char = P;code = 80 char = o;code = 111 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = q;code = 113 char = u;code = 117 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = s;code = 115 char = o;code = 111 char = c;code = 99 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = c;code = 99 char = u;code = 117 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = h;code = 104 char = y;code = 121 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = c;code = 99 char = a;code = 97 char = p;code = 112 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = p;code = 112 char = i;code = 105 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = o;code = 111 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = .;code = 46 result sql = Poor sleep quality is associated with late noninvasive ventilation failure in patients with acute hypercapnic respiratory failure.
Poor sleep quality is associated with late noninvasive ventilation failure in patients with acute hypercapnic respiratory failure.char = <;code = 60 char = b;code = 98 char = >;code = 62 char = O;code = 79 char = B;code = 66 char = J;code = 74 char = E;code = 69 char = C;code = 67 char = T;code = 84 char = I;code = 73 char = V;code = 86 char = E;code = 69 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = T;code = 84 char = o;code = 111 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = e;code = 101 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = e;code = 101 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = q;code = 113 char = u;code = 117 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = h;code = 104 char = e;code = 101 char = l;code = 108 char = p;code = 112 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = i;code = 105 char = c;code = 99 char = t;code = 116 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = u;code = 117 char = t;code = 116 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = c;code = 99 char = u;code = 117 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = h;code = 104 char = y;code = 121 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = c;code = 99 char = a;code = 97 char = p;code = 112 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = p;code = 112 char = i;code = 105 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = o;code = 111 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = .;code = 46 char = ;code = 32 char = D;code = 68 char = e;code = 101 char = s;code = 115 char = p;code = 112 char = i;code = 105 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = c;code = 99 char = l;code = 108 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = i;code = 105 char = m;code = 109 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ,;code = 44 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = a;code = 97 char = r;code = 114 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = u;code = 117 char = r;code = 114 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = y;code = 121 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = v;code = 118 char = e;code = 101 char = r;code = 114 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = y;code = 121 char = s;code = 115 char = .;code = 46 char = ;code = 32 char = B;code = 66 char = e;code = 101 char = c;code = 99 char = a;code = 97 char = u;code = 117 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = u;code = 117 char = b;code = 98 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = s;code = 115 char = o;code = 111 char = c;code = 99 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = g;code = 103 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = i;code = 105 char = t;code = 116 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = y;code = 121 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = ;code = 32 char = u;code = 117 char = s;code = 115 char = e;code = 101 char = f;code = 102 char = u;code = 117 char = l;code = 108 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = i;code = 105 char = d;code = 100 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = f;code = 102 char = y;code = 121 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = c;code = 99 char = t;code = 116 char = o;code = 111 char = r;code = 114 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = t;code = 116 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = y;code = 121 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = i;code = 105 char = c;code = 99 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = p;code = 112 char = l;code = 108 char = a;code = 97 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = P;code = 80 char = A;code = 65 char = T;code = 84 char = I;code = 73 char = E;code = 69 char = N;code = 78 char = T;code = 84 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = W;code = 87 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = s;code = 115 char = p;code = 112 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = u;code = 117 char = d;code = 100 char = i;code = 105 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = 2;code = 50 char = 7;code = 55 char = ;code = 32 char = h;code = 104 char = y;code = 121 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = c;code = 99 char = a;code = 97 char = p;code = 112 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = m;code = 109 char = e;code = 101 char = d;code = 100 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = u;code = 117 char = n;code = 110 char = i;code = 105 char = t;code = 116 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = o;code = 111 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = q;code = 113 char = u;code = 117 char = i;code = 105 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = >;code = 62 char = 4;code = 52 char = 8;code = 56 char = ;code = 32 char = h;code = 104 char = r;code = 114 char = s;code = 115 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = I;code = 73 char = N;code = 78 char = T;code = 84 char = E;code = 69 char = R;code = 82 char = V;code = 86 char = E;code = 69 char = N;code = 78 char = T;code = 84 char = I;code = 73 char = O;code = 79 char = N;code = 78 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = A;code = 65 char = ;code = 32 char = 1;code = 49 char = 7;code = 55 char = -;code = 45 char = h;code = 104 char = r;code = 114 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = l;code = 108 char = y;code = 121 char = s;code = 115 char = o;code = 111 char = m;code = 109 char = n;code = 110 char = o;code = 111 char = g;code = 103 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = h;code = 104 char = y;code = 121 char = ;code = 32 char = (;code = 40 char = 3;code = 51 char = ;code = 32 char = P;code = 80 char = M;code = 77 char = -;code = 45 char = 8;code = 56 char = ;code = 32 char = A;code = 65 char = M;code = 77 char = );code = 41 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = c;code = 99 char = o;code = 111 char = r;code = 114 char = d;code = 100 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = 2;code = 50 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = y;code = 121 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = 4;code = 52 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = y;code = 121 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = L;code = 76 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = f;code = 102 char = i;code = 105 char = n;code = 110 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = h;code = 104 char = ,;code = 44 char = ;code = 32 char = e;code = 101 char = n;code = 110 char = d;code = 100 char = o;code = 111 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = c;code = 99 char = h;code = 104 char = e;code = 101 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = u;code = 117 char = b;code = 98 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ,;code = 44 char = ;code = 32 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = y;code = 121 char = ;code = 32 char = 6;code = 54 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = M;code = 77 char = E;code = 69 char = A;code = 65 char = S;code = 83 char = U;code = 85 char = R;code = 82 char = E;code = 69 char = M;code = 77 char = E;code = 69 char = N;code = 78 char = T;code = 84 char = S;code = 83 char = ;code = 32 char = A;code = 65 char = N;code = 78 char = D;code = 68 char = ;code = 32 char = M;code = 77 char = A;code = 65 char = I;code = 73 char = N;code = 78 char = ;code = 32 char = R;code = 82 char = E;code = 69 char = S;code = 83 char = U;code = 85 char = L;code = 76 char = T;code = 84 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = A;code = 65 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = b;code = 98 char = n;code = 110 char = o;code = 111 char = r;code = 114 char = m;code = 109 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = e;code = 101 char = l;code = 108 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = r;code = 114 char = o;code = 111 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = p;code = 112 char = h;code = 104 char = a;code = 97 char = l;code = 108 char = o;code = 111 char = g;code = 103 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = h;code = 104 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = t;code = 116 char = ;code = 32 char = e;code = 101 char = l;code = 108 char = u;code = 117 char = d;code = 100 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = y;code = 121 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = b;code = 98 char = y;code = 121 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = a;code = 97 char = r;code = 114 char = d;code = 100 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = -;code = 45 char = s;code = 115 char = c;code = 99 char = o;code = 111 char = r;code = 114 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = c;code = 99 char = r;code = 114 char = i;code = 105 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = i;code = 105 char = a;code = 97 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = (;code = 40 char = 5;code = 53 char = 0;code = 48 char = %;code = 37 char = );code = 41 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = 1;code = 49 char = 4;code = 52 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = p;code = 112 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = e;code = 101 char = ;code = 32 char = (;code = 40 char = 8;code = 56 char = %;code = 37 char = );code = 41 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = 1;code = 49 char = 3;code = 51 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = c;code = 99 char = c;code = 99 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = f;code = 102 char = u;code = 117 char = l;code = 108 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = t;code = 116 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = (;code = 40 char = p;code = 112 char = ;code = 32 char = =;code = 61 char = ;code = 32 char = .;code = 46 char = 0;code = 48 char = 3;code = 51 char = );code = 41 char = .;code = 46 char = ;code = 32 char = N;code = 78 char = o;code = 111 char = ;code = 32 char = c;code = 99 char = l;code = 108 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = l;code = 108 char = a;code = 97 char = b;code = 98 char = o;code = 111 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = o;code = 111 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = r;code = 114 char = i;code = 105 char = a;code = 97 char = b;code = 98 char = l;code = 108 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = p;code = 112 char = l;code = 108 char = a;code = 97 char = i;code = 105 char = n;code = 110 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = l;code = 108 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = r;code = 114 char = o;code = 111 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = p;code = 112 char = h;code = 104 char = a;code = 97 char = l;code = 108 char = o;code = 111 char = g;code = 103 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = h;code = 104 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = s;code = 115 char = .;code = 46 char = ;code = 32 char = P;code = 80 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = h;code = 104 char = a;code = 97 char = d;code = 100 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = o;code = 111 char = r;code = 114 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = q;code = 113 char = u;code = 117 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = g;code = 103 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = c;code = 99 char = i;code = 105 char = r;code = 114 char = c;code = 99 char = a;code = 97 char = d;code = 100 char = i;code = 105 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = -;code = 45 char = c;code = 99 char = y;code = 121 char = c;code = 99 char = l;code = 108 char = e;code = 101 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = s;code = 115 char = r;code = 114 char = u;code = 117 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = l;code = 108 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = c;code = 99 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = (;code = 40 char = 6;code = 54 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = [;code = 91 char = r;code = 114 char = a;code = 97 char = n;code = 110 char = g;code = 103 char = e;code = 101 char = ,;code = 44 char = ;code = 32 char = 0;code = 48 char = -;code = 45 char = 1;code = 49 char = 2;code = 50 char = ];code = 93 char = ;code = 32 char = v;code = 118 char = s;code = 115 char = .;code = 46 char = ;code = 32 char = 2;code = 50 char = 6;code = 54 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = [;code = 91 char = r;code = 114 char = a;code = 97 char = n;code = 110 char = g;code = 103 char = e;code = 101 char = ,;code = 44 char = ;code = 32 char = 6;code = 54 char = -;code = 45 char = 4;code = 52 char = 9;code = 57 char = ];code = 93 char = ,;code = 44 char = ;code = 32 char = p;code = 112 char = ;code = 32 char = =;code = 61 char = ;code = 32 char = .;code = 46 char = 0;code = 48 char = 3;code = 51 char = );code = 41 char = ,;code = 44 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = p;code = 112 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = c;code = 99 char = c;code = 99 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = f;code = 102 char = u;code = 117 char = l;code = 108 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = t;code = 116 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = N;code = 78 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = s;code = 115 char = o;code = 111 char = c;code = 99 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = l;code = 108 char = i;code = 105 char = r;code = 114 char = i;code = 105 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = d;code = 100 char = u;code = 117 char = r;code = 114 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = u;code = 117 char = n;code = 110 char = i;code = 105 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = a;code = 97 char = y;code = 121 char = ;code = 32 char = (;code = 40 char = 6;code = 54 char = 4;code = 52 char = %;code = 37 char = ;code = 32 char = v;code = 118 char = s;code = 115 char = .;code = 46 char = ;code = 32 char = 0;code = 48 char = %;code = 37 char = );code = 41 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = C;code = 67 char = O;code = 79 char = N;code = 78 char = C;code = 67 char = L;code = 76 char = U;code = 85 char = S;code = 83 char = I;code = 73 char = O;code = 79 char = N;code = 78 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = L;code = 76 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = e;code = 101 char = l;code = 108 char = d;code = 100 char = e;code = 101 char = r;code = 114 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = c;code = 99 char = u;code = 117 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = h;code = 104 char = y;code = 121 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = c;code = 99 char = a;code = 97 char = p;code = 112 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = p;code = 112 char = i;code = 105 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = o;code = 111 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = i;code = 105 char = l;code = 108 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = s;code = 115 char = o;code = 111 char = c;code = 99 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = e;code = 101 char = a;code = 97 char = r;code = 114 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = b;code = 98 char = a;code = 97 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = c;code = 99 char = l;code = 108 char = u;code = 117 char = d;code = 100 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = b;code = 98 char = n;code = 110 char = o;code = 111 char = r;code = 114 char = m;code = 109 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = e;code = 101 char = l;code = 108 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = r;code = 114 char = o;code = 111 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = p;code = 112 char = h;code = 104 char = a;code = 97 char = l;code = 108 char = o;code = 111 char = g;code = 103 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = h;code = 104 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = n;code = 110 char = ,;code = 44 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = s;code = 115 char = r;code = 114 char = u;code = 117 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = i;code = 105 char = r;code = 114 char = c;code = 99 char = a;code = 97 char = d;code = 100 char = i;code = 105 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = c;code = 99 char = y;code = 121 char = c;code = 99 char = l;code = 108 char = e;code = 101 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = c;code = 99 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = .;code = 46 result sql = OBJECTIVE : To determine whether sleep quality helps to predict noninvasive ventilation outcome in patients with acute hypercapnic respiratory failure. Despite an initial clinical improvement, nearly one fourth of patients may fail noninvasive ventilation after several days. Because late intubation is associated with a poor prognosis, it may be useful to identify factors that may predict or explain late noninvasive ventilation failure.PATIENTS : We prospectively studied 27 hypercapnic patients in a medical intensive care unit who required noninvasive ventilation for >48 hrs.INTERVENTIONS : A 17-hr sleep polysomnography (3 PM-8 AM) was recorded 2 days to 4 days after noninvasive ventilation initiation. Late noninvasive ventilation failure was defined as death, endotracheal intubation, or persistent need for noninvasive ventilation on day 6.MEASUREMENTS AND MAIN RESULTS : An abnormal electroencephalographic pattern that eluded analysis by standard sleep-scoring criteria was noted in seven (50%) of the 14 patients with late noninvasive ventilation failure compared with one (8%) of the 13 patients successfully treated with noninvasive ventilation (p = .03). No clinical or laboratory variables explained the electroencephalographic differences. Patients failing noninvasive ventilation had poorer sleep quality with greater circadian sleep-cycle disruption and less nocturnal rapid eye movement sleep (6 mins [range, 0-12] vs. 26 mins [range, 6-49], p = .03), compared with patients successfully treated with noninvasive ventilation. Noninvasive ventilation failure was associated with delirium during the intensive care unit stay (64% vs. 0%).CONCLUSIONS : Late noninvasive ventilation failure in elderly patients with acute hypercapnic respiratory failure was associated with early sleep disturbances including an abnormal electroencephalographic pattern, disruption of the circadian sleep cycle, and decreased rapid eye movement sleep.
Publication: Crit. Care Med. 2010 Feb ;38(2)::477-85. :doi: 10.1097/CCM.0b013e3181bc8243.
Publication Date: 2010 Feb
Study Author(s): Roche Campo, Ferran;Drouot, Xavier;Thille, Arnaud W;Galia, Fabrice;Cabello, Belen;d'Ortho, Marie-Pia;Brochard, Laurent;
Institution: Medical Intensive Care Unit, AP-HP, Albert Chenevier-Henri Mondor Hospital, Créteil, France.
[email protected]
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OBJECTIVE : To determine whether sleep quality helps to predict noninvasive ventilation outcome in patients with acute hypercapnic respiratory failure. Despite an initial clinical improvement, nearly one fourth of patients may fail noninvasive ventilation after several days. Because late intubation is associated with a poor prognosis, it may be useful to identify factors that may predict or explain late noninvasive ventilation failure.PATIENTS : We prospectively studied 27 hypercapnic patients in a medical intensive care unit who required noninvasive ventilation for >48 hrs.INTERVENTIONS : A 17-hr sleep polysomnography (3 PM-8 AM) was recorded 2 days to 4 days after noninvasive ventilation initiation. Late noninvasive ventilation failure was defined as death, endotracheal intubation, or persistent need for noninvasive ventilation on day 6.MEASUREMENTS AND MAIN RESULTS : An abnormal electroencephalographic pattern that eluded analysis by standard sleep-scoring criteria was noted in seven (50%) of the 14 patients with late noninvasive ventilation failure compared with one (8%) of the 13 patients successfully treated with noninvasive ventilation (p = .03). No clinical or laboratory variables explained the electroencephalographic differences. Patients failing noninvasive ventilation had poorer sleep quality with greater circadian sleep-cycle disruption and less nocturnal rapid eye movement sleep (6 mins [range, 0-12] vs. 26 mins [range, 6-49], p = .03), compared with patients successfully treated with noninvasive ventilation. Noninvasive ventilation failure was associated with delirium during the intensive care unit stay (64% vs. 0%).CONCLUSIONS : Late noninvasive ventilation failure in elderly patients with acute hypercapnic respiratory failure was associated with early sleep disturbances including an abnormal electroencephalographic pattern, disruption of the circadian sleep cycle, and decreased rapid eye movement sleep.
PMID: 19789439