However, the values recorded were clearly worse than those recorded during ventilation (Tables 3 and 4). The quality and quantity of sleep were not adversely affected by the nasal mask, although four of five patients in whom a complete night’s sleep could be measured showed a reduction in slow wave sleep and an increase in REM sleep (Table 5). All patients complied with the treatment for three months, and follow-up measurements were completed for five subjects at 14 months; the other subject (subject 6) expressed important family problems and did not present for the 14-month follow-up. buy flovent inhaler
Following three months of nightly ventilation, there was no change in measurements of pulmonary function or in respiratory muscle strength (Table 1). There was, however, a marked increase in inspiratory muscle endurance at three months that was maintained at 14 months. Inspiratory muscle endurance was measured at the same mean mouth pressure expressed as a percentage of MIP at baseline and at three and 14 months after nocturnal ventilation. Daytime ABG values improved at three and 14 months (Table 6). At 14 months, three of the four subjects in whom complete measurements were obtained had saturation levels at or above 90 percent while breathing room air. Subject 1 did not consent to repeat ABG measurements at three months, and subject 6 was unavailable at 14 months, as stated above. Patients reported an increased sense of well-being and an increase in their ability to carry out functional activities. Four patients were able to resume work on a full-time basis and two resumed their full-time household activities. None of the subjects has been readmitted to hospital for respiratory failure and all have discontinued treatment with diuretic medications. There was an improvement in their six-minute walking test (mean± SD initial test = 429 ±120 m; three months = 567 ± 121 m; 14 months = 569 ± 83 m). Measurements at three months were significantly different from baseline (p<0.05).
Table 5—Quality and Quantity of Sleep at Baseline, during Ventilation, and on the First Postventilatory Night Following 12 Weeks cf Nocturnal Ventilation
|ID||Total Time Asleep,(min)||Stages land 2, min||SWS||REMS||SleepEfficiency||Movement Arousals, per Hour|
|Mean||313 ±50||157 ±69||126 ±60||30 ±21||79 ± 12||17 ±7|
|Mean||333 ±90||172 ±72||87 ±22||73 ±45*||77± 11||15 ±10|
Table 6 — Individual Arterial Blood Gas Values Measured Unassisted, Recumbent, and Breathing Room Air at Baseline, Three Months, and 14 Months After Nocturnal Ventilation by Intermittent Positive Pressure Through Nasal Mask
|Subject||pH||Pco2, mm Hg||Po„ mm Hg||Saturation,%|