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Dolinay T, Hsu L, Maller A, Walsh BC, Szűcs A, Jerng JS, Jun D. Ventilator Weaning in Prolonged Mechanical Ventilation-A Narrative Review. J Clin Med 2024; 13:1909. [PMID: 38610674 PMCID: PMC11012923 DOI: 10.3390/jcm13071909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Patients requiring mechanical ventilation (MV) beyond 21 days, usually referred to as prolonged MV, represent a unique group with significant medical needs and a generally poor prognosis. Research suggests that approximately 10% of all MV patients will need prolonged ventilatory care, and that number will continue to rise. Although we have extensive knowledge of MV in the acute care setting, less is known about care in the post-ICU setting. More than 50% of patients who were deemed unweanable in the ICU will be liberated from MV in the post-acute setting. Prolonged MV also presents a challenge in care for medically complex, elderly, socioeconomically disadvantaged and marginalized individuals, usually at the end of their life. Patients and their families often rely on ventilator weaning facilities and skilled nursing homes for the continuation of care, but home ventilation is becoming more common. The focus of this review is to discuss recent advances in the weaning strategies in prolonged MV, present their outcomes and provide insight into the complexity of care.
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Affiliation(s)
- Tamás Dolinay
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
| | - Lillian Hsu
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
| | - Abigail Maller
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
| | - Brandon Corbett Walsh
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
- Department of Medicine, Division of Palliative Care Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Attila Szűcs
- Department of Anesthesiology, András Jósa County Hospital, 4400 Nyíregyháza, Hungary;
| | - Jih-Shuin Jerng
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Dale Jun
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
- Pulmonary, Critical Care and Sleep Section, West Los Angeles VA Medical Center, Los Angeles, CA 90073, USA
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Saigal A, Shah AJ, Mandal S. Indications and evidence for domiciliary noninvasive ventilation. Expert Rev Respir Med 2023; 17:1141-1150. [PMID: 38112122 DOI: 10.1080/17476348.2023.2295941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Home noninvasive ventilation (HNIV) has expanded globally, with a greater evidence base for its use. HNIV improves multiple patient related outcomes in patients with chronic hypercapnic respiratory failure. Obesity hypoventilation syndrome (OHS) is rapidly taking over as the primary indication for HNIV and COPD patients who overlap with obstructive sleep apnea hypoventilation syndromes (OSAHS) and are increasingly recognized but add to the complexity of HNIV prescribing. Optimal settings vary for differing diseases, with higher inspiratory pressures often required in those with OHS and COPD, yet which settings translate into greatest patient benefit remains unknown. AREAS COVERED We cover the evidence base underpinning the common indications for HNIV in COPD, OHS, neuromuscular disease (NMD), and chest wall disease (CWD) and highlight common HNIV modes used. EXPERT OPINION Active screening for nocturnal hypoventilation in OHS and COPD may be important to guide earlier ventilation. Further research on which HNIV modalities best improve patient related outcomes and the right time for initiation in different patient phenotypes is rapidly needed. Worldwide, clinical research trials should aim to bridge the gap by reporting on patient-related outcomes and cost effectiveness in real-world populations to best understand the true benefit of HNIV amongst heterogenous patient populations.
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Affiliation(s)
- Anita Saigal
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
| | - Amar J Shah
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
| | - Swapna Mandal
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
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Andrade RGS, Masa JF, Borel JC, Drager LF, Genta PR, Mokhlesi B, Lorenzi-Filho G. Impact of treating obesity hypoventilation syndrome on body mass index. Pulmonology 2023:S2531-0437(23)00170-8. [PMID: 37996386 DOI: 10.1016/j.pulmoe.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 11/25/2023] Open
Abstract
STUDY OBJECTIVES To evaluate the impact of positive airway pressure (PAP) therapy on body mass index (BMI) in patients with obesity hypoventilation syndrome (OHS) associated with obstructive sleep apnea (OSA). METHODS A systematic review using the following terms: "obesity hypoventilation syndrome" AND "treatment" AND "randomized" using Cochrane Central Register of Controlled Trials, Medline and Web of Science was performed from the first data available until February 10, 2023. The inclusion criteria were: (1) original article; (2) adult OHS with concomitant OSA (apnea-hypopnea index or AHI ≥5 events/h); (3) randomized trial with PAP arm and standard care (control); (4) BMI evaluation at baseline and after the first months. We performed an individual participant data meta-analysis of randomized controlled trials. RESULTS Our initial search retrieved 32 articles and 3 randomized studies fulfilled study criteria and were included in the final analysis, leading to a total of 342 participants. Patients were predominantly females (62%) and had OHS associated with at least mild OSA. As compared to baseline, a decrease in BMI was observed at study endpoint but this difference was not different intergroups (-0.50 ± 1.49 and -0.50 ±1.83, in control and PAP groups respectively (p=0.939)). Weight change was not associate with PAP adherence, OSA severity or use of supplemental oxygen. CONCLUSIONS In contrast to treatment of eucapnic OSA with PAP that is associated with weight gain, treatment of OSA+OHS patients with or without PAP is associated with weight loss. Future studies are necessary to elucidate the mechanism by which weight loss occurs.
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Affiliation(s)
- R G S Andrade
- Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil
| | - J F Masa
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain
| | - J-C Borel
- HP2 Laboratory, Grenoble Alpes University, Grenoble, France
| | - L F Drager
- Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil
| | - P R Genta
- Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil
| | - B Mokhlesi
- Division of Pulmonary, Critical Care and Sleep Medicine, Rush University Medical Center, Chicago, IL, USA
| | - G Lorenzi-Filho
- Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil.
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Krishnan A, Ellis P, Antoine-Pitterson P, Oakes A, Jones B, Turner A, Mukherjee R. Long-Term Mortality following Acute Noninvasive Ventilation for Obesity-Related Respiratory Failure: A Retrospective Single-Centre Study. Can Respir J 2023; 2023:5370197. [PMID: 37868785 PMCID: PMC10586910 DOI: 10.1155/2023/5370197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/25/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Determinants of long-term mortality following acute hypercapnic respiratory failure have been extensively studied in patients with chronic obstructive pulmonary disease. However, respiratory failure due to obesity has not been studied to the same extent. This retrospective survey aims to identify whether admission pH is associated with long-term mortality in patients requiring acute noninvasive ventilation (NIV) for obesity-related respiratory failure (ORRF). Methods Records from April 2013 to March 2020 were accessed from a NIV quality database at an acute teaching hospital. Adults with hypercapnic ORRF requiring acute NIV were included. pH data were grouped by threshold (pH≤ and >7.25) and correlated with time from presentation to death; multivariable analysis was performed using Cox proportional hazards. Results A total of 277 acute NIV episodes were included. Two-year mortality was similar for patients in both pH categories. Univariable analysis identified pH ≤ 7.25 to increase risk of two-year mortality by 43%. However, multivariable analysis identified that pH was not a significant determinant of long-term mortality, although male sex, older age, and higher admission pCO2 increased the risk of death at two years by 76%, 3% per year of age, and 16% per 1 kPa of pCO2 increase, respectively. Conclusion Severity of hypercapnia on admission, male sex, and older age are associated with worse two-year mortality in patients requiring acute NIV for ORRF. There is scope for further analyses including investigating the role of domiciliary NIV in ORRF patients.
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Affiliation(s)
- Aditya Krishnan
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
| | - Paul Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
| | - Pearlene Antoine-Pitterson
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Amy Oakes
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Bethany Jones
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Rahul Mukherjee
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, ENG, UK
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Agossou M, Simo-Tabué N, Dufeal M, Awanou B, Provost M, Smith K, Badaran E, Zouzou A, Ahouansou N, Tabué-Teguo M, Dramé M. Profiles of Elderly Patients with Obesity Hypoventilation Syndrome in Martinique: A Single-Center Study. J Pers Med 2023; 13:1089. [PMID: 37511702 PMCID: PMC10381235 DOI: 10.3390/jpm13071089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity hypoventilation syndrome (OHS) is a form of chronic respiratory insufficiency related to obesity that affects young and old people. Age appears to be associated with poorer response to treatment by nighttime ventilation. This study aimed to describe the characteristics of elderly subjects (>65 years) with OHS compared to younger patients, with a view to adapting therapy in older individuals. We conducted a retrospective study comparing socio-demographic, clinical, functional characteristics as well as treatment and outcomes between young (<65 years) and older (65 years and older) individuals with OHS at the University Hospital of Martinique. We included 143 patients (114 women), of whom 82 were 65 years or older (57%). Charlson index was higher in the older group. Patients in ≥65 years group were less frequently obese, but more frequently had diabetes mellitus, cardiac arrythmia and arterial hypertension compared to younger patients. There was no difference in the circumstances of diagnosis or arterial blood gas at diagnosis. At follow up, partial pressure of carbon dioxide (pCO2) was higher in ≥65 years group. Despite comparable NIV settings, apart from lower expiratory positive airway pressure (EPAP) with higher apnea-hypopnea index (AHI), patients in the ≥65-year-old group remained more frequently hypercapnic. In conclusion, over half (57%) of patients with OHS in our cohort were aged over 65 years. Older patients developed OHS at lower BMI levels than their younger counterparts, and more frequently, had comorbidities such as diabetes, hypertension and cardiac arrhythmia. Increased Charlson index, lower BMI and female sex were independent factors associated with OHS in the elderly.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Nadine Simo-Tabué
- Department of Geriatrics, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Marion Dufeal
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Bérénice Awanou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Mathilde Provost
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Ketty Smith
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Elena Badaran
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Adel Zouzou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Nelly Ahouansou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Maturin Tabué-Teguo
- Department of Geriatrics, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Moustapha Dramé
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
- Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France
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Ruiz Álvarez I, Fernández Álvarez R, Rubinos Cuadrado G, Vázquez López MJ, García Clemente M. Respiratory Center Function and Its Impact in Obesity Hypoventilation Syndrome Treatment. Arch Bronconeumol 2023:S0300-2896(23)00171-0. [PMID: 37321904 DOI: 10.1016/j.arbres.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Patients with obesity hypoventilation syndrome (OHS) need treatment with positive pressure either with continuous (CPAP) or double pressure (NIV). The apnea-hypopnea index (AHI) is considered a key data for making therapeutic decisions. We hypothesized that HR may be an useful tool to establish different phenotypes and individualize treatment in patients with OHS. Our objective was to analyze the role of the respiratory center response to hypercapnia (HR) in the adequacy of positive airway pressure therapy. METHOD We included subjects with OHS treated with CPAP or NIV according to AHI and baseline pCO2. We analyzed therapeutic effectiveness and treatment changes prioritizing CPAP if AHI>30/h. Therapy was considered adequate if it was effective after two years. HR was measured with the p0.1/pEtCO2 ratio and its capability to select therapy was analyzed. The statistical study was performed by means comparison (Student's t) and multivariate analysis (logistic regression). RESULTS 67 subjects were included of 68(11) years old, 37 (55%) males, initially 45 (67%) treated with NIV and 22 (33%) with CPAP, one case was excluded and in 25 (38%) the treatment was changed. Finally, CPAP was adequate for 29 subjects (44%) and NIV for 37 (56%). The CPAP group showed AHI 57/h (24) and p0.1/pEtCO2 0.37cmH2O/mmHg (0.23), NIV group AHI 43/h (35) and p0.1/pEtCO2 0.24 (0.15) with p=0.049 and 0.006. In multivariate analysis, p0.1/pEtCO2 (p=0.033) and AHI>30 (p=0.001) were predictors of adequate therapy. CONCLUSION Measuring the RH of the respiratory center helps to select the most appropriate treatment for patients with OHS.
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Affiliation(s)
- Inés Ruiz Álvarez
- Respiratory Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
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8
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Carlucci A, Patout M, Winck JC. Does one size fit all? An update on chronic ventilatory support in different respiratory illnesses. Breathe (Sheff) 2023; 19:230046. [PMID: 37492344 PMCID: PMC10365079 DOI: 10.1183/20734735.0046-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023] Open
Abstract
Home noninvasive ventilation (HNIV) improves outcomes in different disease categories. In this article, we discuss indications for when and how to initiate HNIV in COPD, obesity hypoventilation syndrome (OHS) and neuromuscular disorders (NMD). While in COPD, significant diurnal hypercapnia and high-intensity HNIV are essential ingredients for success, in NMD and OHS, early respiratory changes are best detected during sleep through oxy-capnography associated (or not) with respiratory polygraphy. In COPD and OHS, it is crucial to consider the coexistence of obstructive sleep apnoea because treatment with continuous positive airway pressure may be the simplest and most effective treatment that should be proposed even in hypercapnic patients as first-line therapy. In NMD, the need for continuous HNIV and eventual switching to tracheostomy ventilation makes this group's management more challenging. Achieving successful HNIV by improving quality of sleep, quality of life and keeping a good adherence to the therapy is a challenge, above all in COPD patients. In OHS patients, on top of HNIV, initiation of other interventions such as weight loss management is crucial. More resources should be invested in improving all these aspects. Telemonitoring represents a promising method to improve titration and follow-up of HNIV.
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Affiliation(s)
- Annalisa Carlucci
- Dipartimento di Medicina e Chirurgia Malattie dell'Apparato Respiratorio, Università degli Studi dell'Insubria, Varese, Italy
- U.O. di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS Pavia, Pavia, Italy
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - João Carlos Winck
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Syndrome d’apnées du sommeil 1999–2022 : des essais randomisés aux études de cohorte. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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10
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Chen W, Feng J, Dong S, Guo J, Liang Y, Hu R, Wang C, Dong Z. A Novel Nomogram and Online Calculator for Predicting the Risk of Obesity Hypoventilation Syndrome in Bariatric Surgery Candidates. Obes Surg 2023; 33:68-77. [PMID: 36334251 DOI: 10.1007/s11695-022-06324-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Obesity hypoventilation syndrome (OHS) is frequently misdiagnosed and undertreated, increasing the risk of perioperative complications. We aimed to determine the predictors of OHS and to develop and validate a novel nomogram and online calculator for identifying patients at risk of OHS in bariatric surgery candidates. METHODS We retrospectively analyzed the data of patients undergoing bariatric surgery between March 2017 and June 2020. Predictors were identified using univariate and multivariate analyses to establish the nomogram. The discriminative ability, calibration, and clinical value of the nomograms were tested using C-statistics, calibration plots, and decision curve analysis. The nomogram was internally validated using bootstrap resampling. RESULTS A total of 577 patients were enrolled, and OHS was presented in 17.9% (103/577). Body mass index (BMI) (odds ratio [OR], 1.11; 95% confidence interval (CI), 1.04-1.18; p = 0.001), neck circumference (OR, 1.09; 95% CI, 1.01-1.18; p = 0.035), type 2 diabetes (T2D) (OR, 2.02; 95% CI, 1.17-3.45; p = 0.011), serum bicarbonate (OR, 1.47; 95% CI, 1.30-1.67; p < 0.001), and C-reactive protein (CRP) (OR, 1.03; 95% CI, 1.01-1.06; p = 0.017) were independent risk factors for OHS and incorporated to develop the nomogram. The nomogram revealed good discrimination, with a C-index of 0.830 (95% CI: 0.784-0.876) (0.8227 through internal validation), and good calibration. Decision curve analysis further confirmed the nomogram's clinical usefulness. CONCLUSIONS The novel nomogram and online calculator provided an excellent preoperative individualized prediction of OHS in patients undergoing bariatric surgery, hereby potentially assisting clinicians and surgeons in the early detection and intensive monitoring of OHS.
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Affiliation(s)
- Wenhui Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, 510632, China
| | - Jia Feng
- Institute of Biomedicine, Department of Cellular Biology, Jinan University, Guangzhou, 510632, China
| | - Shiliang Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, 510632, China
| | - Jie Guo
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, 510632, China
| | - Yalun Liang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, 510632, China
| | - Ruixiang Hu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, 510632, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, 510632, China.
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, 510632, China.
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11
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Non-invasive ventilation in neuromuscular diseases: should we use higher levels of ventilatory support? Sleep Breath 2022; 27:673-677. [DOI: 10.1007/s11325-022-02658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
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12
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Sobala R, Carlin H, Fretwell T, Shakir S, Cattermole K, Royston A, McCallion P, Davison J, Lumb J, Tedd H, Messer B, De Soyza A. An observational study of Pseudomonas aeruginosa in adult long-term ventilation. ERJ Open Res 2022; 8:00687-2021. [PMID: 35449759 PMCID: PMC9016266 DOI: 10.1183/23120541.00687-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Pseudomonas aeruginosa increases morbidity and mortality in respiratory disease. To date the long-term ventilation population does not have clear guidelines regarding its management. Method We undertook a retrospective observational study in a regional long-term ventilation population (837 patients). We defined the primary outcome as P. aeruginosa isolation. In addition positive cultures for copathogens (Serratia, Proteus species, Stenotrophomonas, Burkholderia cepacia complex and nontuberculous mycobacteria) were recorded. Logistic regression and odds ratios were calculated. Results 17.6% of the cohort isolated P. aeruginosa, and this pathogen was cultured more frequently in patients with a tracheostomy (logistic regression coefficient 2.90, p≤0.0001) and cystic fibrosis/bronchiectasis (logistic regression coefficient 2.48, p≤0.0001). 6.3% of patients were ventilated via tracheostomy. In the P. aeruginosa positive cohort 46.9% of patients were treated with a long-term macrolide, 36.7% received a nebulised antibiotic and 21.1% received both. Tracheostomised P. aeruginosa positive patients received a nebulised antibiotic more frequently (OR 2.63, 95% CI 1.23–5.64, p=0.013). Copathogens were isolated in 33.3% of the P. aeruginosa cohort. In this cohort patients with a tracheostomy grew a copathogen more frequently than those without (OR 2.75, 95% CI 1.28–5.90). Conclusions P. aeruginosa isolation is common within the adult long-term ventilation population and is significantly associated with tracheostomy, cystic fibrosis and bronchiectasis. Further research and international guidelines are needed to establish the prognostic impact of P. aeruginosa and to guide on antimicrobial management. The increased risk of P. aeruginosa should be considered when contemplating long-term ventilation via tracheostomy. Pseudomonas aeruginosa isolation is common (17%) in long-term ventilated adults and significantly associated with tracheostomy, cystic fibrosis and bronchiectasis. Tracheostomy patients with P. aeruginosa isolates culture copathogens more frequently.https://bit.ly/3vvxBbB
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Affiliation(s)
- Ruth Sobala
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Hannah Carlin
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Thomas Fretwell
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Sufyan Shakir
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Katie Cattermole
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Amy Royston
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | | | | | | | - Hilary Tedd
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK.,These authors contributed equally
| | - Anthony De Soyza
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK.,Freeman Hospital, Newcastle, UK.,Population Health Science Institutes, Newcastle University, Newcastle, UK.,These authors contributed equally
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13
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Masa JF, Benítez ID, Sánchez-Quiroga MÁ, Gomez de Terreros FJ, Corral J, Romero A, Caballero-Eraso C, Ordax-Carbajo E, Troncoso MF, González M, López-Martín S, Marin JM, Martí S, Díaz-Cambriles T, Chiner E, Egea C, Barca J, Vázquez-Polo FJ, Negrín MA, Martel-Escobar M, Barbé F, Mokhlesi B. Effectiveness of CPAP vs. Noninvasive Ventilation Based on Disease Severity in Obesity Hypoventilation Syndrome and Concomitant Severe Obstructive Sleep Apnea. Arch Bronconeumol 2022; 58:228-236. [PMID: 35312607 DOI: 10.1016/j.arbres.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea (OSA) is treated with CPAP or noninvasive ventilation (NIV) during sleep. NIV is costlier, but may be advantageous because it provides ventilatory support. However, there are no long-term trials comparing these treatment modalities based on OHS severity. OBJECTIVE To determine if CPAP have similar effectiveness when compared to NIV according to OHS severity subgroups. METHODS Post hoc analysis of the Pickwick randomized clinical trial in which 215 ambulatory patients with untreated OHS and concomitant severe OSA, defined as apnoea-hypopnea index (AHI)≥30events/h, were allocated to NIV or CPAP. In the present analysis, the Pickwick cohort was divided in severity subgroups based on the degree of baseline daytime hypercapnia (PaCO2 of 45-49.9 or ≥50mmHg). Repeated measures of PaCO2 and PaO2 during the subsequent 3 years were compared between CPAP and NIV in the two severity subgroups. Statistical analysis was performed using linear mixed-effects model. RESULTS 204 patients, 97 in the NIV group and 107 in the CPAP group were analyzed. The longitudinal improvements of PaCO2 and PaO2 were similar between CPAP and NIV based on the PaCO2 severity subgroups. CONCLUSION In ambulatory patients with OHS and concomitant severe OSA who were treated with NIV or CPAP, long-term NIV therapy was similar to CPAP in improving awake hypercapnia, regardless of the severity of baseline hypercapnia. Therefore, in this patient population, the decision to prescribe CPAP or NIV cannot be solely based on the presenting level of PaCO2.
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Affiliation(s)
- Juan F Masa
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain.
| | - Iván D Benítez
- Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Maria Á Sánchez-Quiroga
- Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain
| | - Francisco J Gomez de Terreros
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain
| | - Jaime Corral
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain
| | - Auxiliadora Romero
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Candela Caballero-Eraso
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Estrella Ordax-Carbajo
- Respiratory Department, University Hospital, Burgos, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Maria F Troncoso
- Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Mónica González
- Respiratory Department, Valdecilla Hospital, Santander, Spain
| | | | - José M Marin
- Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Sergi Martí
- Respiratory Department, Vall d'Hebron Hospital, Barcelona, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Trinidad Díaz-Cambriles
- Respiratory Department, Doce de Octubre Hospital, Madrid, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Eusebi Chiner
- Respiratory Department, San Juan Hospital, Alicante, Spain
| | - Carlos Egea
- Respiratory Department, Alava University Hospital IRB, Vitoria, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Javier Barca
- Nursing Department, Extremadura University, Cáceres, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain
| | | | - Miguel A Negrín
- Department of Quantitative Methods, Las Palmas de Gran Canaria University Canary Islands, Spain
| | - María Martel-Escobar
- Department of Quantitative Methods, Las Palmas de Gran Canaria University Canary Islands, Spain
| | - Ferrán Barbé
- Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Babak Mokhlesi
- Medicine/Pulmonary and Critical Care, University of Chicago, IL, USA
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BaHammam AS, Aleissi SA, Nashwan SZ, Olaish AH, Almeneessier AS. Results of CPAP Titration and Short-Term Adherence Rates in Patients with Obesity Hypoventilation Syndrome and Mild/Moderate Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:1137-1148. [PMID: 35733818 PMCID: PMC9207127 DOI: 10.2147/nss.s369316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE No study has assessed the titration success of CPAP therapy in patients with obesity hypoventilation syndrome (OHS) and an apnea-hypopnea index (AHI) <30 event/h. This study aimed to assess the titration success of CPAP therapy under polysomnography and subsequent short-term adherence (1 month) in patients with OHS and an AHI <30 event/h. METHODS Consecutive OHS patients with an AHI <30 events/h between 2010 and 2019 were included (n=54). All OHS patients were first started on CPAP during the therapeutic sleep-study. If the therapeutic-study showed that the SpO2 remained < 90% for 20% of the total sleep time, a second therapeutic study was arranged with bi-level PAP (BPAP). Thirty patients agreed to participate in the 1-month follow-up adherence study. We applied the American-Thoracic-Society criteria for PAP adherence. RESULTS The mean age was 54.8±14.6 years, and the mean BMI was 45.9±12.2 kg/m2. Successful titration on CPAP was attained in 36 (66.7%) patients, and 18 (33.3%) required BPAP. Patients who failed the CPAP trial had a significantly higher PaCO2 and bicarbonate, a more restrictive respiratory pattern on spirometry, and a significantly higher time with SpO2<90% (mins) during sleep. The only independent correlate of CPAP-titration success on the multivariable regression analysis was the desaturation index (OR: 1.33 [1.033-1.712]). More than 80% of the participants were using CPAP therapy after one-month with no differences in adherence between the CPAP and BPAP groups. CONCLUSIONS The current results suggest that CPAP therapy could be an acceptable alternative therapy to BPAP in patients with OHS without severe OSA.
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Affiliation(s)
- Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salih A Aleissi
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Samar Z Nashwan
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aljohara S Almeneessier
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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15
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Sleep and Hypoventilation. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Effect of different modes of positive airway pressure treatment on obesity hypoventilation syndrome: a systematic review and network meta-analysis. Sleep Med 2022; 91:51-58. [DOI: 10.1016/j.sleep.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/27/2021] [Accepted: 01/05/2022] [Indexed: 11/20/2022]
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17
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Zheng Y, Phillips CL, Sivam S, Wong K, Grunstein RR, Piper AJ, Yee BJ. Cardiovascular disease in obesity hypoventilation syndrome - A review of potential mechanisms and effects of therapy. Sleep Med Rev 2021; 60:101530. [PMID: 34425490 DOI: 10.1016/j.smrv.2021.101530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
Cardiovascular disease is common in patients with obesity hypoventilation syndrome (OHS) and accounts in part for their poor prognosis. This narrative review article examines the epidemiology of cardiovascular disease in obesity hypoventilation syndrome, explores possible contributing factors and the effects of therapy. All studies that included cardiovascular outcomes and biomarkers were included. Overall, there is a higher burden of cardiovascular disease and cardiovascular risk factors among patients with obesity hypoventilation syndrome. In addition to obesity and sleep-disordered breathing, there are several other pathophysiological mechanisms that contribute to higher cardiovascular morbidity and mortality in OHS. There is evidence emerging that positive airway pressure therapy and weight loss have beneficial effects on the cardiovascular system in obesity hypoventilation syndrome patients, but further research is needed to clarify whether this translates to clinically important outcomes.
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Affiliation(s)
- Yizhong Zheng
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia; Department of Respiratory and Sleep Medicine, St George Hospital, Australia.
| | - Craig L Phillips
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Sheila Sivam
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Keith Wong
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Ronald R Grunstein
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia
| | - Amanda J Piper
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Brendon J Yee
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
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Mokhlesi B, Won CH, Make BJ, Selim BJ, Sunwoo BY. Optimal Noninvasive Medicare Access Promotion: Patients with Hypoventilation Syndromes A Technical Expert Panel Report from the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society. Chest 2021; 160:e377-e387. [PMID: 34339686 DOI: 10.1016/j.chest.2021.06.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/27/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022] Open
Abstract
The existing coverage criteria for home noninvasive ventilation (NIV) do not recognize the diversity of hypoventilation syndromes and advances in technologies. This document summarizes the work of the Hypoventilation Syndromes Technical Expert Panel working group. The most pressing current coverage barriers identified were: 1) overreliance on arterial blood gases (particularly during sleep); 2) need to perform testing on prescribed oxygen; 3) requiring a sleep study to rule out obstructive sleep apnea as the cause of sustained hypoxemia; 4) need for spirometry; 5) need to demonstrate BPAP without a backup rate failure to qualify for BPAP S/T; and 6) qualifying hospitalized patients for home NIV therapy at the time of discharge. Critical evidence support for changes to current policies include randomized clinical trial evidence and clinical practice guidelines. In order to decrease morbidity-mortality by achieving timely access to NIV for patients with hypoventilation, particularly those with obesity hypoventilation syndrome, we make the following key suggestions: 1) Given the significant technological advances, we advise acceptance of surrogate noninvasive end tidal and transcutaneous PCO2 and venous blood gases in lieu of arterial blood gases,; 2) Not requiring PCO2 measures while on prescribed oxygen; 3) Not requiring a sleep study to avoid delays in care in patients being discharged from the hospital; 4) Remove spirometry as a requirement; 5) Not requiring BPAP without a backup rate failure to approve BPAP S/T. The overarching goal of the Technical Expert Panel is to establish pathways that improve clinicians' management capability to provide Medicare beneficiaries access to appropriate home NIV therapy. Adoption of these proposed suggestions would result in the right device, at the right time, for the right type of patients with hypoventilation syndromes.
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Overlooking Obesity Hypoventilation Syndrome: The Need for Obesity Hypoventilation Syndrome Staging and Risk Stratification. Ann Am Thorac Soc 2020; 17:1211-1212. [PMID: 33000959 PMCID: PMC7640632 DOI: 10.1513/annalsats.202006-683ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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