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Research paper
Reduced survival in patients with ALS with upper airway obstructive events on non-invasive ventilation
  1. Marjolaine Georges1,2,
  2. Valérie Attali2,3,
  3. Jean Louis Golmard4,
  4. Capucine Morélot-Panzini1,2,
  5. Lise Crevier-Buchman5,6,
  6. Jean-Marc Collet3,
  7. Anne Tintignac1,
  8. Elise Morawiec1,
  9. Valery Trosini-Desert1,
  10. François Salachas7,
  11. Thomas Similowski1,2,
  12. Jesus Gonzalez-Bermejo1,2
  1. 1Département “R3S”, Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
  2. 2Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
  3. 3Département “R3S”, Service des Pathologies du Sommeil AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
  4. 4Département de biostatistiques, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
  5. 5Unité de la Voix, Service ORL et Chirurgie Cervico-Faciale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
  6. 6Université Paris Descartes, CNRS UMR 7018, Paris, France
  7. 7Département de Neurologie et Centre de Référence pour la SLA, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
  1. Correspondence to Jesus Gonzalez-Bermejo, Département “R3S”, Service de Pneumologie et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-84 Bd de l'hopital, Paris 75651, Cedex 13, France; jesus.gonzalez{at}aphp.fr

Abstract

Introduction Non-invasive ventilation (NIV) is part of standard care in amyotrophic lateral sclerosis (ALS). Intolerance or unavailability of NIV, as well as the quality of correction of nocturnal hypoventilation, has a direct impact on prognosis.

Objectives We describe the importance of NIV failure due to upper airway obstructive events, the clinical characteristics, as well as their impact on the prognosis of ALS.

Methods Retrospective analysis of the data of 190 patients with ALS and NIV in a single centre for the period 2011–2014. 179 patients tolerating NIV for more than 4 h per night without leaks were analysed.

Results Among the 179 patients, after correction of leaks, 73 remained inadequately ventilated at night (defined as more than 5% of the night spent at <90% of SpO2), as a result of obstructive events in 67% of cases (n=48). Patients who remained inadequately ventilated after optimal adjustment of ventilator settings presented with shorter survival than adequately ventilated patients. Unexpectedly, patients with upper airway obstructive events without nocturnal desaturation and in whom no adjustment of treatment was therefore performed also presented with shorter survival. On initiation of NIV, no difference was demonstrated between patients with and without upper airway obstructive events. In all patients, upper airway obstruction was concomitant with reduction of ventilatory drive.

Conclusions This study shows that upper airway obstruction during NIV occurs in patients with ALS and is associated with poorer prognosis. Such events should be identified as they can be corrected by adjusting ventilator settings.

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