Am. J. Respir. Crit. Care Med., Volume 163, Number 1, January 2001, 129-134

Low-flow Oxygen and Bilevel Ventilatory Support
Effects on Ventilation during Sleep in Cystic Fibrosis

MAREE A. MILROSS, AMANDA J. PIPER, MARK NORMAN, HEINRICH F. BECKER, GRANT N. WILLSON, RONALD R. GRUNSTEIN, COLIN E. SULLIVAN, and PETER T. P. BYE

Royal Prince Alfred Hospital, Camperdown, Sydney, Australia; Department of Medicine, University of Sydney, Australia; and University of Marburg, Schlafmed. Labor, Marburg, Germany

We measured ventilation in all sleep stages in patients with cystic fibrosis (CF) and moderate to severe lung disease, and compared the effects of low-flow oxygen (LFO₂) and bilevel ventilatory support (BVS) on ventilation and gas exchange during sleep. Thirteen subjects, age 26 ± 5.9 yr (mean ± 1 SD), body mass index (BMI) 20 ± 3 kg/m², FEV₁ 32 ± 11% predicted, underwent three sleep studies breathing, in random order, room air (RA), LFO₂, and BVS ± O₂ with recording of oxyhemoglobin saturation (Sp_O2) (%) and transcutaneous carbon dioxide (TcCO₂) (mm Hg). During RA and LFO₂ studies, patients wore a nasal mask with a baseline continuous positive airway pressure (CPAP) of 4 to 5 cm H₂O. Minute ventilation ( I) was measured using a pneumotachograph in the circuit and was not different between wake and non-rapid eye movement (NREM) sleep on any night. However, I was reduced on the RA and LFO₂ nights from awake to rapid eye movement (REM) (p < 0.01) and from NREM to REM (p < 0.01). On the BVS night there was no significant difference in I between NREM and REM sleep. Both BVS and LFO₂ improved nocturnal Sp_O2, especially during REM sleep (p < 0.05). The rise in TcCO₂ seen with REM sleep with both RA and LFO₂ was attenuated with BVS (p < 0.05). We conclude that BVS leads to improvements in alveolar ventilation during sleep in this patient group.

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