Patients Report Poor Sleep Quality Despite Nocturnal Noninvasive Ventilation Use

Despite the use of nocturnal noninvasive ventilation (NIV), patients report having poor quality of sleep, according to a recent study.

Polysomnography (PSG) guidance should be used with nocturnal noninvasive ventilation (NIV) to reduce poor sleep quality among patients with chronic respiratory diseases, a study finds.

“In this real-life study, half of a cohort of patients under long-term NIV initiated without PSG guidance reported poor sleep quality according to the PSQI [Poor Sleep Quality Index], irrespective of NIV indication,” wrote the researchers of the study. “This was associated with lower QoL [quality of life], in line with literature.”

The results of this cohort study were published in the official journal of the Portuguese Society of Pulmonology, Pulmonology.

Prior research has shown that NIV can restore sleep quality, according to PSG reports. For individuals with chronic respiratory diseases associated with deteriorated sleep and poor quality of life (QoL), NIV with PSG guidance should be able to restore sleep. However, lack of resources, such as PSG guidance has resulted in patients reporting poor sleep, despite NIV prevalence.

The researchers of this study aimed to evaluate the impact of NIV without PSG guidance on an individual’s sleep quality, and to better understand the potential risk factors that impact a person’s overall QoL.

Over 90 days, the patients enrolled in the study had established being on NIV without PSG guidance, were clinically stable for at least 3 months, and were attending the clinic for a scheduled follow-up. These patients were evaluated using PSQI score, the Severe Respiratory Insufficiency questionnaire (SRI), and the Epworth Sleepiness Scale. Additionally, NIV side effects were assessed on a scale, including factors such as eye irritation, dry mouth, hoarseness, leaks, dysventilation dyspnea, etc. Lastly, NIV usage was assessed using 30-day ventilator logs.

As a result, 159 patients were recruited for the study, but 32 declined or could not participate. In total, 127 patients were enrolled in the study for analysis. Of these patients, 64 (50.5%) were placed in the “poor sleep quality” group.

After analysis, NIV indications, settings, effect on partial pressure of carbon dioxide (PaCO2), and adherence did not differentiate between patients with good sleep quality and patients with poor sleep quality.

However, the patients in the poor sleep quality group reported higher scores for mouth dryness (59% v 40%; P = .033) and overnight NIV interruptions (0.3; 95% CI, 0.0-0.1; P = .026) v (0.1; 95% CI, 0.0-0.3; P = .026) compared with the good quality sleep group. Additionally, the researchers identified odds ratios (ORs) for benzodiazepine use (OR, 6.83; 95% CI, 1.53-30.65; P = .012), airway secretions (OR, 4.66; 95% CI, 1.06-20.42; P = .041), and abnormal leaks (OR, 4.52; 95% CI, 1.25-16.39; P = .022).

Furthermore, SRI-based QoL was lower among poor sleep quality patients (4.52; 95% CI, 39.7-62.5; P<.001) compared with good quality sleep patients (62; 95% CI, 50.0-76.3; P<.001), with PSQI scores inversely correlated with SRI (rho = -0.410; P<.001).

The researchers acknowledge limitations to their study, which include being based in a single-center, was observational in design, lacked evaluation of the effect of NIV initiation on sleep quality, and having a small trial size. Despite these limitations, the researchers believe this study adds to the understanding of NIV efficacy, while identifying factors that may reduce this efficiency.

“The 3 variables independently associated with poor sleep quality in this study can all be subject to medical intervention,” added the researchers. “Our data emphasize the known importance of controlling leaks during home nocturnal NIV. Indeed, leaks can fragment sleep and promote mouth dryness, as in our poor sleep quality group.”


Sutter J, Cuvelier A, Lukaszewicz R, et al. Poor sleep quality and nocturnal home noninvasive ventilation: Prevalence, risk factors and impact. Pulmonology. Published online May 18, 2023. doi:10.1016/j.pulmoe.2023.04.002

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