1
|
Sahoo A. The Interpretation of Arterial Blood Gas During the Apneic Phase of a Patient With Obstructive Sleep Apnea: A Case Report. Cureus 2023; 15:e39184. [PMID: 37378244 PMCID: PMC10292052 DOI: 10.7759/cureus.39184] [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: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) is now increasingly recognized as a disease entity that can play a major role in affecting multiple organ systems. Even though the symptoms of OSA were first described in the 19th century as Pickwickian syndrome, there are a lot of things that came to be known only recently including its pathophysiology and diagnosis. In this case report, we present some findings that mostly have not been reported in OSA patients before. It has been reported that OSA patients have a typical arterial blood gas (ABG) picture of raised bicarbonate (HCO3-) levels, which also aid in adding to the diagnosis, but we found some more findings that are only specific to the apneic phase of the disease. A 65-year-old female patient was put on a ventilator due to dengue-associated acute respiratory distress syndrome (ARDS). She was also diagnosed with obstructive sleep apnea after facing difficulty in weaning from a ventilator. Post extubation, she was put on noninvasive ventilation (NIV), but the patient's arterial blood gas (ABG) drawn during the apneic phase was showing signs of severe metabolic acidosis even on NIV. This was reversible and gets corrected once the patient is awakened or put on NIV. Clinical decisions from ABG in a patient with OSA may result in errors especially when the ABG is drawn during the apneic phase of the disease. Clinicians have to be careful of this phenomenon, and more research needs to be undertaken to fully understand the pathophysiology of this phenomenon.
Collapse
Affiliation(s)
- Ayaskant Sahoo
- Anesthesiology, Manipal Tata Medical College, Jamshedpur, IND
| |
Collapse
|
2
|
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.
Collapse
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
| | | | | |
Collapse
|
3
|
Shah NM, Shrimanker S, Kaltsakas G. Defining obesity hypoventilation syndrome. Breathe (Sheff) 2022; 17:210089. [PMID: 35035556 PMCID: PMC8753617 DOI: 10.1183/20734735.0089-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/24/2021] [Indexed: 01/07/2023] Open
Abstract
With increasing prevalence of obesity, the substantial contribution of obesity hypoventilation syndrome (OHS) to morbidity and mortality is likely to increase. It is therefore crucial that the condition has a clear definition to allow timely identification of patients. OHS was first described as “Pickwickian syndrome” in the 1950s; in subsequent decades, case reports did not clearly delineate between patients suffering from OHS and those suffering from obstructive sleep apnoea. In 1999, the American Academy of Sleep Medicine published a guideline that delineated the cause of daytime hypercapnia as either predominantly upper airway or predominantly hypoventilation. This was the first formal definition of OHS as the presence of daytime alveolar hypoventilation (arterial carbon dioxide tension >45 mmHg) in patients with body mass index >30 kg·m−2 in the absence of other causes of hypoventilation. This definition is reflected in the most recent guidelines published on OHS. Recent developments in defining OHS include proposed classification systems of severity and demonstrating the value of using serum bicarbonate to exclude OHS in patients with a low index of suspicion. Obesity hypoventilation syndrome is defined as daytime alveolar hypoventilation in obese patients in the absence of other causes of hypoventilation. Classifications of severity are now needed to target treatment at the most appropriate individuals.https://bit.ly/3yLuiL9
Collapse
Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Sonia Shrimanker
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| |
Collapse
|
4
|
Abstract
RATIONALE Acute hypercapnic respiratory failure has been shown to be associated with worse outcomes for various disease states, but less is known about patients with compensated hypercapnic respiratory failure. Although these patients have a normal pH, it remains unknown whether chronically elevated partial pressures of carbon dioxide (PaCO2), irrespective of etiology, put patients at risk of adverse events. OBJECTIVES To understand the burden of and clinical factors associated with morbidity and mortality in patients with compensated hypercapnic respiratory failure. METHODS We performed a query of the electronic medical record (EMR) to identify patients hospitalized at the University of Michigan from January 1 - December 31, 2018 who had compensated hypercapnia, using a PaCO2 ≥ 50 mmHg and pH 7.35 - 7.45 on arterial blood gas (ABG). We obtained demographic and clinical data from the EMR. Survival probabilities for PaCO2 subgroups (50.0-54.9; 55.0-64.9; ≥65.0 mmHg) were determined using the Kaplan-Meier product limit estimator. Cox proportional hazard models were constructed to test the association between PaCO2 and all-cause mortality. RESULTS We identified 491 patients with compensated hypercapnia. The mean age was 60.5 ± 16.2. Patients were 57.4% male and 86.2% white. The mean pH and PaCO2 were 7.38 ± 0.03 and 58.8 ± 9.7 mmHg respectively. There were a total of 1,030 hospitalizations, with 44.4% of patients having 2 or more admissions. The median numbers of cumulative hospital and ICU days were 21.0 (IQR 11.0-38.0) and 7.0 (IQR 3.0-14.0) respectively. 217 patients (44.2%) died over a median of 592 days. In univariate analysis, every 5-mmHg increase in PaCO2 was associated with a higher risk of all-cause death (HR 1.09; 95% CI 1.03-1.16; p=0.004). This association was maintained after adjusting for age, sex, BMI, and the Charlson comorbidity index (HR 1.09 for every 5-mmHg increase in PaCO2; 95% CI 1.02-1.16; p=0.009). There was a statistically significant interaction between PaCO2 and BMI on mortality (p= 0.01 for the interaction term). CONCLUSIONS Patients with compensated hypercapnic respiratory failure have high mortality and healthcare utilization with higher PaCO2 associated with worse survival. Obese hypercapnic patients have higher risk of death with increases in PaCO2.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Mokhlesi B, Masa JF, Brozek JL, Gurubhagavatula I, Murphy PB, Piper AJ, Tulaimat A, Afshar M, Balachandran JS, Dweik RA, Grunstein RR, Hart N, Kaw R, Lorenzi-Filho G, Pamidi S, Patel BK, Patil SP, Pépin JL, Soghier I, Tamae Kakazu M, Teodorescu M. Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 200:e6-e24. [PMID: 31368798 PMCID: PMC6680300 DOI: 10.1164/rccm.201905-1071st] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS). Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations. Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level <27 mmol/L to exclude the diagnosis of OHS in obese patients with sleep-disordered breathing when suspicion for OHS is not very high (<20%) but to measure arterial blood gases in patients strongly suspected of having OHS, 2) stable ambulatory patients with OHS receive positive airway pressure (PAP), 3) continuous positive airway pressure (CPAP) rather than noninvasive ventilation be offered as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, 4) patients hospitalized with respiratory failure and suspected of having OHS be discharged with noninvasive ventilation until they undergo outpatient diagnostic procedures and PAP titration in the sleep laboratory (ideally within 2–3 mo), and 5) patients with OHS use weight-loss interventions that produce sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS (which is more likely to be obtained with bariatric surgery). Conclusions: Clinicians may use these recommendations, on the basis of the best available evidence, to guide management and improve outcomes among patients with OHS.
Collapse
|
7
|
Nguyen DAT, Boswell-Ruys CL, McCaughey EJ, Gandevia SC, Hudson AL, Butler JE. Absence of inspiratory premotor potentials during quiet breathing in cervical spinal cord injury. J Appl Physiol (1985) 2020; 128:660-666. [PMID: 32078470 DOI: 10.1152/japplphysiol.00831.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A premotor potential, or Bereitschaftspotential (BP), is a low-amplitude negativity in the electroencephalographic activity (EEG) of the sensorimotor cortex. It begins ~1 s prior to the onset of inspiration in the averaged EEG. Although normally absent during quiet breathing in healthy, younger people, inspiration-related BPs are present in people with respiratory disease and healthy, older people, indicating a cortical contribution to quiet breathing. People with tetraplegia have weak respiratory muscles and increased neural drive during quiet breathing, indicated by increased inspiratory muscle activity. Therefore, we hypothesized that BPs would be present during quiet breathing in people with tetraplegia. EEG was recorded in 17 people with chronic tetraplegia (14M, 3 female; 22-51 yr; C3-C7, American Spinal Injury Association Impairment Scale A-D; >1 yr postinjury). They had reduced lung function and respiratory muscle weakness [FEV1: 54 ± 19% predicted, FVC: 59 ± 22% predicted and MIP: 56 ± 24% predicted (mean ± SD)]. Participants performed quiet breathing and voluntary self-paced sniffs (positive control condition). A minimum of 250 EEG epochs during quiet breathing and 60 epochs during sniffs, time-locked to the onset of inspiration, were averaged to determine the presence of BPs at Cz, FCz, C3, and C4. Fifteen participants (88%) had a BP for the sniffs. Of these 15 participants, only one (7%) had a BP in quiet breathing, a rate similar to that reported during quiet breathing in young able-bodied participants (12%). The findings suggest that, as in young able-bodied people, a cortical contribution to quiet breathing is absent in people with tetraplegia despite higher neural drive.NEW & NOTEWORTHY People with tetraplegia have weak respiratory muscles, increased neural drive during quiet breathing, and a high incidence of sleep-disordered breathing. Using electroencephalographic recordings, we show that inspiratory premotor potentials are absent in people with chronic tetraplegia during quiet breathing. This suggests that cortical activity is not present during resting ventilation in people with tetraplegia who are awake and breathing independently.
Collapse
Affiliation(s)
- David A T Nguyen
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| | - Euan James McCaughey
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| |
Collapse
|
8
|
Bouloukaki I, Mermigkis C, Michelakis S, Moniaki V, Mauroudi E, Tzanakis N, Schiza SE. The Association Between Adherence to Positive Airway Pressure Therapy and Long-Term Outcomes in Patients With Obesity Hypoventilation Syndrome: A Prospective Observational Study. J Clin Sleep Med 2018; 14:1539-1550. [PMID: 30176976 DOI: 10.5664/jcsm.7332] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/20/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the role of different levels of adherence and long-term effects of positive airway pressure (PAP) therapy on gas exchange, sleepiness, quality of life, depressive symptoms, and all-cause mortality in patients with obesity hypoventilation syndrome (OHS). METHODS A total of 252 patients with newly diagnosed OHS were followed up for a minimum of 2 years after PAP initiation. PAP adherence (h/night) was monitored. Arterial blood gas samples were taken with patients being alert for more than 4 hours after morning awakening. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (Short Form 36 [SF-36]) and patient's depressive symptoms (Beck Depression Inventory [BDI]) were assessed before and at the end of the follow-up period, along with all-cause mortality. RESULTS At the end of the follow-up period (median duration [25th-75th percentile], 30 [24-52] months), PaO2 increased from baseline (72.7 ± 10.3 versus 63.2 ± 10.6, P < .001) and both PaCO2 and HCO3- decreased (43.0 [39.2-45.0] versus 50.0 [46.7-55.4] and 27.5 ± 3.2 versus 31.4 ± 4.2, respectively, P < .001). In addition, PAP therapy significantly improved ESS (7 [4-9] versus 14 [11-16], P < .001), BDI (8.8 ± 4.9 versus 15.5 ± 7.3, P < .001) and SF-36 (82 [78-87] versus 74 [67-79], P < .001) scores. Over the follow-up period 11 patients died. Patients who used PAP for > 6 h/night had significant improvements (P < .05) in blood gases and SF-36 scores than less adherent patients. CONCLUSIONS Increased hours of use and long-term therapy with PAP are effective in the treatment of patients with OHS. Clinicians should encourage adherence to PAP therapy in order to provide a significant improvement in clinical status and gas exchange in these patients. COMMENTARY A commenary on this article appears in this issue on page 1455. CLINICAL TRIAL REGISTRATION Title: PAP Therapy in Patients With Obesity Hypoventilation Syndrome, Registry: ClinicalTrials.gov, Identifier: NCT03449641, URL: https://clinicaltrials.gov/ct2/show/NCT03449641.
Collapse
Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Charalampos Mermigkis
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Stylianos Michelakis
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Eleni Mauroudi
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Tzanakis
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Sophia E Schiza
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| |
Collapse
|
9
|
Morbid obesity, sleep apnea, obesity hypoventilation syndrome: Are we sleepwalking into disaster? ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.pcorm.2017.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
10
|
Liu C, Chen MS, Yu H. The relationship between obstructive sleep apnea and obesity hypoventilation syndrome: a systematic review and meta-analysis. Oncotarget 2017; 8:93168-93178. [PMID: 29190986 PMCID: PMC5696252 DOI: 10.18632/oncotarget.21450] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/12/2017] [Indexed: 01/22/2023] Open
Abstract
Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome are two similar diseases. Obstructive Sleep Apnea has been receiving more and more attention while the diagnostic rate of Obesity Hypoventilation Syndrome is not high. Few studies directly evaluated the relationship between them. We systematically analyzed the relevance of the two diseases. MEDLINE®, EMBASE® and the Cochrane Library were carried out to find studies until May 2017. Pooled mean difference and 95% confidence interval were calculated to evaluate the value of clinical and physiologic variables in the prediction of Obesity Hypoventilation Syndrome. 9 Studies (n = 2085) fulfilled the predefined selection criteria. Totally 575 patients (28%) with Obesity Hypoventilation Syndrome were diagnosed from 2085 Obstructive Sleep Apnea patients. Among clearly diagnosed Obstructive Sleep Apnea patients, higher Body Mass Index levels(mean difference:4.72 kg/m2; 95% confidence interval: 4.26 to 5.17; p < 0.00001), higher Apnea-Hypopnea Index (mean difference: 8.36; 95% confidence interval: −3.88 to −2.84; p < 0.00001), greater neck circumference (mean difference:1.01; 95% confidence interval: 0.10 to 1.92; p = 0.03) and lower percent predicted FEV1 (mean difference:−10.28; 95% confidence interval:−11.33 to −9.22; p < 0.00001)were associated with the occurrence with obesity hypoventilation syndrome. We should be highly skeptical of obesity hypoventilation syndrome in Obstructive Sleep Apnea patients with these factors as early identification and appropriate treatment can improve prognosis.
Collapse
Affiliation(s)
- Chaoling Liu
- Respiratory Department, Guangdong Provincial Hospital of Chinese Medicine & the 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Mao-Sheng Chen
- Division of Chest Pain Center, Guangdong Provincial Hospital of Chinese Medicine & the 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Hui Yu
- Respiratory Department, Guangdong Provincial Hospital of Chinese Medicine & the 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| |
Collapse
|