{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:19:09Z","timestamp":1791854349966,"version":"4.3.4"},"reference-count":46,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,6,20]],"date-time":"2016-06-20T00:00:00Z","timestamp":1466380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Italian National Research Council","award":["ME.P01.014.002"],"award-info":[{"award-number":["ME.P01.014.002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and objective<\/jats:title><jats:p>No studies have evaluated the impact of different settings of non\u2010invasive ventilation (NIV) in patients affected by amyotrophic lateral sclerosis (ALS). We explored consequences of positive end\u2010expiratory pressure (PEEP) application on effectiveness of ventilation, sleep architecture and heart rate variability (HRV) in patients with ALS na\u00efve to ventilatory treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In two consecutive nights, 25 patients received in random order 0 or 4\u2009cm\u2009H<jats:sub>2<\/jats:sub>0 of PEEP during nocturnal NIV administration (Idea Ultra ResMed) with the same level of total positive inspiratory pressure. Polysomnographies were performed to evaluate sleep and NIV quality, as well as HRV. HRV was analyzed on 4\u2010h periods and on 5\u2010min segments of stable NREM sleep.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We did not observe differences in gas exchanges during NIV with and without PEEP. Conversely, during PEEP application increases in leaks (41.4\u2009\u00b1\u200929.3% vs 31.0\u2009\u00b1\u200925.7%, <jats:italic>P<\/jats:italic>\u2009=\u20090.0007) and in autotriggerings (4.2 (IQR 1.3\u201310.0) vs 0.9 (IQR 0.0\u20133.0) events\/h, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001, PEEP vs no PEEP, respectively) occurred. Besides, N3 sleep stage duration decreased (2.5% (IQR 0.0\u201318.0) vs 0.0% (IQR0.0\u201312.1), <jats:italic>P<\/jats:italic>\u2009=\u20090.001) and arousal\/awakening index increased (16.9\u2009\u00b1\u20097.4 vs 13.4\u2009\u00b1\u20095.0 events\/h, <jats:italic>P<\/jats:italic>\u2009=\u20090.01). Data on HRV were available in 15 patients. A higher low\/high frequency ratio, either in the 4\u2010h (3.8\u2009\u00b1\u20092.6 vs 2.9\u2009\u00b1\u20091.7, <jats:italic>P<\/jats:italic>\u2009=\u20090.04, PEEP vs no PEEP, respectively) or in the 5\u2010min segments (2.6\u2009\u00b1\u20091.8 vs 1.45\u2009\u00b1\u20090.9 <jats:italic>P<\/jats:italic>\u2009=\u20090.01) was found during PEEP administration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In ALS patients, PEEP application during NIV was associated with worse NIV and sleep quality and with higher sympathetic activity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.12836","type":"journal-article","created":{"date-parts":[[2016,6,21]],"date-time":"2016-06-21T23:18:19Z","timestamp":1466551099000},"page":"1307-1313","source":"Crossref","is-referenced-by-count":28,"title":["Effects of positive end expiratory pressure administration during non\u2010invasive ventilation in patients affected by amyotrophic lateral sclerosis: A randomized crossover study"],"prefix":"10.1111","volume":"21","author":[{"given":"Grazia","family":"Crescimanno","sequence":"first","affiliation":[{"name":"Italian National Research Council Institute of Biomedicine and Molecular Immunology  Palermo Italy"},{"name":"Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases Villa Sofia\u2013Cervello Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Greco","sequence":"additional","affiliation":[{"name":"Italian Union Against Muscular Dystrophy (UILDM)  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvo","family":"Arrisicato","sequence":"additional","affiliation":[{"name":"Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases Villa Sofia\u2013Cervello Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"Morana","sequence":"additional","affiliation":[{"name":"Italian Union Against Muscular Dystrophy (UILDM)  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oreste","family":"Marrone","sequence":"additional","affiliation":[{"name":"Italian National Research Council Institute of Biomedicine and Molecular Immunology  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,6,20]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"CD004427","article-title":"Mechanical ventilation for amyotrophic lateral sclerosis\/motor neuron disease","volume":"3","author":"Radunovic A","year":"2013","journal-title":"Cochrane Database Syst. 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