Noninvasive ventilation in the treatment of sleep-related breathing disorders: concise clinical review

Noninvasive mechanical ventilation (NIPPV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the past 30 years NIPPV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne–Stokes respiration). In this review we discuss the different types of NIPPV, the specific conditions in which they can be used and the indications, recommendations, and evidence supporting the efficacy of NIPPV. Obstructive sleep apnea syndrome (OSA) is characterized commonly by instability of upper airway during sleep, reduction or elimination of airflow, daytime hyper somnolence, and sleep disruption. It is a risk factor for cardiovascular and cerebrovascular disorders including hypertension, myocardial infarction and stroke. Optimizing patient acceptance and adherence to noninvasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determinated in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrea; these effects are related to reduced humidity of inspired gas. Humidification of delivered gas may improve these symptoms. Sleep specialists should review the results of objective testing with the patient and educate the patient concerning the nature of the disorder and treatment options. General education on the impact of weight loss, sleep position, alcohol avoidance, risk factor modification, and medication effects should be discussed. The patient should be counseled on the risks and management of drowsy driving. Patient education should optimally be delivered as a part of a multidisciplinary chronic disease management team.