Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders

Djillali Annane; David Orlikowski; Sylvie Chevret; Jean Claude Chevrolet; Jean Claude Raphaël

doi:10.1002/14651858.CD001941.pub2

Ventilación mecánica nocturna para la hipoventilación crónica en pacientes con trastornos neuromusculares y de la pared torácica

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Referencias

Referencias de los estudios incluidos en esta revisión

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estudios excluidos
otras referencias

Bourke SC, Tomlinson M, Williams TL, Bullock RE, Shaw PJ, Gibson GJ. Effects of non‐invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurology 2006;5(2):140‐7.

Ellis ER, Bye PT, Bruderer JW, Sullivan CE. Treatment of respiratory failure during sleep in patients with neuromuscular disease: positive pressure ventilation through a nose mask. American Review Respiratory Disease 1987;135(1):148‐52. [MEDLINE: 1987098211]

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Restrick LJ, Fox NC, Braid G, Ward EM, Paul EA, Wedzicha JA. Comparison of nasal pressure support ventilation with nasal intermittent positive pressure ventilation in patients with nocturnal hypoventilation. The European Respiratory Journal 1993;6(3):364‐70. [MEDLINE: 1993231313]

Ward S, Chatwin M, Heather S, Simonds AK. Randomised controlled trial of non‐invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax 2005;60(12):1019‐24.

Willson GN, Piper AJ, Norman M, Chaseling WG, Milross MA, Collins ER, et al. Nasal versus full face mask for noninvasive ventilation in chronic respiratory failure. European Respiratory Journal 2004;23(4):605‐9.

Referencias de los estudios excluidos de esta revisión

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estudios incluidos
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Aboussouan LS, Khan SU, Meeker DP, Stelmach K, Mitsumoto H. Effect of noninvasive positive‐pressure ventilation on survival in amyotrophic lateral sclerosis. Annals of Internal Medicine 1997;127(6):450‐3. [MEDLINE: 1997440025]

Ambrosino N, Vitacca M, Polese G, Pagani M, Foglio K, Rossi A. Short term effects of nasal proportional assist ventilation in patients with chronic hypercapnic respiratory insufficiency. European Respiratory Journal 1997;10(12):2829‐34. [MEDLINE: 1998152663]

Bach JR, Rajaraman R, Ballanger F, Tzeng AC, Ishikawa Y, Kulessa R, et al. Neuromuscular ventilatory insufficiency: effect of home mechanical ventilator use versus oxygen therapy on pneumonia and hospitalization rates. American Journal of Physical Medicine and Rehabilitation 1998;77(1):8‐19. [MEDLINE: 1998141478]

Celikel T, Sungur M, Ceyhan B, Karakurt S. Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 1998;114:1636‐42. [MEDLINE: 1999087205]

Elliott MW, Aquilina R, Green M, Moxham J, Simonds AK. A comparison of different modes of noninvasive ventilatory support: effects on ventilation and inspiratory muscle effort. Anaesthesia 1994;49(4):279‐83. [MEDLINE: 1994234496]

Masa JF, Celli BR, Riesco JA, Sanchez de Cos J, Disdier C, Sojo A. Noninvasive positive pressure ventilation and not oxygen may prevent overt ventilatory failure in patients with chest wall diseases. Chest 1997;112(1):207‐13. [MEDLINE: 1997372114]

Meecham Jones DJ, Wedzicha JA. Comparison of pressure and volume preset nasal ventilator systems in stable chronic respiratory failure. European Respiratory Journal 1993;6(7):1060‐4. [MEDLINE: 1993380538]

Padman R, Lawless ST, Kettrick RG. Noninvasive ventilation via bilevel positive airway pressure support in pediatric practice. Critical Care Medicine 1998;26(1):169‐73. [MEDLINE: 1998088837]

Referencias adicionales

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estudios excluidos

Annane D, Quera‐Salva MA, Lofaso F, Vercken JB, Lesieur O, Fromageot C, et al. Mechanisms underlying effects of nocturnal ventilation on daytime blood gases in neuromuscular diseases. The European Respiratory Journal 1999;13(1):157‐62.

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Bach JR, Alba A, Mosher R, Delaubier A. Intermittent positive pressure ventilation via nasal access in the management of respiratory insufficiency. Chest 1987;92(1):169‐70. [MEDLINE: 1987245620]

Barbé F, Quera‐Salva MA, de Lattre J, Gajdos P, Agusti AGN. Long term effects of nasal intermittent positive‐pressure ventilation on pulmonary function and sleep architecture in patients with neuromuscular diseases. Chest 1996;110(5):1179‐83. [MEDLINE: 1997072451]

Carroll N, Branthwaite MA. Control of nocturnal hypoventilation by nasal intermittent positive pressure ventilation. Thorax 1988;43(5):349‐53. [MEDLINE: 1989058895]

Chailleux E, Fauroux B, Binet F, Dautzenberg B, Polu JM for the Observatory Group of ANTADIR. Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation. Chest 1996;109(3):741‐9. [MEDLINE: 1996181815]

Claman DM, Piper A, Sanders MH, Stiller RA, Votteri BA. Nocturnal non‐invasive positive pressure ventilatory assistance. Chest 1996;110(6):1581‐8. [MEDLINE: 1997143070]

Heckmatt JZ, Loh L, Dubowitz V. Night time nasal ventilation in neuromuscular disease. Lancet 1990;335(8689):579‐82. [MEDLINE: 1990173606]

Hoeppner VH, Cockcroft DW, Dosman JA, Cotton DJ. Nighttime ventilation improves respiratory failure in secondary kyphoscoliosis. The American Review of Respiratory Disease 1984;129(2):240‐3. [MEDLINE: 1984126255]

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Lloyd‐Owen SJ, Donaldson GC, Ambrosino N, Escarabill J, Farre R, Fauroux B, et al. Patterns of home mechanical ventilation use in Europe: results of the European Survey. The European Respiratory Journal 2005;25(6):1025‐31.

Loh L, Hughes JM, Davis J. Gas exchange problems in bilateral diaphragm paralysis. Bulletin Européen de Physiopathologie Respiratoire 1979;15(Suppl):137‐41. [MEDLINE: 1981110825]

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Orlikowski D, Prigent H, Gonzalez J, Sharshar T, Raphael JC. Long term domiciliary mechanical ventilation in patients with neuromuscular diseases (indications, establishment and follow up) [Ventilation mécanique à domicile et au long cours des patients neuromusculaires (indications, mise en place et surveillance)]. Revue des Maladies Respiratoires 2005;22(6 Pt 1):1021‐30.

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Raphaël JC, Gajdos P, de Lattre J. [Handicape respiratoire chronique d’origine neuromusculaire: physiopathologie, perspectives thérapeutiques]. Fonction diaphragmatique ‐ Travail respiratoire. Monographie de la Société de Réanimation de Langue Française. Paris: Expansion Scientifique Française, 1987:203‐28.

Raphaël JC, Chevret S, Annane D. Is early noninvasive mechanical ventilation of first choice in stable restrictive patients with chronic respiratory failure?. Monaldi Archives of Chest Disease 1999;54(1):90‐7. [MEDLINE: 1999235005]

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Simonds AK. Home ventilation. The European Respiratory Journal. Supplement 2003;47:38S‐46S.

Skatrud J, Iber C, McHugh W, Rasmussen H, Nichols D. Determinants of hypoventilation during wakefulness and sleep in diaphragmatic paralysis. The American Review of Respiratory Disease 1980;121(3):587‐93. [MEDLINE: 1981019818]

Smith PE, Calverley PM, Edwards RH, Evans GA, Campbell EJ. Practical problems in the respiratory care of patients with muscular dystrophy. The New England Journal of Medicine 1987;316(19):1197‐205. [MEDLINE: 1987201728]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Bourke 2006

Methods	Single centre open study on parallel groups ‐ at least 1‐year follow‐up period.
Participants	n = 41 amyotrophic lateral sclerosis with or without bulbar features ‐ definite diagnostic criteria ‐ orthopnoea with inspiratory maximal pressure less than 60% of predicted or symptomatic daytime hypercapnia.
Interventions	Control = standard care. Experimental = non invasive nasal nocturnal ventilation with bi‐level airway pressure.
Outcomes	Survival time ‐ quality of life SF36 mental component summary and sleep apnoea quality of life index symptoms domain.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Ellis 1987

Methods	Single centre open crossover study.
Participants	n = 5 ‐ spinal muscular atrophy, muscular dystrophy, poliomyelitis, myelitis ‐ chronic stable hypercapnic respiratory failure.
Interventions	Control = no respiratory support. Experimental 1 = one 6 to 7‐hour run of nocturnal NIPPV. Experimental 2 = one 6 to 7‐hour run of nocturnal negative pressure ventilation with tank or cuirass.
Outcomes	Short‐term (24 hour) evaluation of nocturnal hypoventilation related symptoms ‐ arterial blood gases ‐ respiratory function tests ‐ sleep studies.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Laserna 2003

Methods	Single centre open crossover study.
Participants	n = 10. kyphoscoliosis. chronic hypercapnic respiratory failure.
Interventions	Control = spontaneous ventilation. Experimental 1 = nocturnal ventilation with bi‐level airway pressure. Experimental 2 = nocturnal volume‐cycle ventilation.
Outcomes	1‐month improvement in sleep parameters, clinical symptoms and arterial blood gas.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Pinto 1995

Methods	Single centre open study on parallel groups ‐ 3‐year follow‐up period.
Participants	n = 20 ‐ amyotrophic lateral sclerosis with bulbar features ‐ definite diagnostic criteria ‐ chronic hypercapnic respiratory failure.
Interventions	Control = oxygen, bronchodilatators and other palliative measures. Experimental group = non invasive nasal nocturnal ventilation with bi‐level airway pressure.
Outcomes	Mortality at 1 and 3 years ‐ survival time ‐ bulbar and spinal Norris scores ‐ quality of life ‐ modified Barthel score ‐ arterial blood gases and respiratory function tests.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Raphaël 1994

Methods	Multicentre (17 centres in France) open study on parallel groups ‐ Randomisation was done centrally (phone) and stratified for centre ‐ 5‐year inclusion period.
Participants	Individual data were available from the coordinating centre ‐ Children and adults with Duchenne muscular dystrophy ‐ 19 of the 70 included participants presenting with symptoms of nocturnal hypoventilation or day time PaCO2 equal to or above 6 kPa and were evaluable.
Interventions	Control group = combination of antibiotic and physiotherapy, if needed. Experimental group = nocturnal intermittent positive ventilation through a nose mask or a mouthpiece.
Outcomes	Short‐term (24 hours) arterial blood gases long‐term (6 months to 1 year) symptoms of nocturnal hypoventilation, death, number of unplanned hospitalisation, arterial blood gases and forced vital capacity.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Restrick 1993

Methods	Single centre crossover open study ‐ allocation concealment by sealed envelopes.
Participants	n = 7‐ stable chronic hypercapnic respiratory failure ‐ mixed populations ‐ separate data available for neuromuscular patients (polio and post polio syndrome, muscular dystrophy, phrenic nerve paralysis, kyphoscoliosis and thoracoplasty) ‐ none of the participants living in institution ‐ all participants had symptoms of nocturnal hypoventilation and daytime hypercapnia.
Interventions	Control treatment = no ventilatory support. Experimental treatment 1 = a 6‐hour run of nocturnal nasal intermittent positive pressure ventilation (volume cycled ventilation). Experimental treatment 2 = a 6‐hour run of nocturnal bi‐level positive airway pressure (pressure cycled ventilation).
Outcomes	Short‐term assessment of 10 cm visual analogue scale for evaluation of nocturnal hypoventilation related symptoms ‐ daytime arterial blood gases ‐ mean nocturnal SaO2 ‐ median time spent under 90% SaO2.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Ward 2005

Methods	Single centre open study on parallel groups ‐ 2‐year follow‐up period.
Participants	n = 26. Adults and children with congenital neuromuscular and chest wall disease. Chronic respiratory failure with diurnal normocapnia.
Interventions	Control = spontaneous ventilation. Experimental = nocturnal ventilation with bi‐level airway pressure.
Outcomes	Peak transcutaneous arterial CO2 tension. Number of patients who developed criteria for mandatory mechanical ventilation changes in pulmonary function and respiratory muscles strength, SF36 quality of life domain.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Willson 2004

Methods	Single centre crossover open study.
Participants	n = 16. Neuromuscular diseases n = 3, chest wall diseases n = 5 non‐neuromuscular and non‐chest wall diseases n = 8.
Interventions	Control = nocturnal ventilation with bi‐level airway pressure using nasal mask. Experimental = nocturnal ventilation with bi‐level airway pressure using full face mask.
Outcomes	Short‐term (1 night treatment) effects on sleep parameters.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Characteristics of excluded studies [ordered by study ID]

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estudios incluidos

Study	Reason for exclusion
Aboussouan 1997	Non‐randomised open study.
Ambrosino 1997	Mechanical ventilation was implemented for one hour run during daytime. No data are available for nocturnal ventilation effects.
Bach 1998	Non‐randomised open study
Celikel 1998	Participants in an unstable condition, i.e. acute respiratory failure.
Elliott 1994	Mixed population, i.e. COPD and only four participants with chest wall disorders ‐ mechanical ventilation was implemented for five minute courses during daytime. No data were available for night time ventilation effects.
Masa 1997	Non‐randomised open study
Meecham Jones 1993	Mixed population, i.e. COPD and only three participants with neuromuscular or chest wall disorders ‐ mechanical ventilation was implemented for a two hour course during daytime. No data were available for nocturnal ventilation effects.
Padman 1998	Non‐randomised open study ‐ participants in unstable condition, i.e. acute respiratory failure.

Data and analyses

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Comparison 1. Short‐term: nocturnal ventilation versus no ventilation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 No improvement of hypoventilation symptoms Show forest plot	1	10	Risk Ratio (M‐H, Fixed, 95% CI)	0.09 [0.01, 1.31]
Open in figure viewer Analysis 1.1 Comparison 1 Short‐term: nocturnal ventilation versus no ventilation, Outcome 1 No improvement of hypoventilation symptoms.
2 No improvement of daytime hypercapnia Show forest plot	3	43	Risk Ratio (M‐H, Fixed, 95% CI)	0.37 [0.20, 0.65]
Open in figure viewer Analysis 1.2 Comparison 1 Short‐term: nocturnal ventilation versus no ventilation, Outcome 2 No improvement of daytime hypercapnia.
3 Daytime PaCO2 Show forest plot	2	24	Mean Difference (IV, Fixed, 95% CI)	‐0.32 [‐0.84, 0.20]
Open in figure viewer Analysis 1.3 Comparison 1 Short‐term: nocturnal ventilation versus no ventilation, Outcome 3 Daytime PaCO2.
4 Mean nocturnal SaO2 Show forest plot	2	24	Mean Difference (IV, Fixed, 95% CI)	5.45 [1.47, 9.44]
Open in figure viewer Analysis 1.4 Comparison 1 Short‐term: nocturnal ventilation versus no ventilation, Outcome 4 Mean nocturnal SaO2.

Open in table viewer

Comparison 2. Long‐term: nocturnal ventilation versus no ventilation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Unplanned admission to hospital Show forest plot	1	19	Risk Ratio (M‐H, Fixed, 95% CI)	0.13 [0.01, 2.22]
Open in figure viewer Analysis 2.1 Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 1 Unplanned admission to hospital.
2 Death Show forest plot	3	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.42, 0.91]
Open in figure viewer Analysis 2.2 Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 2 Death.
3 No improvement of hypoventilation symptoms Show forest plot	1	19	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.22, 1.19]
Open in figure viewer Analysis 2.3 Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 3 No improvement of hypoventilation symptoms.
4 No improvement of daytime hypercapnia Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 2.4 Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 4 No improvement of daytime hypercapnia.
5 Daytime PaCO2 Show forest plot	3	60	Mean Difference (IV, Fixed, 95% CI)	‐0.26 [‐0.61, 0.09]
Open in figure viewer Analysis 2.5 Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 5 Daytime PaCO2.
6 Forced vital capacity Show forest plot	2	28	Mean Difference (IV, Fixed, 95% CI)	158.50 [‐84.43, 401.43]
Open in figure viewer Analysis 2.6 Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 6 Forced vital capacity.
7 Respiratory muscle strength Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	‐5.72 [‐13.87, 2.43]
Open in figure viewer Analysis 2.7 Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 7 Respiratory muscle strength.
7.1 mean improvement in maximal inspiratory pressure	1	2	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 mean improvement in SNIP	1	26	Mean Difference (IV, Fixed, 95% CI)	‐5.72 [‐13.87, 2.43]
8 Mean nocturnal SaO2 Show forest plot	1	26	Mean Difference (IV, Fixed, 95% CI)	3.00 [1.85, 4.15]
Open in figure viewer Analysis 2.8 Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 8 Mean nocturnal SaO2.

Open in table viewer

Comparison 3. Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 No improvement of hypoventilation symptoms Show forest plot	1	14	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 3.1 Comparison 3 Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 1 No improvement of hypoventilation symptoms.
2 No improvement of daytime hypercapnia Show forest plot	1	14	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.46, 3.88]
Open in figure viewer Analysis 3.2 Comparison 3 Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 2 No improvement of daytime hypercapnia.
3 Daytime PaCO2 Show forest plot	1	14	Mean Difference (IV, Fixed, 95% CI)	0.24 [‐0.38, 0.86]
Open in figure viewer Analysis 3.3 Comparison 3 Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 3 Daytime PaCO2.
4 Mean nocturnal SaO2 Show forest plot	1	14	Mean Difference (IV, Fixed, 95% CI)	‐0.49 [‐3.28, 2.30]
Open in figure viewer Analysis 3.4 Comparison 3 Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 4 Mean nocturnal SaO2.

Open in table viewer

Comparison 4. Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 No improvement of daytime hypercapnia Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.49, 2.05]
Open in figure viewer Analysis 4.1 Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 1 No improvement of daytime hypercapnia.
2 Daytime PaCO2 Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐0.21 [‐0.69, 0.27]
Open in figure viewer Analysis 4.2 Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 2 Daytime PaCO2.
3 Apnea‐hypopnea index Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	2.5 [‐0.60, 5.60]
Open in figure viewer Analysis 4.3 Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 3 Apnea‐hypopnea index.
4 Mean nocturnal SaO2 Show forest plot	1	2	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 4.4 Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 4 Mean nocturnal SaO2.
5 Time spent with an SaO2 below 90% Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	2.0 [‐42.74, 46.74]
Open in figure viewer Analysis 4.5 Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 5 Time spent with an SaO2 below 90%.

Analysis 1.1

Comparison 1 Short‐term: nocturnal ventilation versus no ventilation, Outcome 1 No improvement of hypoventilation symptoms.

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Analysis 1.2

Comparison 1 Short‐term: nocturnal ventilation versus no ventilation, Outcome 2 No improvement of daytime hypercapnia.

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Analysis 1.3

Comparison 1 Short‐term: nocturnal ventilation versus no ventilation, Outcome 3 Daytime PaCO2.

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Analysis 1.4

Comparison 1 Short‐term: nocturnal ventilation versus no ventilation, Outcome 4 Mean nocturnal SaO2.

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Analysis 2.1

Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 1 Unplanned admission to hospital.

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Analysis 2.2

Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 2 Death.

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Analysis 2.3

Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 3 No improvement of hypoventilation symptoms.

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Analysis 2.4

Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 4 No improvement of daytime hypercapnia.

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Analysis 2.5

Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 5 Daytime PaCO2.

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Analysis 2.6

Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 6 Forced vital capacity.

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Analysis 2.7

Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 7 Respiratory muscle strength.

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Analysis 2.8

Comparison 2 Long‐term: nocturnal ventilation versus no ventilation, Outcome 8 Mean nocturnal SaO2.

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Analysis 3.1

Comparison 3 Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 1 No improvement of hypoventilation symptoms.

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Analysis 3.2

Comparison 3 Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 2 No improvement of daytime hypercapnia.

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Analysis 3.3

Comparison 3 Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 3 Daytime PaCO2.

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Analysis 3.4

Comparison 3 Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 4 Mean nocturnal SaO2.

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Analysis 4.1

Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 1 No improvement of daytime hypercapnia.

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Analysis 4.2

Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 2 Daytime PaCO2.

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Analysis 4.3

Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 3 Apnea‐hypopnea index.

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Analysis 4.4

Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 4 Mean nocturnal SaO2.

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Analysis 4.5

Comparison 4 Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation, Outcome 5 Time spent with an SaO2 below 90%.

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Table 1. Methodological quality of included studies


Study ID	Allocation Concealment	Observer blinding	Explicit diagnostic criteria	Explicit outcome criteria	Baseline differences	Completeness of follow‐up
Ellis 1987	C	C	B	A	B	A
Pinto 1995	C	C	A	A	A	A
Raphaël 1994	A	C	A	A	A	A
Restrick 1993	A	C	B	B	A	A
Laserna 2003	C	C	A	A	A	A
Wilson 2004	C	C	A	A	A	A
Ward 2005	C	C	A	A	A	B
Bourke 2006	A	C	A	A	A	A

Table 1. Methodological quality of included studies

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Comparison 1. Short‐term: nocturnal ventilation versus no ventilation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 No improvement of hypoventilation symptoms Show forest plot	1	10	Risk Ratio (M‐H, Fixed, 95% CI)	0.09 [0.01, 1.31]

2 No improvement of daytime hypercapnia Show forest plot	3	43	Risk Ratio (M‐H, Fixed, 95% CI)	0.37 [0.20, 0.65]

3 Daytime PaCO2 Show forest plot	2	24	Mean Difference (IV, Fixed, 95% CI)	‐0.32 [‐0.84, 0.20]

4 Mean nocturnal SaO2 Show forest plot	2	24	Mean Difference (IV, Fixed, 95% CI)	5.45 [1.47, 9.44]

Comparison 1. Short‐term: nocturnal ventilation versus no ventilation

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Comparison 2. Long‐term: nocturnal ventilation versus no ventilation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Unplanned admission to hospital Show forest plot	1	19	Risk Ratio (M‐H, Fixed, 95% CI)	0.13 [0.01, 2.22]

2 Death Show forest plot	3	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.42, 0.91]

3 No improvement of hypoventilation symptoms Show forest plot	1	19	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.22, 1.19]

4 No improvement of daytime hypercapnia Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5 Daytime PaCO2 Show forest plot	3	60	Mean Difference (IV, Fixed, 95% CI)	‐0.26 [‐0.61, 0.09]

6 Forced vital capacity Show forest plot	2	28	Mean Difference (IV, Fixed, 95% CI)	158.50 [‐84.43, 401.43]

7 Respiratory muscle strength Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	‐5.72 [‐13.87, 2.43]

7.1 mean improvement in maximal inspiratory pressure	1	2	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 mean improvement in SNIP	1	26	Mean Difference (IV, Fixed, 95% CI)	‐5.72 [‐13.87, 2.43]
8 Mean nocturnal SaO2 Show forest plot	1	26	Mean Difference (IV, Fixed, 95% CI)	3.00 [1.85, 4.15]

Comparison 2. Long‐term: nocturnal ventilation versus no ventilation

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Comparison 3. Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 No improvement of hypoventilation symptoms Show forest plot	1	14	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 No improvement of daytime hypercapnia Show forest plot	1	14	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.46, 3.88]

3 Daytime PaCO2 Show forest plot	1	14	Mean Difference (IV, Fixed, 95% CI)	0.24 [‐0.38, 0.86]

4 Mean nocturnal SaO2 Show forest plot	1	14	Mean Difference (IV, Fixed, 95% CI)	‐0.49 [‐3.28, 2.30]

Comparison 3. Short‐term: volume‐cycled ventilation versus pressure‐cycled ventilation

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Comparison 4. Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 No improvement of daytime hypercapnia Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.49, 2.05]

2 Daytime PaCO2 Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐0.21 [‐0.69, 0.27]

3 Apnea‐hypopnea index Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	2.5 [‐0.60, 5.60]

4 Mean nocturnal SaO2 Show forest plot	1	2	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

5 Time spent with an SaO2 below 90% Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	2.0 [‐42.74, 46.74]

Comparison 4. Long‐term: volume‐cycled ventilation versus pressure‐cycled ventilation

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Referencias

Referencias de los estudios incluidos en esta revisión

Bourke 2006 {published data only}

Ellis 1987 {published data only}

Laserna 2003 {published data only}

Pinto 1995 {published data only}

Raphaël 1994 {published and unpublished data}

Restrick 1993 {published data only}

Ward 2005 {published data only}

Willson 2004 {published data only}

Referencias de los estudios excluidos de esta revisión

Aboussouan 1997 {published data only}

Ambrosino 1997 {published data only}

Bach 1998 {published data only}

Celikel 1998 {published data only}

Elliott 1994 {published data only}

Masa 1997 {published data only}

Meecham Jones 1993 {published data only}

Padman 1998 {published data only}

Referencias adicionales

Annane 1999

Arras 1995

Bach 1987

Barbé 1996

Carroll 1988

Chailleux 1996

Claman 1996

Heckmatt 1990

Hoeppner 1984

Lloyd‐Owen 2005

Loh 1979

Make 1998

Milligan 1991

Newsom‐Davis 1980

Orlikowski 2005

Raphaël 1987

Raphaël 1999

Simonds 2003

Skatrud 1980

Smith 1987

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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