Figures
- FIGURE 1
Polysomnography recording of an obstructive event in the upper airway with decreased central drive in a patient with amyotrophic lateral sclerosis using noninvasive ventilation in volume-preset mode.
- FIGURE 2
Relationship between minute ventilation (V′E) and end-tidal carbon dioxide tension (PETCO2) representing controller gain (CG) in two amyotrophic lateral sclerosis patients, one with obstruction with decreased central drive index (ODCDI) <5 h−1 and another with ODCDI >5 h−1.
Tables
- TABLE 1
Demographic and pulmonary function in the total population and the groups with obstruction with decreased central drive index (ODCDI) <5 and >5 h−1
Total population ODCDI <5 h−1 ODCDI >5 h−1 p-value Subjects 30 27 3 Sex 0.804 Male 18 16 2 Female 12 11 1 Age years 67.06±12.08 67.18±12.36 66.00±11.26 0.875 BMI kg·m−2 26.19±4.52 26.51±4.70 23.69±0.81 0.319 ALS onset 0.051 Spinal 21 21 0 Bulbar 9 6 3 Time from ALS onset months 38.53±28.34 39.24±29.71 32.66±13.86 0.712 Time from NIV onset months 10.96±16.93 11.55±17.66 5.66±7.23 0.577 ALSFRS-R 22.13±8.69 21.55±8.45 27.33±10.96 0.282 NBS 19.56±12.93 20.44±12.91 11.66±12.42 0.272 FVC L 1.24±0.68 1.22±0.67 1.42±0.83 0.638 FVC % pred 41.49±21.60 40.58±20.59 49.66±33.85 0.500 PImax cmH2O −27.82±17.50 −27.60±17.82 −29.66±17.95 0.851 PEmax cmH2O 46.67±36.93 42.16±37.54 42.00±38.35 0.835 SNIP cmH2O −24.67±16.90 −24.88±17.74 −23.00±8.54 0.860 MIC L 1.54±0.79 1.53±0.80 1.61±0.92 0.871 PCF L·s−1 2.68±1.40 2.65±1.39 2.97±1.75 0.719 PCFMIC L·s−1 3.21±1.57 3.22±1.58 3.12±1.80 0.917 PCFMI-E L·s−1 3.02±0.93 3.05±0.98 2.78±0.22 0.649 BMI: body mass index; ALS: amyotrophic lateral sclerosis; NIV: noninvasive ventilation; ALSFRS-R: Revised Amyotrophic Lateral Sclerosis Functional Rating Scale; NBS: Norris scale bulbar subscore; FVC: forced vital capacity; PImax: maximum inspiratory pressure; PEmax: maximum expiratory pressure; SNIP: sniff nasal inspiratory pressure; MIC: maximum insufflation capacity; PCF: peak cough flow; PCFMIC: manually assisted PCF; PCFMI-E: mechanically assisted PCF.
- TABLE 2
Polysomnography while using noninvasive ventilation and gas exchange parameters in the groups with obstruction with decreased central drive index (ODCDI) <5 and >5 h−1
ODCDI <5 h−1 ODCDI >5 h−1 p-value Subjects 27 3 TST min 339.85±76.42 364.80±95.61 0.610 Sleep latency min 18.13±15.67 18.26±21.01 0.989 Sleep efficiency index % 68.83±12.14 74.16±7.30 0.469 Arousal/awakening index h−1 19.31±18.27 28.50±27.78 0.447 Sleep stage N1 % 24.17±12.26 21.40±13.23 0.719 N2 % 46.95±13.42 49.03±3.09 0.795 N3 % 23.17±14.14 28.50±16.29 0.552 REM % 5.67±5.51 1.03±0.11 0.001 TST90 % 3.77±7.29 7.70±7.63 0.386 ODI h−1 6.79±12.54 28.30±20.03 0.012 Minimum SpO2 % 84.70±9.66 81.00±7.21 0.528 Mean SpO2 % 94.29±1.89 93.33±1.15 0.401 ODCDI h−1 0.88±0.99 12.99±5.77 0.028 pH 7.42±0.02 7.42±0.02 0.865 PaO2 mmHg 79.92±8.57 69.66±10.01 0.062 PaCO2 mmHg 42.37±4.27 48.66±7.57 0.032 HCO3 mmol·L−1 27.48±2.29 29.40±4.80 0.562 TST: total sleep time; REM: rapid eye movement; TST90: time spent with arterial oxygen saturation <90%; ODI: oxygen desaturation index; SpO2: arterial oxygen saturation measured by pulse oximetry; PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension; HCO3: bicarbonate.
- TABLE 3
Associations with the obstruction with decreased central drive index
r-value p-value Age −0.09 0.609 BMI −0.22 0.269 Time from ALS onset −0.08 0.673 Time from NIV onset −0.15 0.429 Daily hours of use of NIV −0.18 0.323 V′E with NIV −0.24 0.205 ALSFRS-R 0.02 0.883 NBS −0.37 0.044 FVC 0.01 0.958 FVC % pred −0.02 0.919 PImax −0.10 0.588 PEmax 0.10 0.592 SNIP 0.13 0.948 MIC −0.05 0.779 PCF −0.03 0.857 PCFMIC −0.13 0.504 PCFMI-E −0.10 0.587 Apnoeic threshold −0.02 0.901 CO2R −0.35 0.037 Controller gain 0.59 0.001 Plant gain −0.23 0.222 BMI: body mass index; ALS: amyotrophic lateral sclerosis; NIV: noninvasive ventilation; V′E: minute ventilation; ALSFRS-R: Revised Amyotrophic Lateral Sclerosis Functional Rating Scale; NBS: Norris scale bulbar subscore; FVC: forced vital capacity; PImax: maximum inspiratory pressure; PEmax: maximum expiratory pressure; SNIP: sniff nasal inspiratory pressure; MIC: maximum insufflation capacity; PCF: peak cough flow; PCFMIC: manually assisted PCF; PCFMI-E: mechanically assisted PCF; CO2R: carbon dioxide reserve.
Supplementary Material
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Supplementary material 00099-2019.supp
Video 1 00099-2019.video1
Video 2 00099-2019.video2
