurring under non-invasive ventilation?

    • Dan Adler, Pierre Olivier Bridevaux, Olivier Contal, Marjolaine Georges, Elise Dupuis-Lozeron, Elisabeth Claudel, Jean Louis Pépin, and Jean Paul Janssens.
    • Division of Pulmonary Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland; Sleep Laboratory, Department of Psychiatry, Geneva University Hospitals, 1211 Geneva 14, Switzerland. Electronic address: dan.adler@hcuge.ch.
    • Respir Med. 2013 Dec 1; 107 (12): 2053-60.

    IntroductionRespiratory events occurring under non-invasive ventilation (NIV) may produce sleep fragmentation. Alternatives to polysomnography (PSG) should be validated for providing simple monitoring tools for patients treated at home with NIV.ObjectivesTo study the value of pulse wave amplitude (PWA) reduction as a surrogate marker of cortical micro-arousals associated with respiratory events occurring during NIV.Methods27 PSG tracings under NIV recorded in 9 stable patients with Obesity Hypoventilation Syndrome (OHS), under 3 different ventilator modes (no back-up rate, low or high back-up rate) were analyzed. For all respiratory events (obstructive, central, or mixed event), the association with EEG-micro-arousals, PWA reduction of more than 30% and the presence of associated SpO2 desaturation ≥ 4% was recorded.Results2474 respiratory events during NREM sleep were analyzed. 73.6% were associated with an EEG-MA, 91.4% with a ≥ 4% decrease in SpO2, and 74.9% with a significant PWA reduction. Sensitivity of PWA for the detection of an EEG-micro-arousal related to a respiratory event was 89.1% [95%CI: 76.7-95.3]. Positive predictive value (PPV) was 87.0% [95%CI: 75.0-94.0]. Sensitivity of PWA was highest in the S mode, compared to both other S/T modes, p = <0.001. Sensitivity of PWA was also higher for central and mixed events, compared to obstructive respiratory events, p = <0.05.ConclusionsPWA reduction is a sensitive marker with a high PPV for the detection of EEG-MA associated with respiratory events during NREM sleep in stable OHS patients treated by NIV. In this situation, PWA could be used to improve scoring of hypopneas and allow an appropriate assessment of sleep fragmentation related to respiratory events.Copyright © 2013 Elsevier Ltd. All rights reserved.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…