Improved NIV adherence with intelligent volume assured pressure support with automatic expiratory positive airway pressure (iVAPS-AE) in amyotrophic lateral sclerosis (ALS)
- Programme
- HSST
- Specialty
- Respiratory and Sleep Science
- Project published
- 28/11/2024
Introduction Few studies have compared adherence rates between volume mode non-invasive ventilation (NIV) and pressure mode (ST) NIV in amyotrophic lateral sclerosis (ALS). The use of intelligent volume assured pressure support with automatic expiratory positive airway pressure (iVAPS-AE) to treat sleep disordered breathing (SDB) in ALS is limited, reflecting clinical uncertainty about its role as an effective mode of NIV in ALS patients with diaphragmatic muscle weakness.
Methods This was a prospective pilot study with randomisation to explore adherence differences between iVAPS-AE and ST and act as a prerequisite for a large-scale study. Fifteen ALS patients were randomised to receive iVAPS-AE or ST mode. Adherence data was recorded at 14, 30, 60 and 90 days. All patients followed a standard ventilatory care pathway for ALS patients.
Results Median adherence from 0 – 90 days for iVAPS-AE was 7.1 hours per day (h/d) (0.28–9.0) and 3.93 h/d for ST (0–7.3). Between group comparisons of adherence by time point showed median adherence for iVAPS-AE to be statistically significantly higher than ST at 30, 60 and 90 days (6.29h/d (0.1–8.55), 2.48h/d (0–7.3); 7.54h/d (2.43–9.08), 5.8h/d (0–7.3) and 9.05h/d (7.8–9.5), 6.22h/d (0–8.66), respectively); figure 1. Seventy nine patients would be required for each NIV mode to provide appropriate statistical power for a large-scale study.
Discussion To our knowledge this is the only pilot study with randomisation comparing adherence between two NIV modes in ALS. Improved NIV adherence was achieved using iVAPS-AE compared to ST. Our study provides novel evidence to shape future clinical practice and recommends a large-scale study to fully explore the impact of iVAPS-AE on adherence rates in ALS.