From the Guidelines
Using non-invasive ventilation (NIV) and Inspire upper airway stimulation therapy simultaneously is not recommended due to potential interference between the two therapies. The most recent and highest quality study, 1, suggests individualizing NIV treatment to achieve ventilation goals, but does not provide guidance on the use of NIV with Inspire therapy. However, based on the principles of respiratory management, it is likely that the positive pressure from NIV may disrupt the sensing mechanism of Inspire that detects breathing patterns, leading to inappropriate or ineffective stimulation. Additionally, the electrical stimulation from Inspire might affect the NIV device's ability to detect respiratory effort accurately.
Some studies, such as 1, discuss the limitations of NIV in achieving certain aims relative to invasive ventilation in patients with de novo acute respiratory failure, but do not provide direct evidence on the use of NIV with Inspire therapy. Other studies, such as 1, focus on inspiratory muscle training and its benefits, but are not directly relevant to the question of using NIV and Inspire therapy simultaneously.
Patients should use either NIV or Inspire therapy individually, not concurrently. If a patient has both devices, they should discuss with their sleep specialist which therapy is most appropriate for their specific condition. In cases where NIV is needed temporarily (such as during respiratory infections), it may be necessary to temporarily deactivate the Inspire device. Regular follow-up with both the sleep medicine physician and the Inspire therapy provider is essential to ensure optimal management of sleep-disordered breathing. Key considerations include:
- Potential interference between NIV and Inspire therapy
- Individualization of NIV treatment to achieve ventilation goals
- Regular follow-up with sleep medicine physician and Inspire therapy provider
- Temporary deactivation of Inspire device if NIV is needed temporarily.
From the Research
Complications with Using NIV and Inspire at the Same Time
- There is limited research directly addressing the complications of using Noninvasive Ventilation (NIV) and Inspire (a type of inspiratory muscle training) simultaneously.
- However, studies have explored the benefits and limitations of NIV in various respiratory conditions 2, 3, 4.
- Inspiratory muscle training, such as Inspire, has been shown to improve weaning from mechanical ventilation and reduce the duration of non-invasive ventilatory support after extubation 5.
- The use of NIV as an additional tool for exercise training has been investigated, with benefits reported in individuals with COPD, heart failure, and lung and thoracic restrictive diseases 3.
- High-flow nasal oxygen and helmet noninvasive ventilation are considered promising techniques for first-line treatment of severe hypoxemic respiratory failure, but no conclusive evidence recommends a single approach over others in moderate-to-severe cases 4.
- Evidence-based recommendations for prehospital care of adult patients with respiratory distress support the use of non-invasive positive pressure ventilation (NIPPV) as a safe and effective treatment, decreasing mortality and the need for intubation 6.