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(Chest. 1994;106:1705-1710.)
© 1994 American College of Chest Physicians

Sleep and Nocturnal Mouthpiece IPPV Efficiency in Postpoliomyelitis Ventilator Users

John R. Bach MD, FCCP1 and Augusta S. Alba MD2

1 From the Department of Physical Medicine and Rehabilitation, UMD-The New Jersey Medical School, Newark, NJ
2 From the Department of Rehabilitation Medicine, New York University and Goldwater Memorial Hospital, New York University Medical Center

Study objective: Intermittent positive pressure ventilation (IPPV) can be delivered via various oral, nasal, or oronasal interfaces as an alternative to tracheostomy for up to 24 h of ventilatory support. Nocturnal nasal IPPV is often associated with frequent transient but at times severe oxyhemoglobin desaturations (dSaO2s) and sleep fragmentation. The purpose of this study was to determine if nocturnal mouthpiece IPPV is also associated with dSaO2s and sleep disruption.

Design: Twenty-seven postpolio ventilator-assisted individuals (VAIs) using mouthpiece IPPV with little or no ventilator-free breathing time (VFBT) underwent nocturnal oxyhemoglobin saturation (SaO2) monitoring. In addition, 15 underwent nocturnal capnography and 13 underwent polysomnography.

Results: Mean nocturnal SaO2 was normal in 22 of 27 and maximum end-tidal Pco2 was normal in 12 of 15 VATs. Use of lipseal retention for nocturnal mouthpiece IPPV significantly improved blood gas values during sleep. The polysomnography results demonstrated relatively normal sleep efficiency.

Conclusions: Nocturnal mouthpiece IPPV is most effective with lipseal retention. It can provide normal alveolar ventilation and SaO2 during sleep for VAIs with little or no measurable vital capacity or VFBT. Because transient dSaO2s can be eliminated with lipseal retention, it may disrupt sleep less than nasal IPPV.

Key Words: kyphoscoliosis • mechanical ventilation • polysomnography • respiratory paralysis • sleep

Submitted on February 23, 1994
Accepted on May 17, 2007




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A. C. Tzeng and J. R. Bach
Prevention of Pulmonary Morbidity for Patients With Neuromuscular Disease
Chest, November 1, 2000; 118(5): 1390 - 1396.
[Abstract] [Full Text] [PDF]


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Copyright © 1994 by the American College of Chest Physicians.