Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Sleep and Breathing
Published in: Sleep and Breathing 3/2021

01-09-2021 | Non-Invasive Ventilation | Sleep Breathing Physiology and Disorders • Original Article

Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular disorders

Authors: Anna Christina Meyer, Jens Spiesshoefer, Nina Christina Siebers, Anna Heidbreder, Christian Thiedemann, Hartmut Schneider, Andrew T. Braun, Winfried Randerath, Peter Young, Michael Dreher, Matthias Boentert

Published in: Sleep and Breathing | Issue 3/2021

Login to get access

Abstract

Purpose

In neuromuscular disorders (NMD), inspiratory muscle weakness may cause sleep-related hypoventilation requiring non-invasive ventilation (NIV). Alternatively, nasal high flow therapy (NHF) may ameliorate mild nocturnal hypercapnia (NH) through washout of anatomical dead space and generation of positive airway pressure. Ventilatory support by NIV or NHF might have favourable short-term effects on sympathovagal balance (SVB). This study comparatively investigated the effects of NHF and NIV on sleep-related breathing and SVB in NMD patients with evolving NH.

Methods

Transcutaneous CO2 (ptcCO2), peripheral oxygen saturation (SpO2), sleep outcomes and SVB (spectral analysis of heart rate, diastolic blood pressure variability) along with haemodynamic measures (cardiac index, total peripheral resistance index) were evaluated overnight in 17 patients. Polysomnographies (PSG) were randomly split into equal parts with no treatment, NIV and NHF at different flow rates (20 l/min vs. 50 l/min). In-depth analysis of SVB and haemodynamics was performed on 10-min segments of stable N2 sleep taken from each intervention.

Results

Compared with no treatment, NHF20 and NHF50 did not significantly change ptcCO2, SpO2 or the apnea hypopnea index (AHI). NHF50 was poorly tolerated. In contrast, NIV significantly improved both gas exchange and AHI without adversely affecting sleep. During daytime, NHF20 and NHF50 had neutral effects on ventilation and oxygenation whereas NIV improved ptcCO2 and SpO2. Effects of NIV and NHF on SVB and haemodynamics were neutral during both night and daytime.

Conclusions

NHF does not correct sleep-disordered breathing in NMD patients with NH. Both NHF and NIV exert no immediate effects on SVB.
Literature
1.
Boentert M, Wenninger S, Sansone VA (2017) Respiratory involvement in neuromuscular disorders. Curr Opin Neurol 30(5):529–537PubMedCrossRef
2.
Benditt JO (2002) Respiratory complications of amyotrophic lateral sclerosis. Semin Respir Crit Care Med 23(3):239–247PubMedCrossRef
3.
4.
Boentert M, Karabul N, Wenninger S, Stubbe-Dräger B, Mengel E, Schoser B, Young P (2015) Sleep-related symptoms and sleep-disordered breathing in adult Pompe disease. Eur J Neurol 22(2):369–376 e27PubMedCrossRef
5.
Laberge L, Bégin P, Dauvilliers Y, Beaudry M, Laforte M, Jean S et al (2009) A polysomnographic study of daytime sleepiness in myotonic dystrophy type 1. J Neurol Neurosurg Psychiatry 80(6):642–646PubMedCrossRef
6.
Henke C, Spiesshoefer J, Kabitz H-J, Herkenrath S, Randerath W, Brix T, Görlich D, Young P, Boentert M (2019) Respiratory muscle weakness in facioscapulohumeral muscular dystrophy. Muscle Nerve 60(6):679–686PubMedCrossRef
7.
Spiesshoefer J, Henke C, Kabitz HJ, Brix T, Görlich D, Herkenrath S, Randerath W, Young P, Boentert M (2019) The nature of respiratory muscle weakness in patients with late-onset Pompe disease. Neuromuscul Disord 29(8):618–627PubMedCrossRef
8.
Runte M, Spiesshoefer J, Heidbreder A, Dreher M, Young P, Brix T, Boentert M (2019) Sleep-related breathing disorders in facioscapulohumeral dystrophy. Sleep Breath 23(3):899–906PubMedCrossRef
9.
Spiesshoefer J, Runte M, Heidbreder A, Dreher M, Young P, Brix T, Boentert M (2019) Sleep-disordered breathing and effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with myotonic dystrophy type I. Neuromuscul Disord 29(4):302–309PubMedCrossRef
10.
Berger KI, Rapoport DM, Ayappa I, Goldring RM (2014) Pathophysiology of hypoventilation during sleep. Sleep Med Clin 9(3):289–300CrossRef
11.
Windisch W, Geiseler J, Simon K, Walterspacher S, Dreher M (2018) German National Guideline for treating chronic respiratory failure with invasive and non-invasive ventilation: revised edition 2017 - part 1. Respiration 96(1):66–97PubMedCrossRef
12.
O'Donoghue FJ, Borel J-C, Dauvilliers Y, Levy P, Tamisier R, Pépin J-L (2017) Effects of 1-month withdrawal of ventilatory support in hypercapnic myotonic dystrophy type 1. Respirology 22(7):1416–1422PubMedCrossRef
13.
Boussaïd G, Lofaso F, Santos DB, Vaugier I, Pottier S, Prigent H, Orlikowski D, Bahrami S (2016) Factors influencing compliance with non-invasive ventilation at long-term in patients with myotonic dystrophy type 1: a prospective cohort. Neuromuscul Disord 26(10):666–674PubMedCrossRef
14.
Millar J, Lutton S, O'Connor P (2014) The use of high-flow nasal oxygen therapy in the management of hypercarbic respiratory failure. Ther Adv Respir Dis 8(2):63–64PubMedCrossRef
15.
Biselli PJC, Kirkness JP, Grote L, Fricke K, Schwartz AR, Smith P, Schneider H (2017) Nasal high-flow therapy reduces work of breathing compared with oxygen during sleep in COPD and smoking controls: a prospective observational study. J Appl Physiol 122(1):82–88PubMedCrossRef
16.
17.
Bräunlich J, Seyfarth H-J, Wirtz H (2015) Nasal high-flow versus non-invasive ventilation in stable hypercapnic COPD: a preliminary report. Multidiscip Respir Med 10(1):27PubMedPubMedCentralCrossRef
18.
Bräunlich J, Wirtz H (2017) NHF and hypercapnia: how brief can you look? Respirology 22(6):1049–1050PubMedCrossRef
19.
Groves N, Tobin A (2007) High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care 20(4):126–131PubMedCrossRef
20.
de Jongh BE, Locke R, Mackley A, Emberger J, Bostick D, Stefano J, Rodriguez E, Shaffer TH (2014) Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressure. J Perinatol 34(1):27–32PubMedCrossRef
21.
Möller W, Feng S, Domanski U, Franke K-J, Celik G, Bartenstein P, Becker S, Meyer G, Schmid O, Eickelberg O, Tatkov S, Nilius G (2017) Nasal high flow reduces dead space. J Appl Physiol 122(1):191–197PubMedCrossRef
22.
Díaz-Lobato S, Folgado MA, Chapa A, Mayoralas AS (2013) Efficacy of high-flow oxygen by nasal cannula with active humidification in a patient with acute respiratory failure of neuromuscular origin. Respir Care 58(12):e164–e167PubMedCrossRef
23.
Bartsch T, Häbler HJ, Jänig W (1999) Hypoventilation recruits preganglionic sympathetic fibers with inspiration-related activity in the superior cervical trunk of the rat. J Auton Nerv Syst 77(1):31–38PubMedCrossRef
24.
Macefield VG, Wallin BG (1999) Respiratory and cardiac modulation of single sympathetic vasoconstrictor and sudomotor neurones to human skin. J Physiol Lond 516(Pt 1):303–314PubMedPubMedCentralCrossRef
25.
Ogna A, Quera Salva M-A, Prigent H, Mroue G, Vaugier I, Annane D, Lofaso F, Orlikowski D (2016) Nocturnal hypoventilation in neuromuscular disease: prevalence according to different definitions issued from the literature. Sleep Breath 20(2):575–581PubMedCrossRef
26.
Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 08(05):597–619CrossRef
27.
Fortin J, Habenbacher W, Heller A, Hacker A, Grüllenberger R, Innerhofer J, Passath H, Wagner C, Haitchi G, Flotzinger D, Pacher R, Wach P (2006) Non-invasive beat-to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement. Comput Biol Med 36(11):1185–1203PubMedCrossRef
28.
Fortin J, Marte W, Grüllenberger R, Hacker A, Habenbacher W, Heller A, Wagner CH, Wach P, Skrabal F (2006) Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops. Comput Biol Med 36(9):941–957PubMedCrossRef
29.
Gratze G, Fortin J, Holler A, Grasenick K, Pfurtscheller G, Wach P, Schönegger J, Kotanko P, Skrabal F (1998) A software package for non-invasive, real-time beat-to-beat monitoring of stroke volume, blood pressure, total peripheral resistance and for assessment of autonomic function. Comput Biol Med 28(2):121–142PubMedCrossRef
30.
31.
Pagani M, Montano N, Porta A, Malliani A, Abboud FM, Birkett C, Somers VK (1997) Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation 95(6):1441–1448PubMedCrossRef
32.
Mirizzi G, Giannoni A, Bramanti F, Ripoli A, Varanini M, Bernardi L, Emdin M, Passino C (2013) A simple method for measuring baroreflex sensitivity holds prognostic value in heart failure. Int J Cardiol 169(1):e9–e11PubMedCrossRef
33.
Mündel T, Feng S, Tatkov S, Schneider H (2013) Mechanisms of nasal high flow on ventilation during wakefulness and sleep. J Appl Physiol 114(8):1058–1065PubMedPubMedCentralCrossRef
34.
Bräunlich J, Beyer D, Mai D, Hammerschmidt S, Seyfarth H-J, Wirtz H (2013) Effects of nasal high flow on ventilation in volunteers, COPD and idiopathic pulmonary fibrosis patients. Respiration 85(4):319–325PubMedCrossRef
35.
Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard J-D (2012) Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care 27(3):324.e9–324.13CrossRef
36.
Amaddeo A, Khirani S, Frapin A, Teng T, Griffon L, Fauroux B (2019) High-flow nasal cannula for children not compliant with continuous positive airway pressure. Sleep Med 63:24–28PubMedCrossRef
37.
Luo J, Duke T, Chisti MJ, Kepreotes E, Kalinowski V, Li J (2019) Efficacy of high-flow nasal cannula vs standard oxygen therapy or nasal continuous positive airway pressure in children with respiratory distress: a meta-analysis. J Pediatr 215:199–208.e8PubMedCrossRef
38.
Fagan EA, Ellis DS, Portmann B, Tovey GM, Williams R, Zuckerman AJ (1987) Microbial structures in a patient with sporadic non-a, non-B fulminant hepatitis treated by liver transplantation. J Med Virol 22(2):189–198PubMedCrossRef
39.
Ejiofor BD, Carroll RW, Bortcosh W, Kacmarek RM (2019) PEEP generated by high-flow nasal cannula in a pediatric model. Respir Care 64(10):1240–1249PubMedCrossRef
40.
Lodeserto FJ, Lettich TM, Rezaie SR (2018) High-flow nasal cannula: mechanisms of action and adult and pediatric indications. Cureus 10(11):e3639PubMedPubMedCentral
41.
Bräunlich J, Dellweg D, Bastian A, Budweiser S, Randerath W, Triché D, Bachmann M, Kähler C, Bayarassou AH, Mäder I, Geiseler J, Köhler N, Petroff D, Wirtz H (2019) Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD. Int J Chron Obstruct Pulmon Dis 14:1411–1421PubMedPubMedCentralCrossRef
42.
van de Borne P, Montano N, Zimmerman B, Pagani M, Somers VK (1997) Relationship between repeated measures of hemodynamics, muscle sympathetic nerve activity, and their spectral oscillations. Circulation 96(12):4326–4332PubMedCrossRef
43.
Kienzle MG, Ferguson DW, Birkett CL, Myers GA, Berg WJ, Mariano DJ (1992) Clinical, hemodynamic and sympathetic neural correlates of heart rate variability in congestive heart failure. Am J Cardiol 69(8):761–767PubMedCrossRef
44.
Ho CH, Chen CL, Yu CC, Yang YH, Chen CY (2020) High-flow nasal cannula ventilation therapy for obstructive sleep apnea in ischemic stroke patients requiring nasogastric tube feeding: a preliminary study. Sci Rep 10(1):8524PubMedPubMedCentralCrossRef
Metadata
Title
Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular disorders
Authors
Anna Christina Meyer
Jens Spiesshoefer
Nina Christina Siebers
Anna Heidbreder
Christian Thiedemann
Hartmut Schneider
Andrew T. Braun
Winfried Randerath
Peter Young
Michael Dreher
Matthias Boentert
Publication date
01-09-2021
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 3/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-020-02263-2

Other articles of this Issue 3/2021

Sleep and Breathing 3/2021 Go to the issue

Sleep Breathing Physiology and Disorders • Original Article

CPAP adherence reduces cardiovascular risk among older adults with obstructive sleep apnea

Sleep Breathing Physiology and Disorders • Original Article

Adherence to prescribed overnight sleep study in patients suspected of sleep apnea: problem size and influential factors

Sleep Breathing Physiology and Disorders • Original Article

Changes in sleepiness and 24-h blood pressure following 4 months of CPAP treatment are not mediated by ICAM-1

Sleep Breathing Physiology and Disorders • Review

The importance of autophagy regulation in obstructive sleep apnea

Epidemiology • Original Article

The association of Sudarshan Kriya Yoga frequency with sleep quality: a cross-sectional study from Singapore

Sleep Breathing Physiology and Disorders • Original Article

Oxygen saturation during sleep as a predictor of inflammation in anovulatory women
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits