Factors associated with non-invasive ventilation usage in patients with hypoventilation disorders

The objective of this study was to investigate the association between demographic, clinical, and interface factors and non-invasive ventilation (NIV) usage. A retrospective cohort analysis of 478 patients prescribed NIV from 2013 to 2021 was performed. Demographic factors, clinical indications for NIV, and interface factors were collected, and linear regression was conducted to evaluate the association between these variables and NIV usage (hr/night). The average usage of the cohort was 6.5hr/night±4.6, with an average age of 57 years±16 and body mass index (BMI) of 40.5kg/m2±14.7. The cohort was mostly male (n = 290, 60.6%). The most common indications for NIV prescription were high pressure requirement for obstructive sleep apnoea (HPR, n = 190, 39.7%), neuromuscular disease (NMD, n = 140, 29.3%) and obesity hypoventilation syndrome (OHS, n = 111, 23.2%). A diagnosis of NMD was a significant predictor of higher NIV usage (8.0±6.1hr/night) in multivariate analysis (p = 0.036). The HPR sub-cohort had the lowest usage of all indications. Age and BMI did not predict usage. A nasal interface (p <0.01) and lower expiratory positive airway pressure (EPAP) setting (p <0.001) were associated with increased NIV usage. This study highlights the multifaceted nature of NIV usage. Where demographic factors were not consistent predictors of usage, interface and clinical indication were associated with usage. These findings highlight that the HPR users are a group at risk of low usage.