Nocturnal
noninvasive ventilation (NNV), the provision of ventilatory assistance via a noninvasive interface mainly during sleep, has assumed an important role in the management of chronic hypoventilatory syndromes. This review focuses on recent developments related to the use of NNV to treat various forms of chronic
respiratory failure or insufficiency. In the past, NNV has been used mainly to treat
respiratory insufficiency in patients with
neuromuscular disease (NMD) or chest wall
deformity; it should be instituted when these patients have
orthopnea or daytime symptoms associated with nocturnal
hypoventilation. An emerging application is to treat
obesity-hypoventilation syndrome, particularly in
continuous positive airway pressure (CPAP) failures. Additionally, it has a role in managing some patients with
obstructive sleep apnea who are hypoventilating or find the lower expiratory pressure with bilevel positive pressure
ventilators more tolerable than with CPAP alone. NNV to treat severe, stable
COPD remains controversial, although a subgroup of patients with hypercapnea and
sleep-disordered breathing (SDB) seems most likely to respond favorably. NNV to treat central SDB in patients with
congestive heart failure continues to be investigated. Recent findings from a Canadian CPAP trial were disappointing, but preliminary results on a novel adaptive NNV mode are promising.