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

Arellano-Maric, M. P., Hamm, C., Duiverman, M. L., Schwarz, S., Callegari, J., Storre, J. H., Schmoor, C., Spielmanns, M., Galetke, W. & Windisch, W., Apr-2020, In : Respirology. 25, 4, p. 435-442 8 p.

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  • Obesity hypoventilation syndrome treated with non‐invasive ventilation Is a switch to CPAP therapy feasible

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DOI

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

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
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

ID: 99604884