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Javaheri S, Javaheri S, Somers VK, Gozal D, Mokhlesi B, Mehra R, McNicholas WT, Zee PC, Campos-Rodriguez F, Martinez-Garcia MA, Cistulli P, Malhotra A. Interactions of Obstructive Sleep Apnea With the Pathophysiology of Cardiovascular Disease, Part 1: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:1208-1223. [PMID: 39293884 DOI: 10.1016/j.jacc.2024.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 09/20/2024]
Abstract
The American Heart Association considers sleep health an essential component of cardiovascular health, and sleep is generally a time of cardiovascular quiescence, such that any deviation from normal sleep may be associated with adverse cardiovascular consequences. Many studies have shown that both impaired quantity and quality of sleep, particularly with obstructive sleep apnea (OSA) and comorbid sleep disorders, are associated with incident cardiometabolic consequences. OSA is associated with repetitive episodes of altered blood gases, arousals, large negative swings in intrathoracic pressures, and increased sympathetic activity. Recent studies show that OSA is also associated with altered gut microbiota, which could contribute to increased risk of cardiovascular disease. OSA has been associated with hypertension, atrial fibrillation, heart failure, coronary artery disease, stroke, and excess cardiovascular mortality. Association of OSA with chronic obstructive lung disease (overlap syndrome) and morbid obesity (obesity hypoventilation syndrome) increases the odds of mortality.
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Affiliation(s)
| | - Sogol Javaheri
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | | | - David Gozal
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | - Babak Mokhlesi
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | - Reena Mehra
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | | | - Phyllis C Zee
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | | | | | - Peter Cistulli
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | - Atul Malhotra
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
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2
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Javaheri S, Javaheri S, Gozal D, Campos-Rodriguez F, Martinez-Garcia MA, Mokhlesi B, Mehra R, McNicholas WT, Somers VK, Zee PC, Cistulli P, Malhotra A. Treatment of OSA and its Impact on Cardiovascular Disease, Part 2: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:1224-1240. [PMID: 39293885 DOI: 10.1016/j.jacc.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 09/20/2024]
Abstract
Many studies have shown an association of obstructive sleep apnea (OSA) with incident cardiovascular diseases, particularly when comorbid with insomnia, excessive sleepiness, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease. Randomized controlled trials (RCTs) have demonstrated that treatment of OSA with positive airway pressure devices (CPAP) improves systemic hypertension, particularly in those with resistant hypertension who are adherent to CPAP. However, large RCTs have not shown long-term benefits of CPAP on hard cardiovascular outcomes, but post hoc analyses of these RCTs have demonstrated improved hard outcomes in those who use CPAP adequately. In theory, low CPAP adherence and patient selection may have contributed to neutral results in intention-to-treat analyses. Only by further research into clinical, translational, and basic underlying mechanisms is major progress likely to continue. This review highlights the various treatment approaches for sleep disorders, particularly OSA comorbid with various other disorders, the potential reasons for null results of RCTs treating OSA with CPAP, and suggested approaches for future trials.
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Affiliation(s)
| | - Sogol Javaheri
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David Gozal
- University of Chicago, Chicago, Illinois, USA
| | | | - Miguel Angel Martinez-Garcia
- Gregorio Marañón Health Research Institute (IISGM), CIBERONC, Department of Medicine, Universidad Complutense, Madrid, Spain
| | | | - Reena Mehra
- Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Phyllis C Zee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Peter Cistulli
- Charles Perkins Centre, University of Sydney/Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Atul Malhotra
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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Paranicova I, Bodnarova S, Trojova I, Hertelyova Z, Gulasova Z, Cimbolakova I, Genzor S, Joppa P, Tkacova R, Pobeha P. Long-term myocardial effects of noninvasive ventilation in patients with obesity hypoventilation syndrome. Respir Med 2024; 231:107735. [PMID: 38977108 DOI: 10.1016/j.rmed.2024.107735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/24/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Chronic effects of noninvasive ventilation on myocardial function in patients with obesity hypoventilation syndrome (OHS) are scarcely understood. The aim of the present study was to evaluate the long-term effects of volume-targeted bilevel positive airway pressure ventilation (BiPAP) on cardiac parameters and myocardial biomarkers in patients with OHS. METHODS Clinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored. RESULTS Thirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m2) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study. CONCLUSIONS The present findings of increased SV, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable OHS and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.
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Affiliation(s)
- I Paranicova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - S Bodnarova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - I Trojova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - Z Hertelyova
- Center of Clinical and Preclinical Research MEDIPARK, P.J. Safarik University, Faculty of Medicine, Kosice, Slovakia
| | - Z Gulasova
- Center of Clinical and Preclinical Research MEDIPARK, P.J. Safarik University, Faculty of Medicine, Kosice, Slovakia
| | - I Cimbolakova
- Institute of Physical Education and Sport, P.J. Safarik University, Kosice, Slovakia
| | - S Genzor
- Department of Respiratory Medicine and Tuberculosis, University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University, Olomouc, Czech Republic
| | - P Joppa
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - R Tkacova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - P Pobeha
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia.
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4
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Bjork S, Jain D, Marliere MH, Predescu SA, Mokhlesi B. Obstructive Sleep Apnea, Obesity Hypoventilation Syndrome, and Pulmonary Hypertension: A State-of-the-Art Review. Sleep Med Clin 2024; 19:307-325. [PMID: 38692755 DOI: 10.1016/j.jsmc.2024.02.009] [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] [Indexed: 05/03/2024]
Abstract
The pathophysiological interplay between sleep-disordered breathing (SDB) and pulmonary hypertension (PH) is complex and can involve a variety of mechanisms by which SDB can worsen PH. These mechanistic pathways include wide swings in intrathoracic pressure while breathing against an occluded upper airway, intermittent and/or sustained hypoxemia, acute and/or chronic hypercapnia, and obesity. In this review, we discuss how the downstream consequences of SDB can adversely impact PH, the challenges in accurately diagnosing and classifying PH in the severely obese, and review the limited literature assessing the effect of treating obesity, obstructive sleep apnea, and obesity hypoventilation syndrome on PH.
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Affiliation(s)
- Sarah Bjork
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA
| | - Deepanjali Jain
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA
| | - Manuel Hache Marliere
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA
| | - Sanda A Predescu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA
| | - Babak Mokhlesi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA.
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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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Cherian M, Adam V, Ross B, Bourbeau J, Kaminska M. Mortality in individuals with COPD on long-term home non-invasive ventilation. Respir Med 2023; 218:107378. [PMID: 37567515 DOI: 10.1016/j.rmed.2023.107378] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Real-world evidence regarding survival of patients with chronic obstructive pulmonary disease (COPD) using chronic non-invasive ventilation (NIV) is scarce. RESEARCH QUESTION How do obesity and other factors relate to mortality in patients with COPD on chronic NIV? STUDY DESIGN and Methods: We retrospectively analyzed data from COPD patients enrolled in a home ventilation program between 2014 and 2018. Survival was compared between obese and non-obese groups using the Kaplan-Meier method. Factors associated with mortality were identified using multivariable Cox proportional regression analyses with Least Absolute Selection and Shrinkage Operator (LASSO) regularization. Univariable analyses were also done stratified by obesity. RESULTS Median survival was 80.0 (95% CI: 71.0-NA) months among obese (n = 205) and 30.0 (95%CI: 19.0-42.0) months in non-obese (n = 61) patients. NIV adherence was high in both groups. Mortality was associated with male gender [HR 1.44], chronic opioids or benzodiazepines use [HR 1.07], home oxygen use [HR 1.82], fixed pressure mode of ventilation [HR 1.55], NIV inspiratory pressure [HR 1.05], and thoracic cancer [HR 1.27]; obesity [HR: 0.43], age [HR 0.99] and NIV expiratory pressure [HR 0.94] were associated with decreased mortality. In the obese, univariable analyses revealed that chest wall disease, thoracic cancer, home oxygen use, FEV1% predicted, and ventilation parameters were associated with mortality. In the non-obese, male gender and respiratory comorbidities were related to mortality. INTERPRETATION Obesity is associated with improved survival in COPD patients highly adherent to NIV. Other factors associated with mortality reflect disease severity and ventilator parameters, with differences between obese and non-obese patients.
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Affiliation(s)
- Mathew Cherian
- Division of Pulmonary Medicine, Sir Mortimer B. David Jewish General Hospital, Montreal, QC, Canada
| | - Veronique Adam
- Quebec National Program for Home Ventilatory Assistance-McGill University Health Center (PNAVD-MUHC), Montreal, QC, Canada
| | - Bryan Ross
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Jean Bourbeau
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marta Kaminska
- Quebec National Program for Home Ventilatory Assistance-McGill University Health Center (PNAVD-MUHC), Montreal, QC, Canada; Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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Agossou M, Awanou B, Inamo J, Dufeal M, Arnal JM, Dramé M. Association between Previous CPAP and Comorbidities at Diagnosis of Obesity-Hypoventilation Syndrome Associated with Obstructive Sleep Apnea: A Comparative Retrospective Observational Study. J Clin Med 2023; 12:2448. [PMID: 37048530 PMCID: PMC10095396 DOI: 10.3390/jcm12072448] [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: 01/25/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Obesity-hypoventilation syndrome (OHS) is associated with many comorbidities. The aim of this study was to evaluate the association between previous continuous positive airway pressure (CPAP) and the prevalence of comorbidities in OHS associated with obstructive sleep apnea (OSA). We performed a retrospective, single-center study at the University Hospital of Martinique, the referral hospital for the island of Martinique. A total of 97 patients with OHS associated with severe OSA on non-invasive ventilation (NIV) were included; 54 patients (56%) had previous treatment of OSA with a positive airway pressure (PAP) device before shifting to NIV (PAP group) and 43 (44%) had no previous treatment of OSA with a PAP device before initiating NIV PAP (no PAP group). Sociodemographic characteristics were similar between groups; there were 40 women (74%) in the PAP group versus 34 (79%) in the no PAP group, mean age at OHS diagnosis was 66 ± 15 versus 67 ± 16 years, respectively, and the mean age at inclusion 72 ± 14 versus 71 ± 15 years, respectively. The average number of comorbidities was 4 ± 1 in the PAP group versus 4 ± 2 in the no PAP group; the mean Charlson index was 5 ± 2 in both groups. The mean BMI was 42 ± 8 kg/m2 in both groups. The mean follow-up duration was 5.8 ± 4.4 years in the PAP group versus 4.7 ± 3.5 years in the no PAP group. Chronic heart failure was less common in patients who had a previous PAP 30% versus 53% (p = 0.02). It is also noted that these patients were diagnosed less often in the context of acute respiratory failure in patients with previous PAP: 56% versus 93% (p < 0.0001). In contrast, asthma patients were more frequent in patients with previous treatment of OSA with a PAP device at the time of OHS diagnosis but not significantly: 37% versus 19% (p = 0.07). Early treatment of severe OSA with a PAP device prior to diagnosis of OHS seems to be associated with a reduced prevalence of cardiac diseases, notably chronic heart failure, in patients diagnosed with OHS associated with severe OSA.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, University Hospital of Martinique, 97200 Fort-de-France, France
| | - Berenice Awanou
- Department of Respiratory Medicine, University Hospital of Martinique, 97200 Fort-de-France, France
| | - Jocelyn Inamo
- Department of Cardiology, University Hospital of Martinique, 97200 Fort-de-France, France
| | - Marion Dufeal
- Department of Respiratory Medicine, University Hospital of Martinique, 97200 Fort-de-France, France
| | - Jean-Michel Arnal
- Service de Réanimation Polyvalente, Hôpital Sainte Musse, 83100 Toulon, France
| | - Moustapha Dramé
- Department of Clinical Research and Innovation, University Hospital of Martinique, 97200 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
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8
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Raphelson JR, Schmickl CN, Sonners C, Kreitinger K, Grunvald E, Horgan S, Malhotra A. Obesity Hypoventilation Syndrome and Postsurgical Outcomes in a Bariatric Surgery Cohort. Obes Surg 2022; 32:1-7. [PMID: 35538187 PMCID: PMC9276616 DOI: 10.1007/s11695-022-06073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022]
Abstract
Purpose Patients with obesity and elevated serum bicarbonate suggesting obesity hypoventilation syndrome (OHS) undergoing bariatric surgery may represent a unique subgroup. Information regarding surgical outcomes in this population remains limited. We sought to test the hypothesis that an elevated bicarbonate would be an important predictor of perioperative complications (i.e., length of hospital stay) and postsurgical outcomes (i.e., weight loss at 1 year). Materials and Methods Consecutive patients undergoing bariatric surgery between January 2015 and December 2018 were included. Patients with a preoperative serum bicarbonate ≥ 27 mEq/L were classified as suspected OHS. Results Of 297 patients, the prevalence of suspected OHS based on an elevated bicarbonate was 19.5% (95% CI: 15.3 to 24.6%). Length of hospital stay was similar in the suspected OHS and non-OHS control group (1.50 vs 1.49 days, P = 0.98). The achieved weight loss from peak preoperative weight to 1 year post-surgery was less in the suspected OHS vs the control group (4.2% [95% CI 1.6 to 6.8]; P = 0.002). Conclusion Patients with serum bicarbonate ≥ 27 mEq/L as a surrogate marker for OHS experienced weight loss that was significantly less than their normal serum bicarbonate counterparts, but still achieved weight loss deemed clinically important by current guidelines. We observed no significant difference in length of hospital stay at time of surgery. Graphical abstract ![]()
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Affiliation(s)
- Janna R Raphelson
- Division of Internal Medicine, UC San Diego Health, San Diego, CA, 92109, USA.
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care, & Sleep Medicine, UC San Diego Health, San Diego, CA, 92109, USA
| | - Christine Sonners
- Division of Internal Medicine, UC San Diego Health, San Diego, CA, 92109, USA
| | - Kimberly Kreitinger
- Division of Internal Medicine, UC San Diego Health, San Diego, CA, 92109, USA
| | - Eduardo Grunvald
- Division of General Internal Medicine, UC San Diego Health, San Diego, CA, 92109, USA.,Bariatric and Metabolic Institute, UC San Diego Health, San Diego, CA, 92109, USA
| | - Santiago Horgan
- Bariatric and Metabolic Institute, UC San Diego Health, San Diego, CA, 92109, USA.,Department of Surgery, UC San Diego Health, San Diego, CA, 92109, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, & Sleep Medicine, UC San Diego Health, San Diego, CA, 92109, USA
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9
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Berger D, Wigger O, de Marchi S, Grübler MR, Bloch A, Kurmann R, Stalder O, Bachmann KF, Bloechlinger S. The effects of positive end-expiratory pressure on cardiac function: a comparative echocardiography-conductance catheter study. Clin Res Cardiol 2022; 111:705-719. [PMID: 35381904 PMCID: PMC9151717 DOI: 10.1007/s00392-022-02014-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/21/2022] [Indexed: 01/09/2023]
Abstract
Background Echocardiographic parameters of diastolic function depend on cardiac loading conditions, which are altered by positive pressure ventilation. The direct effects of positive end-expiratory pressure (PEEP) on cardiac diastolic function are unknown. Methods Twenty-five patients without apparent diastolic dysfunction undergoing coronary angiography were ventilated noninvasively at PEEPs of 0, 5, and 10 cmH2O (in randomized order). Echocardiographic diastolic assessment and pressure–volume-loop analysis from conductance catheters were compared. The time constant for pressure decay (τ) was modeled with exponential decay. End-diastolic and end-systolic pressure volume relationships (EDPVRs and ESPVRs, respectively) from temporary caval occlusion were analyzed with generalized linear mixed-effects and linear mixed models. Transmural pressures were calculated using esophageal balloons. Results τ values for intracavitary cardiac pressure increased with the PEEP (n = 25; no PEEP, 44 ± 5 ms; 5 cmH2O PEEP, 46 ± 6 ms; 10 cmH2O PEEP, 45 ± 6 ms; p < 0.001). This increase disappeared when corrected for transmural pressure and diastole length. The transmural EDPVR was unaffected by PEEP. The ESPVR increased slightly with PEEP. Echocardiographic mitral inflow parameters and tissue Doppler values decreased with PEEP [peak E wave (n = 25): no PEEP, 0.76 ± 0.13 m/s; 5 cmH2O PEEP, 0.74 ± 0.14 m/s; 10 cmH2O PEEP, 0.68 ± 0.13 m/s; p = 0.016; peak A wave (n = 24): no PEEP, 0.74 ± 0.12 m/s; 5 cmH2O PEEP, 0.7 ± 0.11 m/s; 10 cmH2O PEEP, 0.67 ± 0.15 m/s; p = 0.014; E’ septal (n = 24): no PEEP, 0.085 ± 0.016 m/s; 5 cmH2O PEEP, 0.08 ± 0.013 m/s; 10 cmH2O PEEP, 0.075 ± 0.012 m/s; p = 0.002]. Conclusions PEEP does not affect active diastolic relaxation or passive ventricular filling properties. Dynamic echocardiographic filling parameters may reflect changing loading conditions rather than intrinsic diastolic function. PEEP may have slight positive inotropic effects. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02267291, registered 17. October 2014. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02014-1.
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Affiliation(s)
- David Berger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Olivier Wigger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Klinik Für Kardiologie, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Stefano de Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin R Grübler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Bloch
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Zentrum Für Intensivmedizin, Kantonsspital Luzern, Luzern, Switzerland
| | - Reto Kurmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Klinik Für Kardiologie, Kantonsspital Luzern, Luzern, Switzerland
| | | | - Kaspar Felix Bachmann
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Zentrum Für Intensivmedizin, Kantonsspital Luzern, Luzern, Switzerland
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital,, University of Bern, Bern, Switzerland
| | - Stefan Bloechlinger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Klinik Für Kardiologie, Kantonsspital Winterthur, Winterthur, Switzerland
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10
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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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11
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Harańczyk M, Konieczyńska M, Płazak W. Continuous positive airway pressure treatment in sleep apnea: patient compliance and impact on the right heart. Sleep Biol Rhythms 2022; 20:65-72. [PMID: 38469074 PMCID: PMC10897640 DOI: 10.1007/s41105-021-00340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is considered to be an important predisposing factor for cardiovascular diseases. The main objective of this study was to investigate the impact of CPAP treatment on cardiac structure and function and to assess patient compliance over a long-term course of CPAP treatment. A total of 50 patients diagnosed with moderate-to-severe OSAS based on overnight study, without relevant concomitant diseases were enrolled. Patient compliance, along with echocardiographic and CPAP parameters, was assessed. The average time to follow-up was 38 ± 4.2 months. An increase in tricuspid annular plane systolic excursion (TAPSE) (22.1 ± 4.3-25.5 ± 4.6 mm, p = 0.005) and peak early systolic tricuspid annular velocity (S') (14 ± 3.2-17.2 ± 5.2 cm/s, p = 0.005) after CPAP treatment was noted. In patients without CPAP, no significant change in right ventricular (RV) contractility was found. There were no significant differences regarding right atrial (RA) and RV diameters, as well as tricuspid regurgitant peak gradient (TRPG) in both groups; however, a predisposition to increased RA size along with RV and tricuspid annulus diameters was revealed. The mean duration of nightly CPAP use was 3 ± 2.3 h/night in all-day analysis and 4.7 ± 2.1 h/night on days with device usage. The non-adherence rate was 57%. The use of effective CPAP therapy may lead to increased RV systolic function in patients with OSAS in long-term observation. However, long-term patient compliance is generally poor. Regardless of CPAP therapy, a gradual increase in heart size is observed.
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Affiliation(s)
- Michał Harańczyk
- Department of Diagnostic Medicine, John Paul 2nd Hospital, Kraków, Poland
| | | | - Wojciech Płazak
- Department of Cardiac and Vascular Diseases, John Paul 2nd Hospital, Jagiellonian University Medical College, Prądnicka Str 80, 31-202 Kraków, Poland
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12
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Li X, Zhang X, Shen Z, Chen Z, Wang H, Zhang X. GnRH receptor mediates lipid storage in female adipocytes via AMPK pathway. Int J Med Sci 2022; 19:1442-1450. [PMID: 36035370 PMCID: PMC9413554 DOI: 10.7150/ijms.74335] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/03/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: Due to high levels of serum gonadotropin-releasing hormone (GnRH), perimenopausal or menopausal women, girls with central precocious puberty, women of polycystic ovary syndrome, and females receiving long-term GnRH agonist (GnRHa) treatment are at substantially higher risk of developing obesity. However, it remains poorly understood how GnRH affects body weight. Here, we explored whether the gonadotropin-releasing hormone receptor (GnRHR) was expressed in adipocytes and how GnRHR mediated lipid accumulation and the development of obesity. Methods: The samples were from 18 patients with benign tumors operated between 01/2018 and 06/2018 at the Women's Hospital School of Medicine Zhejiang University. Immunofluorescence, Western Blotting, and RT-PCR were used to detect whether the GnRH receptor was expressed in the specimens and human preadipocytes-subcutaneous (HPA-s). The GnRH receptor agonist diphereline with different concentrations was used to stimulate the HPA-s cells for 24, 48, and CCK-8 was used to detect cell proliferation. Oil red-O staining was used to detect lipid droplets in mature adipocytes. The phosphorylation of AMPK-Ser485/Thr172 was detected by Western Blotting. Results: GnRH receptor was expressed in all 18 human subcutaneous adipose tissue specimens. Cultured HPA-s expressed the GnRH receptor, and the expression increased during the process of cell maturation. The GnRH receptor agonist diphereline can stimulate the proliferation of HPA-s cells, which can advance the earliest occurrence of lipid droplets in HPA-s cells and the occurrence of lipid droplets in 50% cells by 1-2 days. Diphereline can stimulate the increase in the number of lipid droplets in mature adipocytes. The phosphorylation level of AMPK-Ser485/Thr172 in mature adipocytes was decreased by diphereline. Conclusion: The GnRH receptor was expressed in adipocytes. As adipocytes mature, GnRH receptor expression gradually increased. GnRHa stimulates the proliferation of HPA-s, promotes adipocyte maturation, increases the formation of lipid droplets in mature adipocytes, and inhibits the activation of the AMPK pathway in adipocytes. Our findings may elucidate the mechanism of obesity in these female populations and provide some evidence on how GnRH contributes to obesity. Additionally, these results provide theoretical support for further research on the mechanisms of obesity, thus enhancing our understanding of the functional diversity of GnRH and establishing a new theoretical basis for the impact of GnRH on metabolism.
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Affiliation(s)
- Xiaoyong Li
- Department of Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang, People's Republic of China
| | - Xueyan Zhang
- Department of Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang, People's Republic of China
| | - Zhaojun Shen
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, School of Medicine Zhejiang University, Yiwu, 322000, Zhejiang, People's Republic of China
| | - Zhengyun Chen
- Department of Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang, People's Republic of China
| | - Hanzhi Wang
- Central laboratory, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang, People's Republic of China
| | - Xinmei Zhang
- Department of Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang, People's Republic of China
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13
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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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14
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Masa JF, Benítez ID, Javaheri S, Mogollon MV, Sánchez-Quiroga MÁ, Terreros FJGD, Corral J, Gallego R, Romero A, Caballero-Eraso C, Ordax-Carbajo E, Gomez-Garcia T, González M, López-Martín S, Marin JM, Martí S, Díaz-Cambriles T, Chiner E, Egea C, Barca J, Barbé F, Mokhlesi B. Risk factors associated with pulmonary hypertension in obesity hypoventilation syndrome. J Clin Sleep Med 2021; 18:983-992. [PMID: 34755598 DOI: 10.5664/jcsm.9760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Pulmonary hypertension (PH) is prevalent in obesity hypoventilation syndrome (OHS). However, there is a paucity of data assessing pathogenic factors associated with PH. Our objective is to assess risk factors that may be involved in the pathogenesis of PH in untreated OHS. METHODS In a post-hoc analysis of the Pickwick trial, we performed a bivariate analysis of baseline characteristics between patients with and without PH. Variables with a p value ≤0.10 were defined as potential risk factors and were grouped by theoretical pathogenic mechanisms in several adjusted models. Similar analysis was carried out for the two OHS phenotypes, with and without severe concomitant obstructive sleep apnea (OSA). RESULTS Of 246 patients with OHS, 122 (50%) had echocardiographic evidence of PH defined as systolic pulmonary artery pressure ≥40 mmHg. Lower levels of awake PaO2 and higher body mass index (BMI) were independent risk factors in the multivariate model, with a negative and positive adjusted linear association, respectively (adjusted odds ratio 0.96; 95% CI 0.93 to 0.98; p = 0.003 for PaO2, and 1.07; 95% CI 1.03 to 1.12; p = 0.001 for BMI). In separate analyses, BMI and PaO2 were independent risk factors in the severe OSA phenotype, whereas BMI and peak in-flow velocity in early (E)/late diastole (A) ratio were independent risk factors in the non-severe OSA phenotype. CONCLUSIONS This study identifies obesity per se as a major independent risk factor for PH, regardless of OHS phenotype. Therapeutic interventions targeting weight loss may play a critical role in improving PH in this patient population. CLINICAL TRIALS REGISTRATION Registry: Clinicaltrial.gov; Identifier: NCT01405976.
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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)
| | - Iván D Benítez
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Institut de Recerca Biomédica de Lleida (IRBLLEIDA), Lleida, Spain
| | - Shahrokh Javaheri
- Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, Ohio
| | | | - Maria Á Sánchez-Quiroga
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE).,Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, 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)
| | - 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)
| | - Rocio Gallego
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE)
| | - Auxiliadora Romero
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Candela Caballero-Eraso
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Estrella Ordax-Carbajo
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, University Hospital, Burgos, Spain
| | - Teresa Gomez-Garcia
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - Mónica González
- Respiratory Department, Valdecilla Hospital, Santander, Spain
| | | | - José M Marin
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain
| | - Sergi Martí
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Trinidad Díaz-Cambriles
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Doce de Octubre Hospital, Madrid, Spain
| | - Eusebi Chiner
- Respiratory Department, San Juan Hospital, Alicante, Spain
| | - Carlos Egea
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Alava University Hospital IRB, Vitoria, Spain
| | - Javier Barca
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE).,Nursing Department, Extremadura University, Cáceres, Spain
| | - Ferrán Barbé
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Institut de Recerca Biomédica de Lleida (IRBLLEIDA), Lleida, Spain
| | - Babak Mokhlesi
- Medicine/Pulmonary and Critical Care, University of Chicago, IL
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15
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[Chronic obstructive pulmonary disease, sleep-disordered breathing and hypoventilation-Influence on the cardiorenal system]. Internist (Berl) 2021; 62:1166-1173. [PMID: 34623471 DOI: 10.1007/s00108-021-01169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Comorbidities are frequently observed in patients suffering from pulmonary diseases due to shared risk factors and intricate interactions between various organ systems. This article aims to characterize the effects of selected diseases of the respiratory system on the cardiovascular system and kidneys. Advanced chronic obstructive pulmonary disease (COPD) often leads to a prognostically unfavorable increased pressure in the pulmonary circulation. In this respect treatment of these patients is primarily aimed at the underlying pulmonary disease and targeted treatment of the pulmonary hypertension should only be carried out according to invasive diagnostics and in an individualized manner. So far, the fact that there is a substantial overlap between COPD and heart failure with preserved ejection fraction has been completely ignored, which should be considered in the diagnostic procedure. Obstructive sleep apnea (OSA) has several unfavorable effects on the cardiovascular system and has been identified as an independent risk factor for cardiovascular diseases. The established treatment of OSA with continuous positive airway pressure (CPAP) has been shown to improve daytime sleepiness and the quality of life; however, an effect of CPAP on the occurrence of cardiovascular events, especially in asymptomatic patients, has so far not been demonstrated in randomized trials. Peripheral edema is frequently observed in patients suffering from chronic hypercapnia, which can be explained by several pathophysiological mechanisms, including pulmonary vasoconstriction and a direct effect of the hypercapnia on renal blood flow. Apart from the administration of diuretics, recompensation of such patients always requires treatment of the hypercapnia by noninvasive ventilation.
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16
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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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17
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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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18
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Esnaud R, Gagnadoux F, Beurnier A, Berrehare A, Trzepizur W, Humbert M, Montani D, Jutant EM. The association between sleep-related breathing disorders and pre-capillary pulmonary hypertension: A chicken and egg question. Respir Med Res 2021; 80:100835. [PMID: 34174525 DOI: 10.1016/j.resmer.2021.100835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 01/04/2023]
Abstract
The level of knowledge about a direct link between sleep-related breathing disorders and pre-capillary pulmonary hypertension (PH) is low and there is a chicken and egg question to know which disease causes the other. On one hand, sleep-related breathing disorders are considered as a cause of group 3 PH, in the subgroup of patients with hypoxemia without lung disease. Indeed, isolated sleep-related breathing disorders can lead to mild pre-capillary PH on their own, although this is rare for obstructive sleep apnea and difficult to establish for obesity-hypoventilation syndrome, the evolution towards PH being observed especially in the presence of respiratory comorbidities. The hemodynamic improvement under treatment with continuous positive airway pressure or non-invasive ventilation also argues for a causal link between pre-capillary PH and sleep-related breathing disorders. On the other hand, patients followed for pre-capillary PH, particularly pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension, develop more sleep-related breathing disorders than the general population, especially sleep hypoxemia, central sleep apnea in patients with severe PH and obstructive sleep apnea in older patients with higher body mass index. The main objective of this article is therefore to answer two main questions, which will then lead us to discuss the bilateral link between these diseases: are sleep-related breathing disorders independent risk factors for pre-capillary PH and does pre-capillary PH induce sleep-related breathing disorders? In other words, who is the chicken and who is the egg?
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Affiliation(s)
- R Esnaud
- INSERM UMR1063, Université d'Angers, Angers, France; Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
| | - F Gagnadoux
- INSERM UMR1063, Université d'Angers, Angers, France; Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
| | - A Beurnier
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service de physiologie et d'explorations fonctionnelles respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - A Berrehare
- Département de Pneumologie, Centre Hospitalier du Mans, Le Mans, France
| | - W Trzepizur
- INSERM UMR1063, Université d'Angers, Angers, France; Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
| | - M Humbert
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - D Montani
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - E-M Jutant
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
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19
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Ainge-Allen HW, Yee BJ, Ip MSM. Contemporary Concise Review 2020: Sleep. Respirology 2021; 26:700-706. [PMID: 34018277 DOI: 10.1111/resp.14084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnoea (OSA) now affects one-seventh of the world's population. Treatment of even mild OSA can improve daytime sleepiness and quality of life. Recent modifications to uvulopalatopharyngoplasty may make it a more widely applicable treatment option in selected patients with OSA. Diet and exercise have effects on sleep apnoea severity independent of weight loss. Insomnia has become increasingly common during the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Henry W Ainge-Allen
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory Medicine, Dubbo Health Service, Dubbo, New South Wales, Australia
| | - Brendon J Yee
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mary S M Ip
- Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Hong Kong, Hong Kong.,Respiratory Division, University of Hong Kong Shenzhen Hospital, Shenzhen, China
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20
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Janssens JP, Michel F, Schwarz EI, Prella M, Bloch K, Adler D, Brill AK, Geenens A, Karrer W, Ogna A, Ott S, Rüdiger J, Schoch OD, Soler M, Strobel W, Uldry C, Gex G. Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology. Respiration 2020; 99:1-36. [PMID: 33302274 DOI: 10.1159/000510086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland,
| | - Franz Michel
- Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Konrad Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Aurore Geenens
- Pulmonary League of the Canton of Vaud, Lausanne, Switzerland
| | | | - Adam Ogna
- Respiratory Medicine Service, Locarno Regional Hospital, Locarno, Switzerland
| | - Sebastien Ott
- Universitätsklinik für Pneumologie, Universitätsspital (Inselspital) und Universität, Bern, Switzerland
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Jochen Rüdiger
- Division of Pulmonary and Sleep Medicine, Medizin Stollturm, Münchenstein, Switzerland
| | - Otto D Schoch
- Division of Pulmonary Diseases, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus Soler
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Werner Strobel
- Division of Pulmonary Diseases, Universitätsspital Basel, Basel, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital, Rolle, Switzerland
| | - Grégoire Gex
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Diseases, Hôpital du Valais, Sion, Switzerland
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21
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Wearn J, Akpa B, Mokhlesi B. Adherence to Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome. Sleep Med Clin 2020; 16:43-59. [PMID: 33485531 DOI: 10.1016/j.jsmc.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because of the prevalence of extreme obesity in the United States, there has been an increase in prevalence of obesity hypoventilation syndrome (OHS). There is limited information on the characteristics and pattern of positive airway pressure (PAP) adherence in patients with OHS compared with eucapnic patients with obstructive sleep apnea (OSA). This article discusses in detail the impact of PAP therapy on outcomes in patients with OHS, compares adherence between continuous PAP and noninvasive ventilation in OHS, and compares PAP adherence in patients with OHS to patients with moderate to severe OSA enrolled in clinical trials designed to improve CPAP adherence.
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Affiliation(s)
- Jeremy Wearn
- Sleep Medicine and Internal Medicine, Oregon Health & Science University and Portland VAMC, 3710 SW US Veterans Hospital Rd, PULM3/Sleep, Portland OR 97239, USA
| | - Bimaje Akpa
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, 420 Delaware Street SE, MMC 276, Minneapolis, MN 55455, USA
| | - Babak Mokhlesi
- Sleep Disorders Center, University of Chicago, 5841 South Maryland Avenue, MC6076/Room M630, Chicago, IL 60637, USA.
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22
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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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23
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Budweiser S, Tratz F, Gfüllner F, Pfeifer M. Long-term outcome with focus on pulmonary hypertension in Obesity Hypoventilation Syndrome. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:940-947. [PMID: 32506595 DOI: 10.1111/crj.13225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulmonary Hypertension (PH) is a frequent comorbidity in Obesity Hypoventilation Syndrome (OHS). OBJECTIVE We investigated long-term outcome of OHS with a particular emphasis on PH. METHODS In a prospective design, 64 patients with OHS and established noninvasive positive pressure ventilation (NPPV), were assessed by serum biomarkers, right heart catheterization, blood gases analysis, lung function, Epworth-Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), World Health Organization-functional class (WHO-FC) and health-related quality of life (HRQL) via the Severe Respiratory Insufficiency (SRI) questionnaire. After a planned follow-up of 5 years patients were reassessed regarding vital status, WHO-FC, ESS, SRI, PSQI, body mass index (BMI) and NPPV use. Prognostic markers were explored using univariate and multivariate Cox regression analyses. RESULTS At the 5-year follow-up, BMI tended to decrease (P = 0.05), while WHO-FC, ESS and PSQI remained unchanged. HRQL deteriorated in terms of SRI summary score and most subdomains (P < .05 each). NPPV adherence still was high (89%), while daily NPPV use increased from 6.7 (5.1; 8.0) h/d to 8.2 (7.4; 9.0) h/d (P < .05). After a 5-year follow-up, mortality was 25.8%. In univariate regression analyses only age > 69.5 years (HR = 4.145, 95%-CI = 1.180-14.565, P = 0.016), NT-proBNP > 1256 pg/mL (HR = 5.162, 95%-CI = 1.136-23.467, P = 0.018), diffusion capacity for carbon monoxide (DLCO, %pred) (HR = 0.341, 95%-CI = 0.114-1.019, P = 0.043) and higher oxygen use during daytime (HR = 5.236, 95%-CI = 1.489-18.406, P = 0.004) predicted mortality. No independent factor predicting mortality was detected in multivariate analysis. CONCLUSION Despite a high long-term NPPV use HRQL worsened. Age, oxygen use at baseline, DLCO (%pred) and NT-proBNP, as a surrogate parameter for PH, were related to long-term survival.
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Affiliation(s)
- Stephan Budweiser
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | - Florian Tratz
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | | | - Michael Pfeifer
- Centre for Pneumology, Donaustauf Hospital, Donaustauf, Germany
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24
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Sunwoo BY, Schmickl CN, Malhotra A. Contemporary Concise Review 2019: Sleep and ventilation. Respirology 2020; 25:552-558. [PMID: 32048407 PMCID: PMC7162714 DOI: 10.1111/resp.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Bernie Y Sunwoo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
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25
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Piper AJ, Lau EM. Positive Airway Pressure in Obesity Hypoventilation: Getting to the Heart of the Matter. Am J Respir Crit Care Med 2020; 201:509-511. [PMID: 31747310 PMCID: PMC7047462 DOI: 10.1164/rccm.201911-2162ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amanda J Piper
- Department of Respiratory & Sleep MedicineRoyal Prince Alfred HospitalCamperdown, Australia.,Faculty of Medicine and Health.,Woolcock Institute of Medical ResearchUniversity of SydneySydney, Australiaand
| | - Edmund M Lau
- Department of Respiratory & Sleep MedicineRoyal Prince Alfred HospitalCamperdown, Australia.,Faculty of Medicine and HealthUniversity of SydneySydney, Australia
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26
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Pulmonary Hypertension and Left Ventricular Diastolic Dysfunction in Patients with Obesity Hypoventilation Syndrome. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00161-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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