P012 Sleeping on Clouds; a comparison of the impact of polysomnography versus remote determination on non-invasive ventilation device settings

Abstract Introduction Non-invasive ventilation (NIV) with home mechanical ventilators is an effective treatment for chronic respiratory failure. Optimal therapy requires titration of NIV settings to ensure adherence. Modern ventilators produce ventilator data for review via cloud-based platforms. The impact of relying on this data for NIV titration compared with polysomnography (PSG) is unknown. The aim of this study was to compare the agreement of ventilator settings based on summarised ventilator data and NIV PSG within participants. Methods A prospective cohort of 30 individuals with chronic respiratory failure were established on NIV. One month later, participants were administered questionnaires to assess NIV satisfaction, underwent in-lab PSG, and their data from the ventilator cloud-based platform was reviewed. Optimal NIV settings were separately determined by blinded review of the summarised ventilator data and PSG data by a respiratory and sleep physician. Results 20/30 users experienced discomfort whilst using NIV therapy. 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 (95% confidence interval 2.0,3.5) and 1.8cmH2O (95%CI 1.1,2.5) lower based on ventilator data. 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). Conclusion User reported discomfort with NIV therapy was common. Differences in IPAP and PS were observed with lower prescribed pressures when titration was performed using ventilator data compared with NIV PSG. This may influence the titration of NIV therapy; however, the clinical impact of this difference on users is currently unknown.