Do sleep studies improve outcomes for patients with respiratory failure who need to use long-term non-invasive ventilation?

Clinical titration of NIPPV settings using daytime monitoring techniques (such as pulse oximetry, clinical assessment and daytime arterial blood gases where required). These will be performed by an experienced respiratory physiotherapist under the supervision of a respiratory/sleep physician. Clinical titration will occur during daylight hours (over typically 2-4hrs) on a single occasion. After an acclimatisation period (2 weeks), those in the intervention group will undergo a single night in-lab attended polysomnography titration of non-invasive positive pressure ventilation (NIPPV). These will be performed and supervised by a sleep scientist and settings will be adjusted to optimise pulse oximetry, reduce hypoventilation and improve synchrony between the patient and the device. Optimised settings will subsequently be determined by a sleep physician experienced in the use of NIPPV and interpretation of polysomnography studies. Participants will continue to use NIPPV every night as prescribed before returning after 6 weeks for a PSG and repeat measures.