Journal article
Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial
Thorax, Vol.64(7), pp.561-566
2009
PMID: 19213769
Abstract
Background: Sleep hypoventilation has been proposed as a cause of progressive hypercapnic respiratory failure and death in patients with severe chronic obstructive pulmonary disease (COPD). A study was undertaken to determine the effects of nocturnal non-invasive bi-level pressure support ventilation (NIV) on survival, lung function and quality of life in patients with severe hypercapnic COPD.
Method: A multicentre, open-label, randomised controlled trial of NIV plus long-term oxygen therapy (LTOT) versus LTOT alone was performed in four Australian University Hospital sleep/respiratory medicine departments in patients with severe stable smoking-related COPD (forced expiratory volume in 1 s (FEV1.0) <1.5 litres or <50% predicted and ratio of FEV1.0 to forced vital capacity (FVC) <60% with awake arterial carbon dioxide tension (PaCO2) >46 mm Hg and on LTOT for at least 3 months) and age <80 years. Patients with sleep apnoea (apnoea-hypopnoea index >20/h) or morbid obesity (body mass index >40) were excluded. Outcome measures were survival, spirometry, arterial blood gases, polysomnography, general and disease-specific quality of life and mood.
Results: 144 patients were randomised (72 to NIV + LTOT and 72 to LTOT alone). NIV improved sleep quality and sleep-related hypercapnia acutely, and patients complied well with therapy (mean (SD) nightly use 4.5 (3.2) h). Compared with LTOT alone, NIV (mean follow-up 2.21 years, range 0.01–5.59) showed an improvement in survival with the adjusted but not the unadjusted Cox model (adjusted hazard ratio (HR) 0.63, 95% CI 0.40 to 0.99, p = 0.045; unadjusted HR 0.82, 95% CI 0.53 to 1.25, p = NS). FEV1.0 and PaCO2 measured at 6 and 12 months were not different between groups. Patients assigned to NIV + LTOT had reduced general and mental health and vigour.
Conclusions: Nocturnal NIV in stable oxygen-dependent patients with hypercapnic COPD may improve survival, but this appears to be at the cost of worsening quality of life.
Details
- Title
- Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial
- Authors/Creators
- R D McEvoy - Adelaide Institute for Sleep HealthR J Pierce - Institute for Breathing and SleepD Hillman - Queen Elizabeth II Medical CentreA Esterman - University of South AustraliaE E Ellis - The University of SydneyP G Catcheside - Flinders UniversityF J O’Donoghue - Institute for Breathing and SleepD J Barnes - The University of SydneyR R Grunstein - The University of SydneyAustralian Trial Non-Invasive VentPeter Eastwood
- Publication Details
- Thorax, Vol.64(7), pp.561-566
- Identifiers
- 991005592760007891
- Copyright
- © 2009 BMJ Publishing Group and British Thoracic Society
- Murdoch Affiliation
- Vice Chancellery
- Language
- English
- Resource Type
- Journal article
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- Citation topics
- 1 Clinical & Life Sciences
- 1.65 Allergy
- 1.65.192 COPD
- Web Of Science research areas
- Respiratory System
- ESI research areas
- Clinical Medicine