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Objectives: Last years, vibrating devices were introduced to treat positional sleep apnoea (POSA). However, few data exist on determinants of effectiveness and adherence in clinical settings. Methods : The NightBalance Sleep Position Trainer (SPT) analyses the patient's position during the first 2 nights, starts to build up vibrations during the following 7 and is 100% performant from night 10 on; and, reports on %supine, usage time, number of (responses on) vibrations. The device was started for a 28-day try-out period in a clinical cohort of 51 consecutive patients with POSA. SPT-stored data were studied on different time points: first 2 nights without vibrations (baseline), first 2 nights on SPT 100% performance (short term) and 2 later nights after having used the full performant device for 14 days (long term). Results : Only 27 patients used the device throughout the long-term period. The baseline %supine was lower than during polysomnography: 22.9 ± 16.2 versus 40.7 ± 20.0% ( p = 0.0005). Apnoea-hypopnoea index calculation taking into account the %supine on SPT revealed that 2/27 patients would not have obstructive sleep apnoea at home. The baseline %supine dropped ( p < 0.0001) on short term without further change on long term. Ten patients could be considered cured and demonstrated higher response on vibrations. Only 29 patients could be considered as adherent, and they demonstrated higher response on vibrations and less side effects; only 13 wanted to purchase the SPT. Conclusion : On polysomnography, the %supine is overestimated. The efficacy and low adherence are influenced by differences in response to vibrations. The training effect is already presented on short term.

ABSTRACT Background and objective Non-invasive ventilation ( NIV) improves survival, quality of life and sleep in patients with amyotrophic lateral sclerosis ( ALS). Nevertheless, NIV titration is conducted in different ways. We aim to provide more insight into NIV titration by comparing the effects of a spontaneous (S) and spontaneous-timed (ST) modes on gas exchange, sleep architecture and patient-ventilator asynchronies ( PVAs). Methods After an initial night of NIV titration, patients were randomized to S or ST mode in a cross-over design. NIV was titrated using polysomnography, oximetry (oxygen saturation, SpO2 %) and transcutaneous carbon dioxide ( PtcCO2 ) measurement. PVAs were analysed breath-by-breath. Results Thirteen patients were analysed after inclusion. ST mode showed better results in gas exchange (minimal SpO2 %: 83 (80-89)% vs 87 (84-89)%; oxygen desaturation index: 15 (5-28)/h sleep vs 7 (3-9)/h sleep; PtcCO2 >55 mm Hg: 20 (0-59)% vs 0 (0-27)% total sleep time for S and ST mode, respectively, all P < 0.05) and respiratory events (obstructive: 8.9 (1.2-18.3)/h sleep vs 1.8 (0.3-4.9)/h sleep and central: 2.6 (0.4-14.1)/h sleep vs 0.2 (0.0-1.1)/h sleep for S and ST mode, respectively, both P < 0.01). No differences in sleep architecture were found. Ineffective efforts and respiratory events were more frequently present in S mode. Nevertheless, four patients were discharged on S mode as these patients showed clinically better results for sleep architecture and PVA during the night on S mode. Conclusion ST mode shows better results in gas exchange, respiratory events and PVA. Nevertheless, accurate NIV titration remains necessary as some patients show equal or better results when using the S mode. [ABSTRACT FROM AUTHOR]

Sleeping with non-invasive ventilation (NIV) in amyotrophic lateral sclerosis appears to be accompanied by a high patient-ventilator asynchrony (PVA) index. This prospective observational cohort study quantifies PVA and leaks, and searches for effects of these events on sleep after polysomnographic NIV titration. Full-video polysomnography, with incorporation of transcutaneous carbon dioxide and ventilator software, was used to analyse sleep epoch-by-epoch and respiratory events and PVA breath-by-breath in 35 patients (17 non-bulbar). After diagnostic polysomnography, NIV was titrated during three consecutive nights. Sleep, PVA and leaks were evaluated at discharge and after one month. Results showed that non-bulbar patients improved in sleep architecture and oxygen and carbon dioxide levels while bulbar patients only improved oxygen saturation. PVA remained present at discharge (non-bulbar 54 (21–101) and bulbar 31 (9–39)/h sleep) and one month (non-bulbar 31 (9–39) and bulbar 32 (17–55)/h sleep), with ineffective effort as most prominent asynchrony. Leaks also persisted after titration (non-bulbar 16.6 (3.1–44.6) and bulbar 5.1 (0.0–19.5)% of total sleep time (TST)) and one month (non-bulbar 7.7 (1.4–29.3) and bulbar 12.7 (0.0–35.2)% TST). PVA and leaks have none to minor effect on sleep architecture. In conclusion, although PVA and leaks remain present after meticulous NIV titration, these events seem not to interfere with sleep. [ABSTRACT FROM PUBLISHER]

It is known that adenosine excess due to monophosphate deaminase deficiency (AMPD1) can be linked to muscle problems. Recently, Perumal et al., 2014 reported a first case of possible impact of AMPD1 on sleep, REM sleep and cholinergic neurotransmission. We report a second patient with similar sleep complaints: long sleep duration with residual daytime sleepiness and a need to sleep after exercise. On polysomnography we observed a long sleep duration, with high sleep efficiency and a SOREMP; on MSLT a shortened sleep latency and 4 SOREMPS were observed. Frequency power spectral heart rate analysis during slow wave sleep, REM sleep and wakefulness revealed an increased parasympathetic tone. In conclusion, AMPD1 could have a profound influence on cholinergic neurotransmission and sleep; further studies are mandatory. [ABSTRACT FROM AUTHOR]