Utility and Outcome of Follow-Up Polysomnography in Patients With Ambulatory Noninvasive Ventilation

Abstract

Background: Noninvasive ventilation (NIV) is a cornerstone of respiratory management in patients with various chronic conditions. While a follow-up polysomnography (PSG) is recommended to optimize ventilatory support, its utility and outcome data are limited. This study aimed to describe problems identified during the follow-up PSG and subsequent ventilator setting adjustments in this population. Methods: The follow-up titration PSGs of patients prescribed with ambulatory NIV between January 2022 and January 2024 were retrospectively reviewed. Mixed effects logistic regression models were used to identify factors associated with setting changes. Results: Two hundred ninety-seven PSGs from 106 patients (median age 15.9 years) were included in the analysis, including 216 titration and 81 baseline studies. Fifty percent of patients were diagnosed with neuromuscular diseases. The most common code of NIV was 77.4% on BPAP-ST, followed by PC-SIMV (14.2%) and PCV mode (8.5%). 81.5% of the titration studies resulted in ventilator setting adjustments. The most common problems identified were residual respiratory events, inadequate ventilation and significant leaks. The lower home IPAP setting and higher BMI were associated with increased odds of ventilator setting adjustment, with odds ratio of 0.86 (95% CI: 0.76, 0.98; p-value 0.021) and 1.02 (95% CI: 1.00, 1.03; p-value 0.017), respectively. Conclusion: Follow-up PSG frequently results in ventilator setting adjustments in patients with ambulatory NIV. Patients with lower IPAP setting and higher BMI are more likely to have changes in ventilator setting after PSG. The facility involving the care of ambulatory NIV patients should be familiar with the common problems found in PSGs.