Sleeping on Clouds; a comparison of the impact of polysomnography versus remote determination on non-invasive ventilation device settings

<bold>Introduction:</bold> Non-invasive ventilation (NIV) is an effective treatment for chronic respiratory failure (CRF). Modern ventilators produce ventilator data for review via cloud-based platforms. It is unknown whether this data provides sufficient information for titration compared with polysomnography (PSG). The aim of this study was to compare the agreement of ventilator settings based on summarised ventilator data and NIV PSG. <bold>Methods:</bold> 30 individuals with CRF were established on NIV. After initiation of therapy, participants were administered questionnaires to assess NIV satisfaction, underwent in-lab PSG , and their data from the ventilator cloud-based platform Airview, was reviewed. Optimal NIV settings were separately determined by blinded review of the Airview and PSG data by a respiratory and sleep physician. <bold>Results:</bold> Questionnaires demonstrated 20/30 users experienced discomfort whilst using NIV. Ventilator prescription using NIV PSG and Airview data were different. Inspiratory positive airway pressure (IPAP) and pressure support (PS) were an average of 2.76cmH2O (standard deviation (SD) 1.92) and 1.8cmH2O (SD 1.76) lower with AirView review. Comparative analysis with Bland Altman plots demonstrated a mean difference (MD) in IPAP of 1.4cmH2O (limits of agreement (LOA) -4.47 to 7.29) and PS MD of 0.96cmH2O (LOA -3.43 to 5.36). <bold>Conclusion:</bold> User reported discomfort with NIV therapy was common. Differences in IPAP and PS were observed with a lower prescribed pressures when titration was performed using Airview data compared with NIV PSG. Whilst this may influence the titration of NIV therapy, the clinical impact on users is currently unknown.