Effects of Nasal Airflow on Sleep in Tracheotomized Patients

Not yet recruiting

Brief Summary: The passage of air through the nasal cavities generates rhythmic oscillations transmitted by the olfactory bulb to the brain, which induces cerebral activation in functional brain areas and is associated with better cognitive performance compared to oral breathing. Consequently, the abolition of nasal ventilation - intrinsic in tracheotomized and ventilated patients - could have deleterious effects on brain activity. Besides the loss of olfaction, the abolition of nasal ventilation could affect brain activity and sleep.

The hypothesis of the present study is that the restoration of nasal stimulation by the passage of humidified nasal airflow in tracheotomized and ventilated patients improves sleep quality, notably with a greater proportion of time spent in REM sleep.

Detailed Description: The use of invasive mechanical ventilation via an endotracheal tube or tracheotomy involves bypassing the nasopharyngeal space and abolishing nasal ventilation. The first consequence is the loss of olfactory function. This function is quickly recovered when nasal ventilation is made possible. However, the abolition of nasal ventilation may have consequences beyond the loss of olfaction. The abolition of nasal ventilation in intubated rats inhibits these rhythmic oscillations, which can be restored by nasal sprays. In humans, nasal ventilation induces cerebral activity in functional brain areas and is associated with better cognitive performance compared to oral ventilation. In a model of intubated and ventilated rats, it has been shown that nasal sprays synchronized with the ventilator reduce hippocampal lesions compared to animals ventilated with an endotracheal tube without nasal sprays. Finally, in patients intubated with an endotracheal tube for toxic comas, the same nasal spray system restored brain activity and neural connectivity.

The aim of this study is to test the effects of nasal airflow of the sleep in tracheostomized patients who are still dependent to invasive mechanical ventilation. Patients will be investigated by a full polysomnography during two consecutive nights, with and without nasal airflow on the top of invasive mechanical ventilation, the two nights being randomized.

Recruitment & Eligibility

Inclusion Criteria

Age ≥ 18 years
Admission to PRRS for weaning from ventilation
Tracheotomy and nocturnal invasive mechanical ventilation
Indication for polysomnography by care team
Agreement to participate by patient or trusted person/relative and signature of consent form
Affiliation with a social security scheme or beneficiary

Exclusion Criteria

Diseases of the central nervous system: cerebrovascular accident (CVA), multiple sclerosis (MS), epilepsy
Psychiatric illnesses (psychoses)
Hyperthermia (temperature > 38.5°C)
Agitation, resuscitation delirium
Continuous use of sedatives
Patients under legal protection (guardianship/curatorship)
Patients deprived of liberty by judicial or administrative decision
Patients under AME
Pregnant or breast-feeding women

Arm && Interventions

Group	Intervention	Description
Patients with prolonged weaning	nasal oxygenation device	Mechanically ventilated tracheotomized patients admitted for ventilation weaning.

Primary Outcome Measures

Name	Time	Method
Effects of nasal ventilation on sleep quality in ventilation-dependent tracheostomized patients.	During the 12 hours duration of PSG	The proportion of time spent in REM sleep over the total sleep time

Secondary Outcome Measures

Name	Time	Method
Effects of nasal ventilation on the proportion of atypical sleep	During the 12 hours duration of PSG	Proportion of time spent in atypical sleep
Effects of nasal ventilation on sleep duration	During the 12 hours duration of PSG	Total sleep time as determined by polysomnography
Effects of nasal ventilation on patient-ventilator asynchrony	During the 12 hours duration of PSG	Asynchrony index (number of asynchronies/total number of respiratory cycles)
Effects of nasal ventilation on night-time awakenings	During the 12 hours duration of PSG	Prevalence of night-time awakenings
Effects of nasal ventilation on sleep architecture	During the 12 hours duration of PSG	Proportion of time spent in stage 1, stage 2 and stage 3 sleeping
Effects of nasal ventilation on minute ventilation	During the 12 hours duration of PSG	Measurement of transcutaneous PaCO2