Obesity hypoventilation syndrome treated with non-invasive ventilation: Is a switch to CPAP therapy feasible?

Maria P Arellano-Maric, Christine Hamm, Marieke L Duiverman, Sarah Schwarz, Jens Callegari, Jan H Storre, Claudia Schmoor, Marc Spielmanns, Wolfgang Galetke, Wolfram Windisch

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    Abstract

    Background and objective: Obesity hypoventilation syndrome (OHS) can be treated with either continuous positive airway pressure (CPAP) or non-invasive ventilation (NIV) therapy; the device choice has important economic and operational implications. Methods: This multicentre interventional trial investigated the safety and short-term efficacy of switching stable OHS patients who were on successful NIV therapy for ≥3 months to CPAP therapy. Patients underwent an autotitrating CPAP night under polysomnography (PSG); if the ensuing parameters were acceptable, they were sent home on a fixed CPAP for a 4–6-week period. It was hypothesized that blood gas analysis, PSG parameters and lung function tests would remain unchanged. Results: A total of 42 OHS patients were recruited, of whom 37 patients were switched to CPAP therapy. All patients had a history of severe obstructive sleep apnoea syndrome; chronic obstructive pulmonary disease (COPD) (Global Initiative for Obstructive Lung Disease (GOLD) I/II) was present in 52%. Regarding the primary outcome, 30 of 42 patients (71%, 95% CI: 55–84%) maintained daytime partial pressure of carbon dioxide (PaCO2) levels ≤45 mm Hg after the home CPAP period. There was no further impairment in quality of life, sleep parameters or lung function. Interestingly, 24 patients (65%) preferred CPAP as their long-term therapy, despite the high pressure levels used (mean: 13.8 ± 1.8 mbar). After the CPAP period, 7 of 37 patients were categorized as CPAP failure, albeit only due to mild hypercapnia (mean: 47.9 ± 2.7 mm Hg). Conclusion: It is feasible to switch most stable OHS patients from NIV to CPAP therapy, a step that could significantly reduce health-related costs. The auto-adjusted CPAP device, used in combination with the analysis of the PSG and capnometry, is a valid titration method in OHS patients.

    Original languageEnglish
    Pages (from-to)435-442
    Number of pages8
    JournalRespirology
    Volume25
    Issue number4
    Early online date2019
    DOIs
    Publication statusPublished - Apr-2020

    Keywords

    • continuous positive airway pressure
    • hypoventilation
    • non-invasive ventilation
    • obesity hypoventilation syndrome
    • polysomnography
    • OBSTRUCTIVE SLEEP-APNEA
    • MECHANICAL VENTILATION
    • RESPIRATORY-FAILURE
    • SPECTRUM
    • TRIAL
    • PART

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