Safety and efficacy of auto-titrating noninvasive ventilation in COPD and obstructive sleep apnoea overlap syndrome

The deleterious effects of comorbid chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) have long been recognised and are frequently encountered as a clinical scenario [1, 2]. Although continuous positive airways pressure can be used in order to abolish upper airways obstruction in OSA, it can have adverse effects on pulmonary mechanics in patients with airways obstruction [3]. Auto-titrating modes of noninvasive ventilation (NIV) that monitor tidal volume, respiratory rate and upper airway patency and can vary back up rate, inspiratory and expiratory positive airway pressure (IPAP and EPAP, respectively) may have clinical benefits. However, these auto-titration modes and the software algorithms driving the ventilators are being engineered and modified at a rapid rate. The clinician, therefore, needs to be reassured that these novel modes have an established safety and efficacy profile. We hypothesised that auto-titrating NIV would enhance overnight gas exchange, sleep quality, and patient comfort when compared to standard fixed-level NIV in COPD-OSA patients with chronic respiratory failure. Auto-titrating NIV controls sleep disordered breathing and augments patient sleep comfort in COPD-OSA overlap http://ow.ly/NtL24