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da Silva DIC, Ishimoto LY, Franco EAT, dos Santos MSC, Brizola LFP, Colombo CA, Savadkouhi EG, Machado LHS, Tanni SE, Prudente R. Long-term oxygen therapy to reduce length of hospital stay in COVID-19. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231379. [PMID: 39045926 PMCID: PMC11262311 DOI: 10.1590/1806-9282.20231379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/24/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of long-term oxygen therapy as a strategy to reduce hospitalization time in patients affected by COVID-19. METHODS Between April and December 2021, COVID-19 patients with stable clinical conditions needing supplementary oxygen therapy during hospitalization were oriented to have hospital discharge with long-term oxygen therapy and reassessment after 15 days. RESULTS A total of 62 patients were evaluated and, 15 days after discharge, 69% of patients had suspended long-term oxygen therapy, with no difference between the groups admitted to the intensive care unit or the ward (p=0.319). Among the individuals who needed to maintain long-term oxygen therapy, in addition to worse P/F ratio (265±57 vs. 345±51; p<0.001) and lower partial pressure of oxygen (55±12 vs. 72±11 mmHg; p<0.001), were those more obese (37±8 vs. 30±6 kg/m2; p=0.032), needed more time for invasive mechanical ventilation (46±27 vs. 20±16 days; p=0.029), had greater persistence of symptoms (p<0.001), and shorter time between the onset of symptoms and the need for hospitalization (7 [2-9] vs. 10 [6-12] days; p=0.039). CONCLUSION Long-term oxygen therapy is an effective strategy for reducing hospitalization time in COVID-19 patients, regardless of gravity. Additionally, more obese patients with persistence of respiratory symptoms, faster disease evolution, and more days of invasive mechanical ventilation needed to maintain the long-term oxygen therapy longer.
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Affiliation(s)
| | - Letícia Yumi Ishimoto
- São Paulo State University (UNESP), Medical School, Distrito de Rubião Junior s/n – Botucatu (SP), Brazil
| | | | | | | | - Camila Aparecida Colombo
- São Paulo State University (UNESP), Medical School, Distrito de Rubião Junior s/n – Botucatu (SP), Brazil
| | - Edris Guardiano Savadkouhi
- São Paulo State University (UNESP), Medical School, Distrito de Rubião Junior s/n – Botucatu (SP), Brazil
| | | | - Suzana Erico Tanni
- São Paulo State University (UNESP), Medical School, Distrito de Rubião Junior s/n – Botucatu (SP), Brazil
| | - Robson Prudente
- São Paulo State University (UNESP), Medical School, Distrito de Rubião Junior s/n – Botucatu (SP), Brazil
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Orozco González BN, Rodriguez Plascencia N, Palma Zapata JA, Llamas Domínguez AE, Rodríguez González JS, Diaz JM, Ponce Muñoz M, Ponce-Campos SD. Obesity hypoventilation syndrome, literature review. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae033. [PMID: 38966619 PMCID: PMC11223067 DOI: 10.1093/sleepadvances/zpae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/12/2024] [Indexed: 07/06/2024]
Abstract
Obesity is a global health concern that has been increasing over the years, and it is associated with several pathophysiological changes affecting the respiratory system, including alveolar hypoventilation. Obesity hypoventilation syndrome (OHS) is one of the six subtypes of sleep-hypoventilation disorders. It is defined as the presence of obesity, chronic alveolar hypoventilation leading to daytime hypercapnia and hypoxia, and sleep-disordered breathing. The existence of a sleep disorder is one of the characteristics that patients with OHS present. Among them, 90% of patients have obstructive sleep apnea (OSA), and the remaining 10% of patients with OHS have non-obstructive sleep hypoventilation without OSA or with mild OSA. This review aims to provide a comprehensive understanding of the epidemiological and pathophysiological impact of OHS and to highlight its clinical features, prognosis, and severity, as well as the available treatment options.
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Affiliation(s)
| | - Nidia Rodriguez Plascencia
- Pneumology Service, Hospital of Specialties at the National Medical Center of the West (IMSS), Guadalajara, México
| | | | | | | | - Juan Manuel Diaz
- Department of Microbiology and Immunology, University of Western Ontario, London, ON, Canada
| | - Miguel Ponce Muñoz
- Department of Medicine, Autonomous University of Aguascalientes, Aguascalientes, México
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Locke BW, Brown JP, Sundar KM. The Role of Obstructive Sleep Apnea in Hypercapnic Respiratory Failure Identified in Critical Care, Inpatient, and Outpatient Settings. Sleep Med Clin 2024; 19:339-356. [PMID: 38692757 PMCID: PMC11068091 DOI: 10.1016/j.jsmc.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
An emerging body of literature describes the prevalence and consequences of hypercapnic respiratory failure. While device qualifications, documentation practices, and previously performed clinical studies often encourage conceptualizing patients as having a single "cause" of hypercapnia, many patients encountered in practice have several contributing conditions. Physiologic and epidemiologic data suggest that sleep-disordered breathing-particularly obstructive sleep apnea (OSA)-often contributes to the development of hypercapnia. In this review, the authors summarize the frequency of contributing conditions to hypercapnic respiratory failure among patients identified in critical care, emergency, and inpatient settings with an aim toward understanding the contribution of OSA to the development of hypercapnia.
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Affiliation(s)
- Brian W Locke
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jeanette P Brown
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Krishna M Sundar
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Thomas A, Jaffré S, Guardiolle V, Perennec T, Gagnadoux F, Goupil F, Bretonnière C, Danielo V, Morin J, Blanc FX. Does PaCO 2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation? Heliyon 2024; 10:e26437. [PMID: 38420381 PMCID: PMC10901024 DOI: 10.1016/j.heliyon.2024.e26437] [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: 05/18/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
Background and objective Non-invasive ventilation (NIV) improves survival of patients with chronic respiratory failure (CRF). Most often, pressure settings are made to normalize arterial blood gases. However, this objective is not always achieved due to intolerance to increased pressure or poor compliance. Few studies have assessed the effect of persistent hypercapnia on ventilated patients' survival. Data from the Pays de la Loire Respiratory Health Research Institute cohort were analyzed to answer this question. Study design and methods NIV-treated adults enrolled between 2009 and 2019 were divided into 5 subgroups: obesity-hypoventilation syndrome (OHS), COPD, obese COPD, neuromuscular disease (NMD) and chest wall disease (CWD). PaCO2 correction was defined as the achievement of a PaCO2 < 6 kPa or a 20% decrease in baseline PaCO₂ in COPD patients. The endpoint was all-cause mortality. Follow-up was censored in case of NIV discontinuation. Results Data from 431 patients were analyzed. Median survival was 103 months and 148 patients died. Overall, PaCO2 correction was achieved in 74% of patients. Bivariate analysis did not show any survival difference between patients who achievedPaCO₂ correction and those who remained hypercapnic: overall population: p = 0.74; COPD: p = 0.97; obese COPD: p = 0.28; OHS: p = 0.93; NMD: p = 0.84; CWD: p = 0.28. Conclusion Moderate residual hypercapnia under NIV does not negatively impact survival in CRF patients. In individuals with poor tolerance of pressure increases, residual hypercapnia can therefore be tolerated under long-term NIV. Larger studies, especially with a higher number of patients with residual PaCO2 > 7 kPa, are needed to confirm these results.
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Affiliation(s)
- Audrey Thomas
- Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, France
| | - Sandrine Jaffré
- Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, France
| | - Vianney Guardiolle
- Nantes Université, CHU Nantes, Data Clinic, INSERM CIC 1413, Nantes, France
| | - Tanguy Perennec
- Radiotherapy Department, West Cancer Institute, Saint Herblain, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | - Cédric Bretonnière
- Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, France
| | - Vivien Danielo
- Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, France
| | - Jean Morin
- Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, France
| | - François-Xavier Blanc
- Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, France
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D’Cruz RF, Hart N. A history of home mechanical ventilation: The past, present and future. Chron Respir Dis 2024; 21:14799731241240776. [PMID: 38512223 PMCID: PMC10958804 DOI: 10.1177/14799731241240776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
This state-of-the-art review provides an overview of the history of home mechanical ventilation (HMV), including early descriptions of mechanical ventilation from ancient and Renaissance perspectives and the mass development of ventilators designed for long-term use during the poliomyelitis epidemic. Seminal data from key clinical trials supports the application of HMV in certain patients with chronic obstructive pulmonary disease, neuromuscular disease and obesity-related respiratory failure. Innovative engineering coupled with refined physiological understanding now permits widespread delivery of home mechanical ventilation to a global population, using portable devices with advanced ventilatory modes and telemonitoring capabilities. Exponential growth in digital technology continues, and ongoing research is needed to understand how to harness clinical and physiological data to benefit patients and healthcare services in a clinically- and cost-effective manner.
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Affiliation(s)
- Rebecca F D’Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King’s College London, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King’s College London, London, UK
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6
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Krishnan A, Ellis P, Antoine-Pitterson P, Oakes A, Jones B, Turner A, Mukherjee R. Long-Term Mortality following Acute Noninvasive Ventilation for Obesity-Related Respiratory Failure: A Retrospective Single-Centre Study. Can Respir J 2023; 2023:5370197. [PMID: 37868785 PMCID: PMC10586910 DOI: 10.1155/2023/5370197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/25/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Determinants of long-term mortality following acute hypercapnic respiratory failure have been extensively studied in patients with chronic obstructive pulmonary disease. However, respiratory failure due to obesity has not been studied to the same extent. This retrospective survey aims to identify whether admission pH is associated with long-term mortality in patients requiring acute noninvasive ventilation (NIV) for obesity-related respiratory failure (ORRF). Methods Records from April 2013 to March 2020 were accessed from a NIV quality database at an acute teaching hospital. Adults with hypercapnic ORRF requiring acute NIV were included. pH data were grouped by threshold (pH≤ and >7.25) and correlated with time from presentation to death; multivariable analysis was performed using Cox proportional hazards. Results A total of 277 acute NIV episodes were included. Two-year mortality was similar for patients in both pH categories. Univariable analysis identified pH ≤ 7.25 to increase risk of two-year mortality by 43%. However, multivariable analysis identified that pH was not a significant determinant of long-term mortality, although male sex, older age, and higher admission pCO2 increased the risk of death at two years by 76%, 3% per year of age, and 16% per 1 kPa of pCO2 increase, respectively. Conclusion Severity of hypercapnia on admission, male sex, and older age are associated with worse two-year mortality in patients requiring acute NIV for ORRF. There is scope for further analyses including investigating the role of domiciliary NIV in ORRF patients.
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Affiliation(s)
- Aditya Krishnan
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
| | - Paul Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
| | - Pearlene Antoine-Pitterson
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Amy Oakes
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Bethany Jones
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Rahul Mukherjee
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, ENG, UK
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7
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Agossou M, Barzu R, Awanou B, Bellegarde-Joachim J, Arnal JM, Dramé M. Factors Associated with the Efficiency of Home Non-Invasive Ventilation in Patients with Obesity-Hypoventilation Syndrome in Martinique. J Clin Med 2023; 12:jcm12103381. [PMID: 37240487 DOI: 10.3390/jcm12103381] [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: 03/23/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Obesity-hypoventilation syndrome (OHS) is a respiratory complication of obesity characterized by chronic hypercapnic respiratory failure. It is often associated with several comorbidities and is treated by positive airway pressure (PAP) therapy. This study aimed to identify factors associated with persistent hypercapnia in patients receiving home non-invasive ventilation (NIV). We performed a retrospective study including patients with documented OHS. In total, 143 patients were included (79.7% women, age 67 ± 15.5 years, body mass index 41.6 ± 8.3 kg/m2). After 4.6 ± 4.0 years of follow-up, 72 patients (50.3%) remained hypercapnic. In bivariable analysis, clinical data showed no difference in follow-up duration, number of comorbidities, comorbidities, or circumstance of discovery. Patients with persistent hypercapnia on NIV were generally older, with lower BMI and more comorbidities. (5.5 ± 1.8 versus 4.4 ± 2.1, p = 0.001), female sex (87.5% versus 71.8%), was treated by NIV (100% versus 90.1%, p < 0.01), had lower FVC (56.7 ± 17.2 versus 63.6 ± 18% of theoretical value, p = 0.04), lower TLC (69.1 ± 15.3 versus 74.5 ± 14.6% of theoretical value, p = 0.07), lower RV (88.4 ± 27.1 versus 102.5 ± 29.4% of theoretical value, p = 0.02), higher pCO2 at diagnosis (59.7 ± 11.7 versus 54.6 ± 10.1 mmHg, p = 0.01) and lower pH (7.38 ± 0.03 versus 7.40 ± 0.04, p = 0.007), higher pressure support (12.6 ± 2.6 versus 11.5 ± 2.4 cmH2O, p = 0.04) and lower EPAP (8.2 ± 1.9 versus 9 ± 2.0 cmH2O, p = 0.06). There was no difference in non-intentional leaks and daily use between patients between both groups. By multivariable analysis, sex, BMI, pCO2 at diagnosis, and TLC were independent risk factors for persistent hypercapnia on home NIV. In individuals with OHS, persistent hypercapnia on home NIV therapy is frequent. Sex, BMI, pCO2 at diagnosis, and TLC were all associated with an increased risk of persistent hypercapnia in persons treated with home NIV.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Ramona Barzu
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Bérénice Awanou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | | | - Jean-Michel Arnal
- Service de Réanimation Polyvalente, Hôpital Sainte Musse, 83100 Toulon, France
| | - Moustapha Dramé
- Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
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8
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Chung Y, Garden FL, Marks GB, Vedam H. Causes of hypercapnic respiratory failure and associated in-hospital mortality. Respirology 2023; 28:176-182. [PMID: 36210347 PMCID: PMC10092076 DOI: 10.1111/resp.14388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Hypercapnic respiratory failure (HRF) can occur due to severe respiratory disease but also because of multiple coexistent causes. There are few data on the prevalence of antecedent causes for HRF and the effect of these causes on prognosis, especially where study inclusion has not been biased with respect to primary diagnosis, interventions received or clinical outcome. We sought to determine the prevalence of pre-specified conditions among patients with HRF and to determine the effect of these causes on in-hospital mortality. METHODS Cross-sectional study of patients with HRF from 2013 to 2017. Inclusion criteria were PaCO2 >45 mm Hg and pH ≤7.45. Causes of interest were identified using diagnosis codes from hospital records. We used directed acyclic graphs to inform logistic regression models for the outcome of in-hospital death. RESULTS We identified 873 persons with HRF in the study period. Mean (SD) age was 69 years and 50.4% were males. Acidosis (pH <7.35) was present in 488 (55%) cases. Most (83%) had one or more of the following: obstructive lung disease, lower respiratory tract infection, congestive cardiac failure, sleep disordered breathing, neuromuscular disease, opioid or benzodiazepine use. In-hospital mortality was 12.8%. Obstructive lung disease and cardiac failure were associated with a lower risk of death, whereas respiratory tract infection and neuromuscular disease were associated with increased risk of death. CONCLUSION HRF is associated with a range of potentially causative conditions, which significantly impact hospital survival. Systematic evaluation of patients with HRF may increase detection of treatable comorbidities.
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Affiliation(s)
- Yewon Chung
- South Western Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Frances L Garden
- South Western Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Guy B Marks
- South Western Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Hima Vedam
- South Western Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
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Marwah V, Dhar R, Choudhary R, Elliot M. Domiciliary noninvasive ventilation for chronic respiratory diseases. Med J Armed Forces India 2022; 78:380-386. [PMID: 36267521 PMCID: PMC9577344 DOI: 10.1016/j.mjafi.2022.09.006] [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: 03/18/2022] [Accepted: 06/29/2022] [Indexed: 10/14/2022] Open
Abstract
Patients with chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), neuromuscular diseases, kyphoscoliosis and obstructive sleep apnoea-obesity hypoventilation syndrome (OSA-OHS), are at a higher risk of decompensation in the form of hypercapnic respiratory failure leading to intensive care unit (ICU) admission and increased mortality. This article reviews the evidence of role of domiciliary noninvasive ventilation (NIV) in patients with diseases with chronic ventilatory failure, including the mechanism of the effect of (NIV).
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Affiliation(s)
- Vikas Marwah
- Professor & Head (Pulmonary Medicine), Critical Care & Sleep Medicine, Army Institute of Cardio Thoracic Sciences (AICTS), Pune, India
| | - Raja Dhar
- Director & Head (Pulmonology), Calcutta Medical Research Institute, Kolkata, West Bengal, India
| | - Robin Choudhary
- Assistant Professor (Pulmonary Medicine), Critical Care & Sleep Medicine, Army Institute of Cardio Thoracic Sciences (AICTS), Pune, India
| | - Mark Elliot
- Consultant, St James's University Hospital, Leeds, UK
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Kotanen P, Brander P, Kreivi HR. The prevalence of non-invasive ventilation and long-term oxygen treatment in Helsinki University Hospital area, Finland. BMC Pulm Med 2022; 22:248. [PMID: 35752824 PMCID: PMC9233351 DOI: 10.1186/s12890-022-02044-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic respiratory failure (CRF) can be treated at home with non-invasive ventilation (NIV) and/or long-term oxygen (LTOT). The prevalence of these treatments is largely unknown. We aimed to clarify the prevalence and indications of the treatments, and the three-year mortality of the treated patients in the Helsinki University Hospital (HUH) area in Finland. METHODS In this retrospective study we analyzed the prevalence of adult CRF patients treated with NIV and/or LTOT on 1.1.2018 and followed these patients until 1.1.2021. Data collected included the underlying diagnosis, patient characteristics, information on treatment initiation and from the last follow-up visit, and mortality during the three-year follow-up. Patients with home invasive mechanical ventilation or sleep apnea were excluded. RESULTS On 1.1.2018, we had a total of 815 patients treated with NIV and/or LTOT in the Helsinki University Hospital (HUH) area, with a population of 1.4 million. The prevalence of NIV was 35.4 per 100,000, of LTOT 24.6 per 100,000 and of the treatments combined 60.0 per 100,000. Almost half, 44.5%, were treated with NIV, 41.0% with LTOT, and 14.4% underwent both. The most common diagnostic groups were chronic obstructive pulmonary disease (COPD) (33.3%) and obesity-hypoventilation syndrome (OHS) (26.6%). The three-year mortality in all patients was 45.2%. In the COPD and OHS groups the mortality was 61.3% and 21.2%. In NIV treated patients, the treatment durations varied from COPD patients 5.3 years to restrictive chest wall disease patients 11.4 years. The age-adjusted Charlson co-morbidity index (ACCI) median for all patients was 3.0. CONCLUSIONS NIV and LTOT are common treatments in CRF. The prevalence in HUH area was comparable to other western countries. As the ACCI index shows, the treated patients were fragile, with multiple co-morbidities, and their mortality was high. Treatment duration and survival vary greatly depending on the underlying diagnosis.
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Affiliation(s)
- Petra Kotanen
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland. .,Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland.
| | - Pirkko Brander
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland
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Rantala HA, Leivo-Korpela S, Lehtimäki L, Lehto JT. Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency. J Palliat Care 2022; 37:134-141. [PMID: 34841962 PMCID: PMC9109583 DOI: 10.1177/08258597211049592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: Patients with chronic respiratory insufficiency suffer from advanced disease, but their overall symptom burden is poorly described. We evaluated the symptoms and screening of depression in subjects with chronic respiratory insufficiency by using the Edmonton symptom assessment system (ESAS). Methods: In this retrospective study, 226 subjects with chronic respiratory insufficiency answered the ESAS questionnaire measuring symptoms on a scale from 0 (no symptoms) to 10 (worst possible symptom), and the depression scale (DEPS) questionnaire, in which the cut-off point for depressive symptoms is 9. Results: The most severe symptoms measured with ESAS (median [interquartile range]) were shortness of breath 4.0 (1.0-7.0), dry mouth 3.0 (1.0-7.0), tiredness 3.0 (1.0-6.0), and pain on movement 3.0 (0.0-6.0). Subjects with a chronic obstructive pulmonary disease as a cause for chronic respiratory insufficiency had significantly higher scores for shortness of breath, dry mouth, and loss of appetite compared to others. Subjects with DEPS ≥9 reported significantly higher symptom scores in all ESAS categories than subjects with DEPS <9. The area under the receiver operating characteristic curve for ESAS depression score predicting DEPS ≥9 was 0.840 (P < .001). If the ESAS depression score was 0, there was an 89% probability of the DEPS being <9, and if the ESAS depression score was ≥4, there was an 89% probability of the DEPS being ≥9. The relation between ESAS depression score and DEPS was independent of subjects' characteristics and other ESAS items. Conclusions: Subjects with chronic respiratory insufficiency suffer from a high symptom burden due to their advanced disease. The severity of symptoms increases with depression and 4 or more points in the depression question of ESAS should lead to a closer diagnostic evaluation of depression. Symptom-centered palliative care including psychosocial aspects should be early integrated into the treatment of respiratory insufficiency.
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Affiliation(s)
- Heidi A. Rantala
- Department of Respiratory Medicine, Tampere University Hospital,
Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University,
Tampere, Finland
| | - Sirpa Leivo-Korpela
- Department of Respiratory Medicine, Tampere University Hospital,
Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University,
Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University,
Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Juho T. Lehto
- Faculty of Medicine and Health Technology, Tampere University,
Tampere, Finland
- Department of Oncology, Palliative Care Unit, Tampere University
Hospital, Tampere, Finland
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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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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
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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
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14
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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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15
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Daabek N, Tamisier R, Foote A, Revil H, Joyeux-Jaure M, Pépin JL, Bailly S, Borel JC. Impact of Healthcare Non-Take-Up on Adherence to Long-Term Positive Airway Pressure Therapy. Front Public Health 2021; 9:713313. [PMID: 34485235 PMCID: PMC8416102 DOI: 10.3389/fpubh.2021.713313] [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: 05/22/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background: The effectiveness of positive airway pressure therapies (PAP) is contingent on treatment adherence. We hypothesized that forgoing healthcare may be a determinant of adherence to PAP therapy. Research Question: The objectives were: (i) to assess the impact of forgoing healthcare on adherence to PAP in patients with Chronic Respiratory Failure (CRF) and patients with Obstructive Sleep Apnea Syndrome (OSAS); (ii) to compare forgoing healthcare patterns in these two chronic conditions. Study design and methods: Prospective cohort of patients with OSAS or CRF, treated with PAP therapies at home for at least 12 months. At inclusion, patients were asked to fill-in questionnaires investigating (i) healthcare forgone, (ii) deprivation (EPICES score), (iii) socio-professional and familial status. Characteristics at inclusion were extracted from medical records. PAP adherence was collected from the device's built-in time counters. Multivariable logistic regression models were used to assess the associations between healthcare forgone and the risk of being non-adherent to CPAP treatment. Results: Among 298 patients included (294 analyzed); 33.7% reported forgoing healthcare. Deprivation (EPICES score > 30) was independently associated with the risk of non-adherence (OR = 3.57, 95%CI [1.12; 11.37]). Forgoing healthcare had an additional effect on the risk of non-adherence among deprived patients (OR = 7.74, 95%CI [2.59; 23.12]). OSAS patients mainly forwent healthcare for financial reasons (49% vs. 12.5% in CRF group), whereas CRF patients forwent healthcare due to lack of mobility (25%, vs. 5.9 % in OSAS group). Interpretation: Forgoing healthcare contributes to the risk of PAP non-adherence particularly among deprived patients. Measures tailored to tackle forgoing healthcare may improve the overall quality of care in PAP therapies. Clinical Trial Registration: The study protocol was registered in ClinicalTrials.gov, identifier: NCT03591250.
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Affiliation(s)
- Najeh Daabek
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Research Division, Grenoble Alpes University Hospital, Grenoble, France
| | - Hélèna Revil
- Social Sciences Research - PACTE Laboratory, CNRS UMR 5194, University Grenoble Alpes, Grenoble, France
| | - Marie Joyeux-Jaure
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France
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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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Lebret M, Léotard A, Pépin JL, Windisch W, Ekkernkamp E, Pallero M, Sánchez-Quiroga MÁ, Hart N, Kelly JL, Patout M, Funk GC, Duiverman ML, Masa JF, Simonds A, Murphy PB, Wijkstra PJ, Dreher M, Storre J, Khouri C, Borel JC. Nasal versus oronasal masks for home non-invasive ventilation in patients with chronic hypercapnia: a systematic review and individual participant data meta-analysis. Thorax 2021; 76:1108-1116. [PMID: 33859049 DOI: 10.1136/thoraxjnl-2020-215613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The optimal interface for the delivery of home non-invasive ventilation (NIV) to treat chronic respiratory failure has not yet been determined. The aim of this individual participant data (IPD) meta-analysis was to compare the effect of nasal and oronasal masks on treatment efficacy and adherence in patients with COPD and obesity hypoventilation syndrome (OHS). METHODS We searched Medline and Cochrane Central Register of Controlled Trials for prospective randomised controlled trials (RCTs) of at least 1 month's duration, published between January 1994 and April 2019, that assessed NIV efficacy in patients with OHS and COPD. The main outcomes were diurnal PaCO2, PaO2 and NIV adherence (PROSPERO CRD42019132398). FINDINGS Of 1576 articles identified, 34 RCTs met the inclusion criteria and IPD were obtained for 18. Ten RCTs were excluded because only one type of mask was used, or mask data were missing. Data from 8 RCTs, including 290 IPD, underwent meta-analysis. Oronasal masks were used in 86% of cases. There were no differences between oronasal and nasal masks for PaCO2 (0.61 mm Hg (95% CI -2.15 to 3.38); p=0.68), PaO2 (-0.00 mm Hg (95% CI -4.59 to 4.58); p=1) or NIV adherence (0·29 hour/day (95% CI -0.74 to 1.32); p=0.58). There was no interaction between the underlying pathology and the effect of mask type on any outcome. INTERPRETATION Oronasal masks are the most used interface for the delivery of home NIV in patients with OHS and COPD; however, there is no difference in the efficacy or tolerance of oronasal or nasal masks.
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Affiliation(s)
- Marius Lebret
- Pneumology Department, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
| | | | - Jean Louis Pépin
- HP2 Laboratory INSERM U1042, Univ. Grenoble Alpes, Grenoble, France
| | - Wolfram Windisch
- Department of Pneumology and Critical Care Medicine, Cologne Merheim Hospital, Cologne, Germany.,Depatment of Pneumology, Kliniken der Stadt Köln gGmbH, Cologne, Germany.,Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Emelie Ekkernkamp
- Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - Mercedes Pallero
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Julia L Kelly
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Maxime Patout
- Departement of pneumology and intensive care, University Hospital, Rouen, France
| | - Georg Chistian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Marieke L Duiverman
- Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen, Groningen, Netherlands
| | - Juan F Masa
- San Pedro de Alcantara Hospital, Caceres, Spain
| | - Anita Simonds
- National Institute of Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Respiratory Medicine, Imperial College London, London, UK
| | | | - Peter J Wijkstra
- Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Michael Dreher
- Pneumology and Intensive Care Medicine, Universitatsklinikum Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Jan Storre
- Pneumology Department, University Medical Center Freiburg, Freiburg, Germany.,Praxis Pneumologie Solln, Munich, Germany
| | - Charles Khouri
- HP2 Laboratory INSERM 1042, Grenoble Universites, Saint-Martin-d'Heres, France
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18
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The Role of Positive Airway Pressure Therapy in Adults with Obesity Hypoventilation Syndrome. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2021; 17:344-360. [PMID: 31726017 DOI: 10.1513/annalsats.201907-528oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Obesity hypoventilation syndrome (OHS) is an undesirable complication of severe obesity. Although weight loss is an accepted component of management, it is difficult to achieve and sustain the degree of weight loss necessary to reverse OHS. As such, positive airway pressure (PAP) during sleep has become the cornerstone therapy for most patients with OHS. However, the value of PAP therapy remains uncertain.Objective: To perform a systematic review to determine whether adults with OHS should be treated with PAP therapy or not.Methods: This systematic review informed an international, multidisciplinary panel of experts who had converged to develop a clinical practice guideline on OHS for the American Thoracic Society. MEDLINE, the Cochrane Library, and Embase were searched from January 1946 to March 2019 for studies that compared PAP therapy (i.e., continuous PAP or noninvasive ventilation) to no PAP therapy in patients with OHS. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to appraise the quality of evidence.Results: The search identified 2,994 unique articles. The full text of 56 articles was reviewed, and 25 studies were selected, including 3 randomized trials, 12 nonrandomized comparative studies, and 10 randomized and nonrandomized studies without a comparator group. Sample size ranged from 21 to 1,527 patients. PAP was associated with increased resolution of OHS and improvements in mortality, gas exchange, daytime sleepiness, sleep quality, quality of life, and emergency department visits. Nearly half of patients experienced trivial adverse effects related to PAP therapy. Certainty in the estimated effects was low or very low for most outcomes.Conclusions: The panel made a conditional (i.e., weak) recommendation that PAP therapy during sleep be offered to patients with OHS to improve outcomes. This recommendation was based on very low-quality evidence.
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Rantala HA, Leivo-Korpela S, Kettunen S, Lehto JT, Lehtimäki L. Survival and end-of-life aspects among subjects on long-term noninvasive ventilation. Eur Clin Respir J 2020; 8:1840494. [PMID: 33209213 PMCID: PMC7646568 DOI: 10.1080/20018525.2020.1840494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The need for noninvasive ventilation (NIV) is commonly considered a predictor of poor survival, but life expectancy may vary depending on the underlying disease. We studied the factors associated with decreased survival and end-of-life characteristics in an unselected population of subjects starting NIV. Methods We conducted a retrospective study including 205 subjects initiating NIV from 1/1/2012-31/12/2015 who were followed up until 31/12/2017. Results The median survival time was shorter in subjects needing help with activities of daily living than in independent subjects (hazard ratio (HR) for death 1.7, 95% CI 1.2–2.6, P = 0.008) and was also shorter in subjects on long-term oxygen therapy (LTOT) than in those not on LTOT (HR for death 2.8, 95% CI 1.9–4.3, P < 0.001). There was marked difference in survival according to the disease necessitating NIV, and subjects with amyotrophic lateral sclerosis or interstitial lung disease seemed to have the shortest survival. The two most common diseases resulting in the need for NIV were chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS). The median survival time was 4.4 years in COPD subjects, but the median survival time was not reached in subjects with OHS (HR for death COPD vs. OHS: 3.2, 95% CI 1.9–5.5, P < 0.001). Most of the deceased subjects (55.6%) died in the hospital, while only 20.0% died at home. The last hospitalization admission leading to death occurred through the emergency room in 44.4% of the subjects. Conclusions Survival among subjects starting NIV in this real-life study varied greatly depending on the disease and degree of functional impairment. Subjects frequently died in the hospital after admission through the emergency department. A comprehensive treatment approach with timely advance care planning is therefore needed, especially for those needing help with activities of daily living and those with both NIV and LTOT.
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Affiliation(s)
- Heidi A Rantala
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sirpa Leivo-Korpela
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Siiri Kettunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
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20
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Ramírez Molina VR, Masa Jiménez JF, Gómez de Terreros Caro FJ, Corral Peñafiel J. Effectiveness of different treatments in obesity hypoventilation syndrome. Pulmonology 2020; 26:370-377. [PMID: 32553827 DOI: 10.1016/j.pulmoe.2020.05.012] [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: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/23/2022] Open
Abstract
Obesity hypoventilation syndrome (OHS) is an undesirable consequence of obesity, defined as daytime hypoventilation, sleep disorder breathing and obesity; during the past few years the prevalence of extreme obesity has markedly increased worldwide consequently increasing the prevalence of OHS. Patients with OHS have a lower quality of life and a higher risk of unfavourable cardiometabolic consequences. Early diagnosis and effective treatment can lead to significant improvement in patient outcomes; therefore, such data has noticeably raised interest in the management and treatment of this sleep disorder. This paper will discuss the findings on the main current treatment modalities OHS will be discussed.
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Affiliation(s)
- V R Ramírez Molina
- Pulmonary and Sleep Medicine, Regional General Hospital N.2 of the Mexican Social Security Institute (IMSS), Querétaro, Mexico
| | - J F Masa Jiménez
- Division of Pulmonary Medicine, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain.
| | | | - J Corral Peñafiel
- Division of Pulmonary Medicine, San Pedro de Alcántara Hospital, Cáceres, Spain
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21
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Yüksel A, Çiftçi F, Çiledağ A, Kaya A. The effects of home noninvasive ventilation on the quality of life and physiological parameters of patients with chronic respiratory failure. CLINICAL RESPIRATORY JOURNAL 2020; 14:880-888. [PMID: 32460414 DOI: 10.1111/crj.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/01/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Home noninvasive mechanical ventilation (HNIV) in patients with chronic hypercapnic respiratory failure (CHRF) may improve the health-related quality of life (HRQoL) and reduce hospitalizations. OBJECTIVE To determine the effects of HNIV on HRQoL, sleep quality and hospitalization rates in restrictive thoracic diseases (RTD) and chronic obstructive pulmonary disease (COPD) patients with CHRF. METHODS In this prospective, single center study patients divided into two groups; the COPD and the RTD groups. HRQoL assessed by The Medical Outcome Study 36-Item Short-form Health Survey (SF-36) and Severe Respiratory Insufficiency (SRI); the sleep quality was assessed by Epworth and Pittsburgh Sleep Quality Index questionnaires. The patients were reevaluated first month, third months, sixth months and 1 year following HNIV establishment, during which time, hospitalization rates were recorded. RESULTS Ninety (COPD n = 50, RTD n = 40) out of 102 eligible patients completed the study. Significant improvements in blood gases and HRQoL were observed in the first month of HNIV establishment and remained stable. Mean ± SD SRI summary scale improved significantly from 30 ± 12 baseline to 65 ± 16 at 1 year in COPD group (P < 0.001) and from 39 ± 13 to 63 ± 18 in RTD group (P < 0.001). HNIV reduced hospitalization rates from a mean of 1.9 ± 1.1 to 0.5 ± 0.9 in COPD group (P < 0.001) and a mean of 1.9 ± 1 to 0.5 ± 0.7 in RTD group (P < 0.001). CONCLUSION HNIV improves HRQoL, sleep quality and gas exchange and reduces hospitalizations in patients with CHRF regardless of etiology.
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Affiliation(s)
- Aycan Yüksel
- Faculty of Medicine, Department of Chest Diseases, Ankara University, Ankara, Turkey
| | - Fatma Çiftçi
- Faculty of Medicine, Department of Chest Diseases, Ankara University, Ankara, Turkey
| | - Aydın Çiledağ
- Faculty of Medicine, Department of Chest Diseases, Ankara University, Ankara, Turkey
| | - Akın Kaya
- Faculty of Medicine, Department of Chest Diseases, Ankara University, Ankara, Turkey
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22
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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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23
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Mokhlesi B, Masa JF, Afshar M, Almadana Pacheco V, Berlowitz DJ, Borel JC, Budweiser S, Carrillo A, Castro-Añón O, Ferrer M, Gagnadoux F, Golpe R, Hart N, Howard ME, Murphy PB, Palm A, Perez de Llano LA, Piper AJ, Pépin JL, Priou P, Sánchez-Gómez JF, Soghier I, Tamae Kakazu M, Wilson KC. The Effect of Hospital Discharge with Empiric Noninvasive Ventilation on Mortality in Hospitalized Patients with Obesity Hypoventilation Syndrome. An Individual Patient Data Meta-Analysis. Ann Am Thorac Soc 2020; 17:627-637. [PMID: 32023419 DOI: 10.1513/annalsats.201912-887oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/05/2020] [Indexed: 11/20/2022] Open
Abstract
Rationale: Hospitalized patients with acute-on-chronic hypercapnic respiratory failure due to obesity hypoventilation syndrome (OHS) have increased short-term mortality. It is unknown whether prescribing empiric positive airway pressure (PAP) at the time of hospital discharge reduces mortality compared with waiting for an outpatient evaluation (i.e., outpatient sleep study and outpatient PAP titration).Objectives: An international, multidisciplinary panel of experts developed clinical practice guidelines on OHS for the American Thoracic Society. The guideline panel asked whether hospitalized adult patients with acute-on-chronic hypercapnic respiratory failure suspected of having OHS, in whom the diagnosis has not yet been made, should be discharged from the hospital with or without empiric PAP treatment until the diagnosis of OHS is either confirmed or ruled out.Methods: A systematic review with individual patient data meta-analyses was performed to inform the guideline panel's recommendation. Grading of Recommendations, Assessment, Development, and Evaluation was used to summarize evidence and appraise quality.Results: The literature search identified 2,994 articles. There were no randomized trials. Ten studies met a priori study selection criteria, including two nonrandomized comparative studies and eight nonrandomized noncomparative studies. Individual patient data on hospitalized patients who survived to hospital discharge were obtained from nine of the studies and included a total of 1,162 patients (1,043 discharged with PAP and 119 discharged without PAP). Empiric noninvasive ventilation was prescribed in 91.5% of patients discharged on PAP, and the remainder received empiric continuous PAP. Discharge with PAP reduced mortality at 3 months (relative risk 0.12, 95% confidence interval 0.05-0.30, risk difference -14.5%). Certainty in the estimated effects was very low.Conclusions: Hospital discharge with PAP reduces mortality following acute-on-chronic hypercapnic respiratory failure in patients with OHS or suspected of having OHS. Well-designed clinical trials are needed to confirm this finding.
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Affiliation(s)
- Babak Mokhlesi
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Juan Fernando Masa
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain
| | - Majid Afshar
- Department of Health Informatics and Data Science, Loyola University, Chicago, Illinois
| | | | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | | | - Stephan Budweiser
- Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | - Andres Carrillo
- Intensive Care Unit, Hospital J.M. Morales Meseguer, Murcia, Spain
| | | | - Miquel Ferrer
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain
- Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Frédéric Gagnadoux
- Department of Respiratory Diseases, and
- INSERM U1063, Angers University Hospital, Angers, France
| | - Rafael Golpe
- Pneumology Service, Lucus Augusti University Hospital, Galicia, Spain
| | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Patrick B Murphy
- Lane Fox Respiratory Service, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andreas Palm
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Amanda J Piper
- Royal Prince Alfred Hospital, and
- University of Sydney, Camperdown, New South Wales, Australia
| | - Jean Louis Pépin
- HP2 Laboratory, INSERM U1042, University of Grenoble Alpes, Grenoble, France
| | - Pascaline Priou
- Department of Respiratory Diseases, and
- INSERM U1063, Angers University Hospital, Angers, France
| | | | - Israa Soghier
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Maximiliano Tamae Kakazu
- Division of Pulmonary and Critical Care Medicine Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Kevin C Wilson
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and
- American Thoracic Society, New York, New York
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24
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Masa JF, Benítez I, Sánchez-Quiroga MÁ, Gomez de Terreros FJ, Corral J, Romero A, Caballero-Eraso C, Alonso-Álvarez ML, Ordax-Carbajo E, Gomez-Garcia T, 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. Long-term Noninvasive Ventilation in Obesity Hypoventilation Syndrome Without Severe OSA: The Pickwick Randomized Controlled Trial. Chest 2020; 158:1176-1186. [PMID: 32343963 DOI: 10.1016/j.chest.2020.03.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is an effective form of treatment in obesity hypoventilation syndrome (OHS) with severe OSA. However, there is paucity of evidence in patients with OHS without severe OSA phenotype. RESEARCH QUESTION Is NIV effective in OHS without severe OSA phenotype? STUDY DESIGN AND METHODS In this multicenter, open-label parallel group clinical trial performed at 16 sites in Spain, we randomly assigned 98 stable ambulatory patients with untreated OHS and apnea-hypopnea index < 30 events/h (ie, no severe OSA) to NIV or lifestyle modification (control group) using simple randomization through an electronic database. The primary end point was hospitalization days per year. Secondary end points included other hospital resource utilization, incident cardiovascular events, mortality, respiratory functional tests, BP, quality of life, sleepiness, and other clinical symptoms. Both investigators and patients were aware of the treatment allocation; however, treating physicians from the routine care team were not aware of patients' enrollment in the clinical trial. The study was stopped early in its eighth year because of difficulty identifying patients with OHS without severe OSA. The analysis was performed according to intention-to-treat and per-protocol principles and by adherence subgroups. RESULTS Forty-nine patients in the NIV group and 49 in the control group were randomized, and 48 patients in each group were analyzed. During a median follow-up of 4.98 years (interquartile range, 2.98-6.62), the mean hospitalization days per year ± SD was 2.60 ± 5.31 in the control group and 2.71 ± 4.52 in the NIV group (adjusted rate ratio, 1.07; 95% CI, 0.44-2.59; P = .882). NIV therapy, in contrast with the control group, produced significant longitudinal improvement in Paco2, pH, bicarbonate, quality of life (Medical Outcome Survey Short Form 36 physical component), and daytime sleepiness. Moreover, per-protocol analysis showed a statistically significant difference for the time until the first ED visit favoring NIV. In the subgroup with high NIV adherence, the time until the first event of hospital admission, ED visit, and mortality was longer than in the low adherence subgroup. Adverse events were similar between arms. INTERPRETATION In stable ambulatory patients with OHS without severe OSA, NIV and lifestyle modification had similar long-term hospitalization days per year. A more intensive program aimed at improving NIV adherence may lead to better outcomes. Larger studies are necessary to better determine the long-term benefit of NIV in this subgroup of OHS. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01405976; URL: www.clinicaltrials.gov.
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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), Badajoz, Spain.
| | - Iván Benítez
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain
| | - Maria Á Sánchez-Quiroga
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, Spain; 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), Badajoz, 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), Badajoz, Spain
| | - 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
| | - Maria L Alonso-Álvarez
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, University Hospital, Burgos, 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), Badajoz, Spain; Nursing Department, Extremadura University, Cáceres, Spain
| | - Francisco J Vázquez-Polo
- Department of Quantitative Methods, Las Palmas de Gran Canaria University, Canary Islands, 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
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain
| | - Babak Mokhlesi
- Department of Medicine/Pulmonary and Critical Care, University of Chicago, IL
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25
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Masa JF, Mokhlesi B, Benítez I, Gómez de Terreros Caro FJ, Sánchez-Quiroga MÁ, Romero A, Caballero C, Alonso-Álvarez ML, Ordax-Carbajo E, Gómez-García T, 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, Corral-Peñafiel J. Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea. Thorax 2020; 75:459-467. [PMID: 32217780 DOI: 10.1136/thoraxjnl-2019-213622] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/16/2019] [Accepted: 11/25/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Obesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities. OBJECTIVES We performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure. METHODS Hospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed. RESULTS In total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91-3.14) years for NIV group and 3.00 (2.92-3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups. CONCLUSION CPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA. TRIAL REGISTRATION NUMBER NCT01405976.
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Affiliation(s)
- Juan F Masa
- Respiratory Department, San Pedro de Alcantara Hospital, Caceres, Spain .,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain
| | - Babak Mokhlesi
- Instituto Universitario deInvestigación Biosanitaria de Extremadura (INUBE), Romero, Auxiliadora
| | - Iván Benítez
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Medicine/Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, USA
| | - Francisco Javier Gómez de Terreros Caro
- Respiratory Department, San Pedro de Alcantara Hospital, Caceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain
| | - M-Ángeles Sánchez-Quiroga
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain.,Respiratory Department, Virgen del Rocio University Hospital, Plasencia, Spain
| | - 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/Universidad de Sevilla, Sevilla, Spain
| | - Candela Caballero
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
| | - Maria Luz Alonso-Álvarez
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Universitario de Burgos Hospital, Burgos, Spain
| | - Estrella Ordax-Carbajo
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Universitario de Burgos Hospital, Burgos, Spain
| | - Teresa Gómez-García
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Pulmonology, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - Mónica González
- Respiratory Department, Valdecilla Hospital, Santander, Spain
| | | | - Jose 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, Valld'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
- Respiratory Department, Gregorio Marañon Hospital, Madrid, Spain.,Respiratory Department, La Paz Hospital, Madrid, Spain
| | - Javier Barca
- Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain.,Nursing Department, Extremadura University, Cáceres, Spain
| | | | - Miguel Angel Negrín
- Department of Quantitative Methods, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - María Martel-Escobar
- Department of Quantitative Methods, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Ferran Barbé
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Medicine/Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, USA
| | - Jaime Corral-Peñafiel
- Respiratory Department, San Pedro de Alcantara Hospital, Caceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain
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BaHammam AS, Almeneessier AS. Is Obesity Hypoventilation Syndrome A Postmenopausal Disorder? Open Respir Med J 2019; 13:51-54. [PMID: 31956377 PMCID: PMC6952852 DOI: 10.2174/1874306401913010051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/21/2019] [Accepted: 10/15/2019] [Indexed: 11/22/2022] Open
Abstract
Previous studies have assessed the role of gender and menopause in Obstructive Sleep Apnea (OSA). It is well known that menopause is a major risk factor for OSA. However, analogous studies on obesity Hypoventilation Syndrome (OHS) are limited. Recent studies have suggested that OHS is more prevalent in postmenopausal women. Moreover, women with OHS seem to have excess comorbidities, including hypothyroidism, hypertension, pulmonary hypertension, and diabetes mellitus, compared to men. In the present perspective, we discuss recent data on the prevalence and comorbidities associated with OHS in women, as well as the use of noninvasive ventilation in women with OHS, and try to answer the question, “Is OHS a disorder of postmenopausal women?”
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Affiliation(s)
- Ahmed S BaHammam
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia.,Prince Naif Health Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Aljohara S Almeneessier
- Prince Naif Health Research Center, King Saud University, Riyadh, Saudi Arabia.,Prince Naif Health Research Center, King Saud University, Riyadh, Saudi Arabia.,Prince Naif Health Research Center, King Saud University, Riyadh, Saudi Arabia
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27
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Pierucci P, Di Lecce V, Marra L, Resta O. Is there a threat of an increase in the rates of obesity hypoventilation syndrome? Expert Rev Respir Med 2019; 14:117-119. [PMID: 31709854 DOI: 10.1080/17476348.2020.1690992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Paola Pierucci
- Cardio-Thoracic Department, Respiratory and Sleep disorders Unit, Policlinic University hospital, UNIBA, Bari, Italy
| | - Valentina Di Lecce
- Cardio-Thoracic Department, Respiratory and Sleep disorders Unit, Policlinic University hospital, UNIBA, Bari, Italy
| | - Lorenzo Marra
- Cardio-Thoracic Department, Respiratory and Sleep disorders Unit, Policlinic University hospital, UNIBA, Bari, Italy
| | - Onofrio Resta
- Cardio-Thoracic Department, Respiratory and Sleep disorders Unit, Policlinic University hospital, UNIBA, Bari, Italy
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28
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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 2019; 200:e6-e24. [PMID: 31368798 PMCID: PMC6680300 DOI: 10.1164/rccm.201905-1071st] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [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.
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Masa JF, Mokhlesi B, Benítez I, Gomez de Terreros FJ, Sánchez-Quiroga MÁ, Romero A, Caballero-Eraso C, Terán-Santos J, Alonso-Álvarez ML, 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, Barbe F, Corral J. Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. Lancet 2019; 393:1721-1732. [PMID: 30935737 DOI: 10.1016/s0140-6736(18)32978-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity hypoventilation syndrome is commonly treated with continuous positive airway pressure or non-invasive ventilation during sleep. Non-invasive ventilation is more complex and costly than continuous positive airway pressure but might be advantageous because it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. We therefore aimed to determine the long-term comparative effectiveness of both treatment modalities. METHODS We did a multicentre, open-label, randomised controlled trial at 16 clinical sites in Spain. We included patients aged 15-80 years with untreated obesity hypoventilation syndrome and an apnoea-hypopnoea index of 30 or more events per h. We randomly assigned patients, using simple randomisation through an electronic database, to receive treatment with either non-invasive ventilation or continuous positive airway pressure. Both investigators and patients were aware of the treatment allocation. The research team was not involved in deciding hospital treatment, duration of treatment in the hospital, and adjustment of medications, as well as adjudicating cardiovascular events or cause of mortality. Treating clinicians from the routine care team were not aware of the treatment allocation. The primary outcome was the number of hospitalisation days per year. The analysis was done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01405976. FINDINGS From May 4, 2009, to March 25, 2013, 100 patients were randomly assigned to the non-invasive ventilation group and 115 to the continuous positive airway pressure group, of which 97 patients in the non-invasive ventilation group and 107 in the continuous positive airway pressure group were included in the analysis. The median follow-up was 5·44 years (IQR 4·45-6·37) for all patients, 5·37 years (4·36-6·32) in the continuous positive airway pressure group, and 5·55 years (4·53-6·50) in the non-invasive ventilation group. The mean hospitalisation days per patient-year were 1·63 (SD 3·74) in the continuous positive airway pressure group and 1·44 (3·07) in the non-invasive ventilation group (adjusted rate ratio 0·78, 95% CI 0·34-1·77; p=0·561). Adverse events were similar between both groups. INTERPRETATION In stable patients with obesity hypoventilation syndrome and severe obstructive sleep apnoea, non-invasive ventilation and continuous positive airway pressure have similar long-term effectiveness. Given that continuous positive airway pressure has lower complexity and cost, continuous positive airway pressure might be the preferred first-line positive airway pressure treatment modality until more studies become available. FUNDING Instituto de Salud Carlos III, Spanish Respiratory Foundation, and Air Liquide Spain.
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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), Cáceres, Spain.
| | - Babak Mokhlesi
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Iván Benítez
- Respiratory Department, Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Francisco Javier 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), Cáceres, Spain
| | - Maria Ángeles 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), Cáceres, Spain
| | - 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, Universidad de Sevilla, 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, Universidad de Sevilla, Sevilla, Spain
| | - Joaquin Terán-Santos
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, University Hospital, Burgos, Spain
| | - Maria Luz Alonso-Álvarez
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, University Hospital, Burgos, Spain
| | - Maria F Troncoso
- 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, Valld'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), Cáceres, Spain; Nursing Department, Extremadura University, Cáceres, Spain
| | | | - Miguel A Negrín
- Department of Quantitative Methods, Las Palmas de Gran Canarias University Canary Islands, Spain
| | - María Martel-Escobar
- Department of Quantitative Methods, Las Palmas de Gran Canarias University Canary Islands, Spain
| | - Ferran Barbe
- Respiratory Department, Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, 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), Cáceres, Spain
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Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, Sánchez-Quiroga MÁ. Obesity hypoventilation syndrome. Eur Respir Rev 2019; 28:180097. [PMID: 30872398 PMCID: PMC9491327 DOI: 10.1183/16000617.0097-2018] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Obesity hypoventilation syndrome (OHS) is defined as a combination of obesity (body mass index ≥30 kg·m-2), daytime hypercapnia (arterial carbon dioxide tension ≥45 mmHg) and sleep disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. OHS prevalence has been estimated to be ∼0.4% of the adult population. OHS is typically diagnosed during an episode of acute-on-chronic hypercapnic respiratory failure or when symptoms lead to pulmonary or sleep consultation in stable conditions. The diagnosis is firmly established after arterial blood gases and a sleep study. The presence of daytime hypercapnia is explained by several co-existing mechanisms such as obesity-related changes in the respiratory system, alterations in respiratory drive and breathing abnormalities during sleep. The most frequent comorbidities are metabolic and cardiovascular, mainly heart failure, coronary disease and pulmonary hypertension. Both continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) improve clinical symptoms, quality of life, gas exchange, and sleep disordered breathing. CPAP is considered the first-line treatment modality for OHS phenotype with concomitant severe obstructive sleep apnoea, whereas NIV is preferred in the minority of OHS patients with hypoventilation during sleep with no or milder forms of obstructive sleep apnoea (approximately <30% of OHS patients). Acute-on-chronic hypercapnic respiratory failure is habitually treated with NIV. Appropriate management of comorbidities including medications and rehabilitation programmes are key issues for improving prognosis.
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Affiliation(s)
- Juan F Masa
- San Pedro de Alcántara Hospital, Cáceres, Spain
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE) , Cáceres, Spain
| | - Jean-Louis Pépin
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France
- CHU de Grenoble, Laboratoire EFCR, Pôle Thorax et Vaisseaux, Grenoble, France
| | - Jean-Christian Borel
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France
- AGIR à dom. Association, Meylan, France
| | | | - Patrick B Murphy
- Guy's & St Thomas' NHS Foundation Trust, London, UK
- Centre for Human & Applied Physiological Sciences King's College London, London, UK
| | - Maria Ángeles Sánchez-Quiroga
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE) , Cáceres, Spain
- Virgen del Puerto Hospital, Cáceres, Spain
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31
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Castellana G, Dragonieri S, Marra L, Quaranta VN, Carratù P, Ranieri T, Resta O. Nocturnal Hypoventilation May Have a Protective Effect on Ischemic Heart Disease in Patients with Obesity Hypoventilation Syndrome. Rejuvenation Res 2019; 22:13-19. [DOI: 10.1089/rej.2017.2030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giorgio Castellana
- Institute of Respiratory Diseases, University of Bari “Aldo Moro,” Bari, Italy
| | - Silvano Dragonieri
- Institute of Respiratory Diseases, University of Bari “Aldo Moro,” Bari, Italy
| | - Lorenzo Marra
- Institute of Respiratory Diseases, University of Bari “Aldo Moro,” Bari, Italy
| | | | - Pierluigi Carratù
- Institute of Respiratory Diseases, University of Bari “Aldo Moro,” Bari, Italy
| | - Teresa Ranieri
- Institute of Respiratory Diseases, University of Bari “Aldo Moro,” Bari, Italy
| | - Onofrio Resta
- Institute of Respiratory Diseases, University of Bari “Aldo Moro,” Bari, Italy
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32
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Obesity cardiomyopathy: the role of obstructive sleep apnea and obesity hypoventilation syndrome. Ir J Med Sci 2019; 188:783-790. [DOI: 10.1007/s11845-018-01959-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023]
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Markussen H, Lehmann S, Nilsen RM, Natvig GK. Health-related quality of life as predictor for mortality in patients treated with long-term mechanical ventilation. BMC Pulm Med 2019; 19:13. [PMID: 30635052 PMCID: PMC6330471 DOI: 10.1186/s12890-018-0768-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022] Open
Abstract
Background The Severe Respiratory Insufficiency (SRI) questionnaire is a specific measure of health-related quality of life (HRQoL) in patients treated with long-term mechanical ventilation (LTMV). The aim of the present study was to examine whether SRI sum scores and related subscales are associated with mortality in LTMV patients. Methods The study included 112 LTMV patients (non-invasive and invasive) from the Norwegian LTMV registry in Western Norway from 2008 with follow-up in August 2014. SRI data were obtained through a postal questionnaire, whereas mortality data were obtained from the Norwegian Cause of Death Registry. The SRI questionnaire contains 49 items and seven subscales added into a summary score (range 0–100) with higher scores indicating a better HRQoL. The association between the SRI score and mortality was estimated as hazard ratios (HRs) with 95% confidence intervals (95% CI) using Cox regression models and HRs were estimated per one unit change in the SRI score. Results Of the 112 participating patients in 2008, 52 (46%) had died by August 2014. The mortality rate was the highest in patients with chronic obstructive pulmonary disease (75%), followed by patients with neuromuscular disease (46%), obesity hypoventilation syndrome (31%) and chest wall disease (25%) (p < 0.001). Higher SRI sum scores in 2008 were associated with a lower mortality risk after adjustment for age, education, hours a day on LTMV, time since initiation of LTMV, disease category and comorbidity (HR 0.98, 95% CI: 0.96–0.99). In addition, SRI-Physical Functioning (HR 0.98, 95% CI: 0.96–0.99), SRI-Psychological Well-Being (HR 0.98, 95% CI: 0.97–0.99), and SRI-Social Functioning (HR 0.98, 95% CI: 0.97–0.99) remained significant risk factors for mortality after covariate adjustment. In the subgroup analyses of patient with neuromuscular diseases we found significant inverse associations between some of the SRI subscales and mortality. Conclusions SRI score is associated with mortality in LTMV-treated patients. We propose the use of SRI in the daily clinic with repeated measurements as part of individual follow-up. Randomized clinical trials with interventions aimed to improve HRQoL in LTMV patients should consider the SRI questionnaire as the standard HRQoL measurement. Electronic supplementary material The online version of this article (10.1186/s12890-018-0768-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi Markussen
- The Norwegian National Advisory Unit on Longterm Mechanical Ventilation, Department of Thoracic Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway. .,Department of Global Public Health and Primary Care, University in Bergen, Kalfarveien 31, 5018, Bergen, Norway.
| | - Sverre Lehmann
- The Norwegian National Advisory Unit on Longterm Mechanical Ventilation, Department of Thoracic Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Clinical Science, University in Bergen, Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
| | - Gerd K Natvig
- Department of Global Public Health and Primary Care, University in Bergen, Kalfarveien 31, 5018, Bergen, Norway
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Guan L, Wu W, Huo Y, Li X, Guo B, Yang Y, Xu J, Jiang F, Zhou L, Chen R. Efficacy of bilevel positive airway pressure and continuous positive airway pressure therapy in patients with obesity hypoventilation syndrome: protocol for systematic review and meta-analysis. BMJ Open 2018; 8:e020832. [PMID: 29724743 PMCID: PMC5942402 DOI: 10.1136/bmjopen-2017-020832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Obesity hypoventilation syndrome (OHS) is a major respiratory complication caused by severe obesity, being associated with significant morbidity, negative impacts on quality of life and reduced survival if not treated appropriately. Positive airway pressure therapy is the first-line treatment for OHS although the optimal modality remains unclear. The goal of this study is to identify the efficacy of home bilevel positive airway pressure therapy by comparison to continuous positive airway pressure therapy and determine the best strategy for patients with OHS. METHODS AND ANALYSIS This study will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement. We will search the following databases: PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL. Ongoing studies will be identified through the ClinicalTrials.gov and WHO International Clinical Trials Registry Platform Search Portal. Grey literature will be recognised through Google Scholar and other search engines. Only randomised controlled trials meeting the eligibility criteria will be included. The risk of bias of the included studies will be evaluated through the Cochrane Collaboration's tool. RevMan V.5.3.5 software will be used for data analysis. The Q statistic and I2 index will be used for investigating heterogeneity, and subgroup analysis or sensitivity analysis will be used to explore the source of heterogeneity. In addition, the Grading of Recommendations Assessment, Development and Evaluation system will be used to inspect the quality of evidence. ETHICS AND DISSEMINATION Ethics approval is not required because this study contains no primary data collected from humans. This systematic review and meta-analysis will be submitted to a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER CRD42017078369.
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Affiliation(s)
- Lili Guan
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiliang Wu
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yating Huo
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoying Li
- Department of Respiratory Medicine, The First Affiliated Hospital/School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China
| | - Bingpeng Guo
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiawen Xu
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fangfang Jiang
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luqian Zhou
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Tan GP, McArdle N, Dhaliwal SS, Douglas J, Rea CS, Singh B. Patterns of use, survival and prognostic factors in patients receiving home mechanical ventilation in Western Australia: A single centre historical cohort study. Chron Respir Dis 2018; 15:356-364. [PMID: 29415556 PMCID: PMC6234575 DOI: 10.1177/1479972318755723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Home mechanical ventilation (HMV) is used in a wide range of disorders associated with chronic hypoventilation. We describe the patterns of use, survival and predictors of death in Western Australia. We identified 240 consecutive patients (60% male; mean age 58 years and body mass index 31 kg m-2) referred for HMV between 2005 and 2010. The patients were grouped into four categories: motor neurone disorders (MND; 39%), pulmonary disease (PULM; 25%, mainly chronic obstructive pulmonary disease), non-MND neuromuscular and chest wall disorders (NMCW; 21%) and the obesity hypoventilation syndrome (OHS; 15%). On average, the patients had moderate ventilatory impairment (forced vital capacity: 51%predicted), sleep apnoea (apnoea-hypopnea index: 25 events h-1), sleep-related hypoventilation (transcutaneous carbon dioxide rise of 20 mmHg) and daytime hypercarbia (PCO2: 54 mmHg). Median durations of survival from HMV initiation were 1.0, 4.2, 9.9 and >11.5 years for MND, PULM, NMCW and OHS, respectively. Independent predictors of death varied between primary indications for HMV; the predictors included (a) age in all groups except for MND (hazard ratios (HRs) 1.03-1.10); (b) cardiovascular disease (HR: 2.35, 95% confidence interval (CI): 1.08-5.10) in MND; (c) obesity (HR: 0.28, 95% CI: 0.13-0.62) and oxygen therapy (HR: 0.33, 95% CI: 0.14-0.79) in PULM; and (d) forced expiratory volume in 1 s (%predicted; HR: 0.93, 95% CI: 0.88-1.00) in OHS.
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Affiliation(s)
- Geak Poh Tan
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia.,3 Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Nigel McArdle
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia.,4 University of Western Australia, Nedlands, Western Australia
| | | | - Jane Douglas
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Clare Siobhan Rea
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Bhajan Singh
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia.,4 University of Western Australia, Nedlands, Western Australia
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Abstract
Prevalence studies have shown heterogeneous use of home mechanical ventilation in different conditions, with a marked increase in uptake especially in users of noninvasive ventilation. Although randomized controlled trials have examined noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease, for weaning from invasive ventilation and for postextubation respiratory failure, the evidence base for long-term noninvasive ventilation and comparisons with invasive ventilation are less well developed. The combination of noninvasive ventilation and cough-assist devices has reduced the indications for tracheotomy ventilation in some situations (e.g., Duchenne muscular dystrophy, spinal muscular atrophy, myopathies, and amyotrophic lateral sclerosis) and has also prolonged survival. Several excellent overviews have been written on the history of home mechanical ventilation and its evolution from negative pressure to positive pressure techniques, including a systematic review of outcomes. This review, instead, will cover recent trials, trends in the field, outcomes, and safety. Because the greatest growth has been in home noninvasive ventilation, this will be the main focus of this article.
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Simonds AK. The Road Not Taken: Missed Opportunities in Managing Acute Exacerbations of Hypercapnic Respiratory Failure. Am J Respir Crit Care Med 2017; 196:124-125. [PMID: 28707975 DOI: 10.1164/rccm.201612-2543ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anita K Simonds
- 1 NIHR Respiratory Biomedical Research Unit Royal Brompton & Harefield NHS Foundation Trust London, United Kingdom
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38
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Pépin JL, Timsit JF, Tamisier R, Borel JC, Lévy P, Jaber S. Prevention and care of respiratory failure in obese patients. THE LANCET RESPIRATORY MEDICINE 2017; 4:407-18. [PMID: 27304558 DOI: 10.1016/s2213-2600(16)00054-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 12/14/2022]
Abstract
With the increase in the global prevalence of obesity, there is a parallel rise in the proportion of obese patients admitted to intensive care units, referred for major surgery or requiring long-term non-invasive ventilation (NIV) at home for chronic respiratory failure. We describe the physiological effect of obesity on the respiratory system mainly in terms of respiratory mechanics, respiratory drive, and patency of the upper airways. Particular attention is given to the prevention and the clinical management of respiratory failure in obese patients with a main focus on invasive and NIV in intensive care during the perioperative period and long-term use of NIV on return home. We also address other aspects of care of obese patients, including antibiotic dosing and catheter-related infections.
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Affiliation(s)
- Jean Louis Pépin
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France.
| | - Jean François Timsit
- IAME, INSERM UMR 1137, Paris Diderot University, Paris, France; Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University and Bichat Hospital, Paris, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean Christian Borel
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France
| | - Patrick Lévy
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France
| | - Samir Jaber
- Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, Montpellier, France; Centre National de la Recherche Scientifique (CNRS 9214), Institut National de la Santé et de la Recherche Medicale (INSERM U-1046), Montpellier University, Montpellier, France
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Borel JC, Borel AL, Piper AJ. NERO: a pilot study but important step towards comprehensive management of obesity hypoventilation syndrome. Thorax 2017; 73:5-6. [DOI: 10.1136/thoraxjnl-2017-211032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Mandal S, Suh ES, Harding R, Vaughan-France A, Ramsay M, Connolly B, Bear DE, MacLaughlin H, Greenwood SA, Polkey MI, Elliott M, Chen T, Douiri A, Moxham J, Murphy PB, Hart N. Nutrition and Exercise Rehabilitation in Obesity hypoventilation syndrome (NERO): a pilot randomised controlled trial. Thorax 2017; 73:62-69. [DOI: 10.1136/thoraxjnl-2016-209826] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 08/06/2017] [Accepted: 09/11/2017] [Indexed: 11/03/2022]
Abstract
BackgroundRespiratory management of obesity hypoventilation syndrome (OHS) focusses on the control of sleep-disordered breathing rather than the treatment of obesity. Currently, there are no data from randomised trials of weight loss targeted rehabilitation programmes for patients with OHS.InterventionA 3-month multimodal hybrid inpatient–outpatient motivation, exercise and nutrition rehabilitation programme, in addition to non invasive ventilation (NIV), would result in greater per cent weight loss compared with standard care.MethodsA single-centre pilot randomised controlled trial allocated patients to either standard care or standard care plus rehabilitation. Primary outcome was per cent weight loss at 12 months with secondary exploratory outcomes of weight loss, exercise capacity and health-related quality of life (HRQOL) at the end of the rehabilitation programme to assess the intervention effect.ResultsThirty-seven patients (11 male, 59.8±12.7 years) with a body mass index of 51.1±7.7 kg/m2 were randomised. At 12 months, there was no between-group difference in per cent weight loss (mean difference −5.9% (95% CI −14.4% to 2.7%; p=0.17)). At 3 months, there was a greater per cent weight loss (mean difference −5% (95% CI −8.3% to −1.4%; p=0.007)), increased exercise capacity (6 min walk test 60 m (95% CI 29.5 to 214.5) vs 20 m (95% CI 11.5 to 81.3); p=0.036) and HRQL (mean difference SF-36 general health score (10 (95% CI 5 to 21.3) vs 0 (95% CI −5 to 10); p=0.02)) in the rehabilitation group.ConclusionIn patients with OHS, a 3-month comprehensive rehabilitation programme, in addition to NIV, resulted in improved weight loss, exercise capacity and QOL at the end of the rehabilitation period, but these effects were not demonstrated at 12 months, in part, due to the limited retention of patients at 12 months.Trial registration numberPre-results; NCT01483716.
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Piper AJ, BaHammam AS, Javaheri S. Obesity Hypoventilation Syndrome: Choosing the Appropriate Treatment of a Heterogeneous Disorder. Sleep Med Clin 2017; 12:587-596. [PMID: 29108613 DOI: 10.1016/j.jsmc.2017.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The obesity hypoventilation syndrome (OHS) is associated with significant morbidity and increased mortality compared with simple obesity and eucapnic obstructive sleep apnea. Accurate diagnosis and commencement of early and appropriate management is fundamental in reducing the significant personal and societal burdens this disorder poses. Sleep disordered breathing is a major contributor to the developmental of sleep and awake hypercapnia, which characterizes OHS, and is effectively addressed through the use of positive airway pressure (PAP) therapy. This article reviews the current evidence supporting different modes of PAP currently used in managing these individuals.
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Affiliation(s)
- Amanda J Piper
- Sleep Unit, Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia; Central Medical School, University of Sydney, Sydney 2006, New South Wales, Australia.
| | - Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia; National Plan for Science and Technology, King Saud University, Riyadh 11324, Saudi Arabia
| | - Shahrokh Javaheri
- Montgomery Sleep Laboratory, Bethesda North Hospital, Cincinnati, OH 45242, USA; Pulmonary and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Cardiology, Ohio State University, Columbus, OH, USA
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Adler D, Pépin JL, Dupuis-Lozeron E, Espa-Cervena K, Merlet-Violet R, Muller H, Janssens JP, Brochard L. Comorbidities and Subgroups of Patients Surviving Severe Acute Hypercapnic Respiratory Failure in the Intensive Care Unit. Am J Respir Crit Care Med 2017; 196:200-207. [PMID: 27973930 DOI: 10.1164/rccm.201608-1666oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE No methodical assessment of the lung, cardiac, and sleep function of patients surviving an acute hypercapnic respiratory failure episode requiring admission to the intensive care unit (ICU) has been reported in the literature. OBJECTIVES To prospectively investigate the prevalence and impact of comorbidities in patients treated by mechanical ventilator support (invasive or noninvasive) for acute hypercapnic respiratory failure in the ICU. METHODS Seventy-eight consecutive patients admitted for an episode of acute hypercapnic respiratory failure underwent an assessment of lung, cardiac, and sleep function by pulmonary function tests, transthoracic echocardiography, and polysomnography 3 months after ICU discharge. MEASUREMENTS AND MAIN RESULTS Sixty-seven percent (52 of 78) of patients exhibited chronic obstructive pulmonary disease (COPD), although only 19 had been previously diagnosed. Patients without COPD were primarily obese. Prevalence of severe obstructive sleep apnea was 51% (95% confidence interval, 34-69) in patients with COPD and 81% (95% confidence interval, 54-96) in patients without COPD. Previously undiagnosed cardiac dysfunction with preserved ejection fraction was highly prevalent (44%), as was hypertension (67%). More than half of the population demonstrated at least three major comorbidities known to precipitate acute hypercapnic respiratory failure. Multimorbidity was associated with longer time to hospital discharge. Hospital readmission or death occurred in 46% of patients over an average of 3.5 months after discharge. CONCLUSIONS Severe hypercapnic respiratory failure requiring ICU admission resulted primarily from COPD or obesity. Major comorbidities are highly prevalent in both cases and most often ignored. Surviving acute hypercapnic respiratory failure should be an opportunity to systematically evaluate lung, heart, and sleep functions to improve poor outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT 02111876).
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Affiliation(s)
| | - Jean-Louis Pépin
- 2 Université Grenoble Alpes, Hypoxie Physiopathologie, Institut National de la Santé et de la Recherche Médicale, U1042, CHU de Grenoble, Laboratoire Exploration Fonctionelle Cardiorespiratoire, Pôle Thorax et Vaisseaux, Grenoble, France
| | | | | | | | - Hajo Muller
- 4 Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Laurent Brochard
- 5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; and.,6 Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
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43
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Borel JC, Guerber F, Jullian-Desayes I, Joyeux-Faure M, Arnol N, Taleux N, Tamisier R, Pépin JL. Prevalence of obesity hypoventilation syndrome in ambulatory obese patients attending pathology laboratories. Respirology 2017; 22:1190-1198. [DOI: 10.1111/resp.13051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/08/2017] [Accepted: 02/26/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Jean-Christian Borel
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University; Grenoble France
- AGIR à dom. Association; Meylan France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| | | | | | - Marie Joyeux-Faure
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University; Grenoble France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| | - Nathalie Arnol
- AGIR à dom. Association; Meylan France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| | | | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University; Grenoble France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University; Grenoble France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
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44
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Netchitaïlo M, Destors M, Bosc C, Pépin JL, Tamisier R. [Obstructive sleep apnea syndrome. Diagnostic strategies in various clinical settings]. Presse Med 2017; 46:404-412. [PMID: 28126505 DOI: 10.1016/j.lpm.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022] Open
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) is a common disease, whose prevalence and expression may vary depending on the associated pathology, age or gender. Thus, the prevalence of OSAS is up to 80% in case of refractory hypertension. This led up to individualize clinical presentation of clusters, although currently, the individualization of these different phenotypes did not conduct to a specific care or predict different evolution. Offering the best strategy for the right patient remains an important objective. However, the frequent association of OSAS and various metabolic diseases, and thus induced cardiovascular risk factors, is to be considered in the therapeutic care and judgment of the response to established treatments. By acting on all components in pathological cause in these patients with OSAS, a combined support will thus permit optimal beneficial effect.
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Affiliation(s)
- Marie Netchitaïlo
- CHU de Rouen, service de physiologie digestive, urinaire, respiratoire et sportive, 76031 Rouen, France; Université Grenoble Alpes, laboratoire HP2 Inserm U1042, 38042 Grenoble, France
| | - Marie Destors
- CHU de Grenoble, Grenoble, clinique de physiologie, sommeil et exercice, pôle thorax et vaisseaux, 38043 Grenoble, France; Université Grenoble Alpes, laboratoire HP2 Inserm U1042, 38042 Grenoble, France
| | - Cécile Bosc
- CHU de Grenoble, Grenoble, clinique de physiologie, sommeil et exercice, pôle thorax et vaisseaux, 38043 Grenoble, France; Université Grenoble Alpes, laboratoire HP2 Inserm U1042, 38042 Grenoble, France
| | - Jean-Louis Pépin
- CHU de Grenoble, Grenoble, clinique de physiologie, sommeil et exercice, pôle thorax et vaisseaux, 38043 Grenoble, France; Université Grenoble Alpes, laboratoire HP2 Inserm U1042, 38042 Grenoble, France
| | - Renaud Tamisier
- CHU de Grenoble, Grenoble, clinique de physiologie, sommeil et exercice, pôle thorax et vaisseaux, 38043 Grenoble, France; Université Grenoble Alpes, laboratoire HP2 Inserm U1042, 38042 Grenoble, France.
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45
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Masa JF, Corral J, Romero A, Caballero C, Terán-Santos J, Alonso-Álvarez ML, Gomez-Garcia T, González M, López-Martínez S, De Lucas P, Marin JM, Marti S, Díaz-Cambriles T, Chiner E, Merchan M, Egea C, Obeso A, Mokhlesi B. The Effect of Supplemental Oxygen in Obesity Hypoventilation Syndrome. J Clin Sleep Med 2016; 12:1379-1388. [PMID: 27568890 DOI: 10.5664/jcsm.6194] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). However, there is a paucity of data regarding its efficacy and safety. The objective of this study was to assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS. METHODS In this post hoc analysis of a previous randomized controlled trial, we studied 302 sequentially screened OHS patients who were randomly assigned to noninvasive ventilation, continuous positive airway pressure, or lifestyle modification. Outcomes at 2 mo included arterial blood gases, symptoms, quality of life, blood pressure, polysomnography, spirometry, 6-min walk distance, and hospital resource utilization. Statistical analysis comparing patients with and without oxygen therapy in the three treatment groups was performed using an intention-to-treat analysis. RESULTS In the noninvasive ventilation group, supplemental oxygen reduced systolic blood pressure although this could be also explained by a reduction in body weight experienced in this group. In the continuous positive airway pressure group, supplemental oxygen increased the frequency of morning confusion. In the lifestyle modification group, supplemental oxygen increased compensatory metabolic alkalosis and decreased the apnea-hypopnea index during sleep. Oxygen therapy was not associated with an increase in hospital resource utilization in any of the groups. CONCLUSIONS After 2 mo of follow-up, chronic oxygen therapy produced marginal changes that were insufficient to consider it, globally, as beneficial or deleterious. Because supplemental oxygen therapy did not increase hospital resource utilization, we recommend prescribing oxygen therapy to patients with OHS who meet criteria with close monitoring. Long-term studies examining outcomes such as incident cardiovascular morbidity and mortality are necessary. CLINICAL TRIALS REGISTRATION Clinicaltrial.gov, ID: NCT01405976.
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Affiliation(s)
- Juan F Masa
- San Pedro de Alcántara Hospital, Cáceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Jaime Corral
- San Pedro de Alcántara Hospital, Cáceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | | | | | - Joaquin Terán-Santos
- University Hospital, Burgos, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Maria L Alonso-Álvarez
- University Hospital, Burgos, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | | | | | | | | | - José M Marin
- Miguel Servet Hospital, Zaragoza, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Sergi Marti
- Valld'Hebron Hospital, Barcelona, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Trinidad Díaz-Cambriles
- Doce de Octubre Hospital, Madrid, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | | | | | - Carlos Egea
- Sleep Unit, Respiratory Department, Alava University Hospital IRB, Vitoria, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Ana Obeso
- Department of Physiology, University of Valladolid, Spain
| | - Babak Mokhlesi
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
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Altinoz H, Adiguzel N, Salturk C, Gungor G, Mocin O, Berk Takir H, Kargin F, Balci M, Dikensoy O, Karakurt Z. Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation. Int J Chron Obstruct Pulmon Dis 2016; 11:1895-901. [PMID: 27578969 PMCID: PMC4998020 DOI: 10.2147/copd.s108813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30 kg/m2, and the second group consisted of subjects with BMI >30 kg/m2. Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m2, while 80 subjects had BMI >30 kg/m2. The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects (P=0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival.
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Affiliation(s)
- Hilal Altinoz
- Pulmonary Division, Acibadem University School of Medicine
| | - Nalan Adiguzel
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Cuneyt Salturk
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Gokay Gungor
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Ozlem Mocin
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Huriye Berk Takir
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Feyza Kargin
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Merih Balci
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Oner Dikensoy
- Pulmonary Division, Acibadem University School of Medicine
| | - Zuhal Karakurt
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
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47
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Masa JF, Corral J, Caballero C, Barrot E, Terán-Santos J, Alonso-Álvarez ML, Gomez-Garcia T, González M, López-Martín S, De Lucas P, Marin JM, Marti S, Díaz-Cambriles T, Chiner E, Egea C, Miranda E, Mokhlesi B, García-Ledesma E, Sánchez-Quiroga MÁ, Ordax E, González-Mangado N, Troncoso MF, Martinez-Martinez MÁ, Cantalejo O, Ojeda E, Carrizo SJ, Gallego B, Pallero M, Ramón MA, Díaz-de-Atauri J, Muñoz-Méndez J, Senent C, Sancho-Chust JN, Ribas-Solís FJ, Romero A, Benítez JM, Sanchez-Gómez J, Golpe R, Santiago-Recuerda A, Gomez S, Bengoa M. Non-invasive ventilation in obesity hypoventilation syndrome without severe obstructive sleep apnoea. Thorax 2016; 71:899-906. [PMID: 27406165 PMCID: PMC5036235 DOI: 10.1136/thoraxjnl-2016-208501] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/17/2016] [Indexed: 01/05/2023]
Abstract
Background Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO2) as the main outcome measure. Methods Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. Results A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO2 of −6 (95% CI −7.7 to −4.2) mm Hg versus −2.8 (95% CI −4.3 to −1.3) mm Hg, (p<0.001) and serum bicarbonate of −3.4 (95% CI −4.5 to −2.3) versus −1 (95% CI −1.7 to −0.2 95% CI) mmol/L (p<0.001). PaCO2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. Conclusions NIV is more effective than lifestyle modification in improving daytime PaCO2, sleepiness and polysomnographic parameters. Long-term prospective studies are necessary to determine whether NIV reduces healthcare resource utilisation, cardiovascular events and mortality. Trial registration number NCT01405976; results.
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Affiliation(s)
- Juan F Masa
- San Pedro de Alcántara Hospital, Cáceres, Spain Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Jaime Corral
- San Pedro de Alcántara Hospital, Cáceres, Spain Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | | | - Joaquin Terán-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain University Hospital, Burgos, Spain
| | - Maria L Alonso-Álvarez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain University Hospital, Burgos, Spain
| | | | | | | | | | - José M Marin
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Miguel Servet Hospital, Zaragoza, Spain
| | - Sergi Marti
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Valld'Hebron Hospital, Barcelona, Spain
| | - Trinidad Díaz-Cambriles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Doce de Octubre Hospital, Madrid, Spain
| | | | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Sleep Unit and Respiratory Department, Alava University Hospital IRB, Vitoria, Spain
| | - Erika Miranda
- Araba Health Research Unit, Osakidetza, Alava Hospital, Spain
| | - Babak Mokhlesi
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, USA
| | | | | | | | - Estrella Ordax
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain University Hospital, Burgos, Spain
| | - Nicolás González-Mangado
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain IIS Fundación Jiménez Díaz, Madrid, Spain
| | - Maria F Troncoso
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain IIS Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | - Santiago J Carrizo
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Miguel Servet Hospital, Zaragoza, Spain
| | | | - Mercedes Pallero
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Valld'Hebron Hospital, Barcelona, Spain
| | - M Antonia Ramón
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Valld'Hebron Hospital, Barcelona, Spain
| | - Josefa Díaz-de-Atauri
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Doce de Octubre Hospital, Madrid, Spain
| | - Jesús Muñoz-Méndez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Doce de Octubre Hospital, Madrid, Spain
| | | | | | | | | | | | | | - Rafael Golpe
- Lucus Augusti Universitary Hospital, Lugo, Spain
| | | | - Silvia Gomez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Arnau de Vilanova Hospital, Lleida, Spain
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48
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Masa JF, Corral J, Romero A, Caballero C, Terán-Santos J, Alonso-Álvarez ML, Gomez-Garcia T, González M, López-Martín S, De Lucas P, Marin JM, Marti S, Díaz-Cambriles T, Chiner E, Merchan M, Egea C, Obeso A, Mokhlesi B, García-Ledesma E, Sánchez-Quiroga MÁ, Ordax E, González-Mangado N, Troncoso MF, Martinez-Martinez MÁ, Cantalejo O, Ojeda E, Carrizo SJ, Gallego B, Pallero M, Ramón MA, Díaz-de-Atauri J, Muñoz-Méndez J, Senent C, Sancho-Chust JN, Ribas-Solis FJ, Barrot E, Benítez JM, Sanchez-Gómez J, Golpe R, Santiago-Recuerda A, Gomez S, Bengoa M. Protective Cardiovascular Effect of Sleep Apnea Severity in Obesity Hypoventilation Syndrome. Chest 2016; 150:68-79. [DOI: 10.1016/j.chest.2016.02.647] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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49
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Jullian-Desayes I, Borel JC, Guerber F, Borel AL, Tamisier R, Levy P, Schwebel C, Pepin JL, Joyeux-Faure M. Drugs influencing acid base balance and bicarbonate concentration readings. Expert Rev Endocrinol Metab 2016; 11:209-216. [PMID: 30058869 DOI: 10.1586/17446651.2016.1147951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Serum bicarbonate dosage is sensitive to pharmacological interferences. However, elevated bicarbonate concentration reflects chronic hypoventilation and has been proposed as a simple marker for screening patients with Obesity Hypoventilation Syndrome (OHS), a currently underdiagnosed multimorbid and high mortality disease. We provide a practical overview of the different drugs acting on the acid-base equilibrium to aid clinicians to interpret bicarbonate concentration readings. Little is known about the chronic impact of the usual doses of these drugs on serum bicarbonate concentration and further studies are needed. It is essential to take into account drugs that could interfere with this parameter to avoid misinterpretation of serum bicarbonate levels.
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Affiliation(s)
- Ingrid Jullian-Desayes
- a Laboratory HP2, University of Grenoble Alpes , Grenoble , France
- b INSERM U1042, Laboratory HP2 , Grenoble , France
| | - Jean-Christian Borel
- a Laboratory HP2, University of Grenoble Alpes , Grenoble , France
- b INSERM U1042, Laboratory HP2 , Grenoble , France
- c Research and development department , AGIR à dom , Meylan , France
| | - Fabrice Guerber
- d Oriade Laboratory , Oriapole , Saint Martin d'Heres , France
| | - Anne-Laure Borel
- a Laboratory HP2, University of Grenoble Alpes , Grenoble , France
- b INSERM U1042, Laboratory HP2 , Grenoble , France
- e Endocrinology Department , Grenoble University Hospital (CHU de Grenoble) , Grenoble , France
| | - Renaud Tamisier
- a Laboratory HP2, University of Grenoble Alpes , Grenoble , France
- b INSERM U1042, Laboratory HP2 , Grenoble , France
- f Thorax and vessels, EFCR , Grenoble University Hospital (CHU de Grenoble) , Grenoble , France
| | - Patrick Levy
- a Laboratory HP2, University of Grenoble Alpes , Grenoble , France
- b INSERM U1042, Laboratory HP2 , Grenoble , France
- f Thorax and vessels, EFCR , Grenoble University Hospital (CHU de Grenoble) , Grenoble , France
| | - Carole Schwebel
- g Intensive Care Unit , Grenoble University Hospital (CHU de Grenoble) , Grenoble , France
| | - Jean-Louis Pepin
- a Laboratory HP2, University of Grenoble Alpes , Grenoble , France
- b INSERM U1042, Laboratory HP2 , Grenoble , France
- f Thorax and vessels, EFCR , Grenoble University Hospital (CHU de Grenoble) , Grenoble , France
| | - Marie Joyeux-Faure
- a Laboratory HP2, University of Grenoble Alpes , Grenoble , France
- b INSERM U1042, Laboratory HP2 , Grenoble , France
- f Thorax and vessels, EFCR , Grenoble University Hospital (CHU de Grenoble) , Grenoble , France
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50
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Abstract
Obesity hypoventilation syndrome is becoming an increasingly encountered condition both in respiratory outpatient clinics and in hospitalized patients. The health consequences and social disadvantages of obesity hypoventilation syndrome are significant. Unfortunately, the diagnosis and institution of appropriate therapy is commonly delayed when the syndrome is not recognized or misdiagnosed. Positive airway pressure therapy remains the mainstay of treatment and is effective in controlling sleep-disordered breathing and improving awake blood gases in the majority of individuals. Evidence supporting one mode of therapy over another is limited. Both continuous and bilevel therapy modes can successfully improve daytime gas exchange, with adherence to therapy an important modifiable factor in the response to treatment. Despite adherence to therapy, these individuals continue to experience excess mortality primarily due to cardiovascular events compared with those with eucapnic sleep apnea using CPAP. This difference likely arises from ongoing systemic inflammation secondary to the morbidly obese state. The need for a comprehensive approach to managing nutrition, weight, and physical activity in addition to reversal of sleep-disordered breathing is now widely recognized. Future studies need to evaluate the impact of a more aggressive and comprehensive treatment plan beyond managing sleep-disordered breathing. The impact of early identification and treatment of sleep-disordered breathing on the development and reversal of cardiometabolic dysfunction also requires further attention.
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Affiliation(s)
- Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Camperdown, and Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
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