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Duiverman ML, Jesus F, Bladder G, Wijkstra PJ. Initiation of Chronic Non-invasive Ventilation. Sleep Med Clin 2024; 19:419-430. [PMID: 39095140 DOI: 10.1016/j.jsmc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Initiation of home non-invasive ventilation (NIV) requires careful consideration of the patient's condition, motivation, expectations, wishes, and social circumstances. The decision to start NIV depends on a combination of factors including patient symptoms and objective evidence of nocturnal hypoventilation. A solid understanding of the underlying pathophysiology is key to a systematic and well-balanced clinical approach to titrating NIV. The location where NIV is initiated is not the most relevant issue, provided that it is a comfortable, safe environment in which adequate monitoring can be assured. The majority of patients prefer their own home for treatment initiation.
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Affiliation(s)
- Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Filipa Jesus
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Pulmonology Department, Unidade Local de Saúde da Guarda EPE, Rainha D. Amélia, s/n 6301-857 Guarda, Portugal
| | - Gerrie Bladder
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Paranicova I, Bodnarova S, Trojova I, Hertelyova Z, Gulasova Z, Cimbolakova I, Genzor S, Joppa P, Tkacova R, Pobeha P. Long-term myocardial effects of noninvasive ventilation in patients with obesity hypoventilation syndrome. Respir Med 2024; 231:107735. [PMID: 38977108 DOI: 10.1016/j.rmed.2024.107735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/24/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Chronic effects of noninvasive ventilation on myocardial function in patients with obesity hypoventilation syndrome (OHS) are scarcely understood. The aim of the present study was to evaluate the long-term effects of volume-targeted bilevel positive airway pressure ventilation (BiPAP) on cardiac parameters and myocardial biomarkers in patients with OHS. METHODS Clinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored. RESULTS Thirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m2) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study. CONCLUSIONS The present findings of increased SV, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable OHS and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.
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Affiliation(s)
- I Paranicova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - S Bodnarova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - I Trojova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - Z Hertelyova
- Center of Clinical and Preclinical Research MEDIPARK, P.J. Safarik University, Faculty of Medicine, Kosice, Slovakia
| | - Z Gulasova
- Center of Clinical and Preclinical Research MEDIPARK, P.J. Safarik University, Faculty of Medicine, Kosice, Slovakia
| | - I Cimbolakova
- Institute of Physical Education and Sport, P.J. Safarik University, Kosice, Slovakia
| | - S Genzor
- Department of Respiratory Medicine and Tuberculosis, University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University, Olomouc, Czech Republic
| | - P Joppa
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - R Tkacova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - P Pobeha
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia.
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Brown LK. Targeting Hypercapnia in Chronic Lung Disease and Obesity Hypoventilation: Benefits and Challenges. Sleep Med Clin 2024; 19:357-369. [PMID: 38692758 DOI: 10.1016/j.jsmc.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Hypoventilation is a complication that is not uncommon in chronic obstructive pulmonary disease and calls for both medical treatment of the underlying disease and, frequently, noninvasive ventilation either during exacerbations requiring hospitalization or in a chronic state in the patient at home. Obesity hypoventilation syndrome by definition is associated with ventilatory failure and hypercapnia. It may or may not be accompanied by obstructive sleep apnea, which when detected becomes an additional target for positive airway pressure treatment. Intensive research has not completely resolved the best choice of treatment, and the simplest modality, continuous positive airway pressure, may still be entertained.
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Affiliation(s)
- Lee K Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
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4
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Bhatt A, Azam MU, Munagala R, Zetola N, Cho Y, Kwon Y, Healy WJ. The Emergence of Inpatient Sleep Medicine: Screening for Sleep Disordered Breathing to Reduce the Burden of Cardiovascular Disease. CURRENT SLEEP MEDICINE REPORTS 2024; 10:51-61. [PMID: 39185359 PMCID: PMC11343479 DOI: 10.1007/s40675-024-00275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 08/27/2024]
Abstract
Purpose of Review Treatment of obstructive sleep apnea (OSA) has historically been centered on outpatients given sleep testing is performed on an outpatient basis. Much of this practice originates from insurers only covering sleep testing on an outpatient basis. Over the last decade, there have been innovations made in the portability of sleep monitors which have allowed sleep testing on inpatients to be facilitated. There is also emerging data that inpatient sleep testing may reduce readmissions and healthcare costs in certain cardiovascular conditions. Accordingly, this review aims to provide comprehensive coverage of recent advances in the practice of inpatient sleep medicine and its effect on reducing the burden of cardiovascular disease. Recent Findings Chief cardiovascular diseases that intersect with OSA in inpatients are stroke, atrial fibrillation, and heart failure. There is data from the National Inpatient Sample comparing arrhythmia burdens in patients with OSA and HFpEF showing that OSA patients have higher mortality rates, hospital durations, and medical costs. Also, OSA is associated with higher burdens of arrhythmia. It is currently unknown whether treatment of inpatients with PAP therapy lowers the occurrence of arrhythmias. Recent data suggests that costs for heart failure patients with OSA that are readmitted are higher than those for heart failure patients without OSA. A recent analysis of patients with HFpEF (heart failure with preserved ejection fraction) and OSA showed that the PAP adherent patients had fewer healthcare related costs, lower readmission rates, and fewer emergency room visits than those that were nonadherent. In broader terms, rapid initiation of PAP therapy in a large administration database query of 23 million Medicare patients appears to reduce annual healthcare costs and reduce readmissions although further study is required. Summary OSA is globally underdiagnosed, with an estimated one billion individuals affected. OSA's pathogenesis involves a combination of risk factors, such as obesity, age, and increased neck circumference that contribute to fragmented sleep patterns and in turn, numerous cardiovascular comorbidities, such as stroke, atrial fibrillation, and coronary artery disease. Recently, inpatient sleep medicine programs have emerged as a promising avenue for improving diagnosis, patient safety, and potentially reducing readmissions. Integrating inpatient sleep medicine into healthcare systems to address the significant health and economic burden associated with undiagnosed OSA. Improved coverage of inpatient sleep testing and services will be a key driver of addressing inpatient gaps in sleep medicine care. The current research findings provide a bedrock from which further investigations may proceed in a prospective and randomized, controlled fashion to further clarify the effects of treatment of OSA on cardiovascular outcomes of inpatients.
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Affiliation(s)
- Arjun Bhatt
- Medical College of Georgia School of Medicine, Augusta,
GA
| | - Mohammad Umair Azam
- Division of Pulmonary, Critical Care, and Sleep Medicine,
Medical College of Georgia at Augusta University, Augusta, GA 30912
| | - Rohit Munagala
- Department of Internal Medicine, Northwell Health (NS/LIJ),
Manhasset, New York, NY
| | - Nicola Zetola
- Division of Pulmonary, Critical Care, and Sleep Medicine,
Medical College of Georgia at Augusta University, Augusta, GA 30912
| | - Yeilim Cho
- VA Puget Sound Medical Center, Seattle, WA
| | - Younghoon Kwon
- Division of Cardiology, University of Washington, Seattle,
WA
| | - William J. Healy
- Division of Pulmonary, Critical Care, and Sleep Medicine,
Medical College of Georgia at Augusta University, Augusta, GA 30912
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5
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Andrade RGS, Masa JF, Borel JC, Drager LF, Genta PR, Mokhlesi B, Lorenzi-Filho G. Impact of treating obesity hypoventilation syndrome on body mass index. Pulmonology 2023:S2531-0437(23)00170-8. [PMID: 37996386 DOI: 10.1016/j.pulmoe.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 11/25/2023] Open
Abstract
STUDY OBJECTIVES To evaluate the impact of positive airway pressure (PAP) therapy on body mass index (BMI) in patients with obesity hypoventilation syndrome (OHS) associated with obstructive sleep apnea (OSA). METHODS A systematic review using the following terms: "obesity hypoventilation syndrome" AND "treatment" AND "randomized" using Cochrane Central Register of Controlled Trials, Medline and Web of Science was performed from the first data available until February 10, 2023. The inclusion criteria were: (1) original article; (2) adult OHS with concomitant OSA (apnea-hypopnea index or AHI ≥5 events/h); (3) randomized trial with PAP arm and standard care (control); (4) BMI evaluation at baseline and after the first months. We performed an individual participant data meta-analysis of randomized controlled trials. RESULTS Our initial search retrieved 32 articles and 3 randomized studies fulfilled study criteria and were included in the final analysis, leading to a total of 342 participants. Patients were predominantly females (62%) and had OHS associated with at least mild OSA. As compared to baseline, a decrease in BMI was observed at study endpoint but this difference was not different intergroups (-0.50 ± 1.49 and -0.50 ±1.83, in control and PAP groups respectively (p=0.939)). Weight change was not associate with PAP adherence, OSA severity or use of supplemental oxygen. CONCLUSIONS In contrast to treatment of eucapnic OSA with PAP that is associated with weight gain, treatment of OSA+OHS patients with or without PAP is associated with weight loss. Future studies are necessary to elucidate the mechanism by which weight loss occurs.
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Affiliation(s)
- R G S Andrade
- Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil
| | - J F Masa
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain
| | - J-C Borel
- HP2 Laboratory, Grenoble Alpes University, Grenoble, France
| | - L F Drager
- Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil
| | - P R Genta
- Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil
| | - B Mokhlesi
- Division of Pulmonary, Critical Care and Sleep Medicine, Rush University Medical Center, Chicago, IL, USA
| | - G Lorenzi-Filho
- Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil.
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6
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Amra B, Ghasemi M, Soltaninejad F, Salmasi M. Positive Pressure Ventilation Treatment Based on Daytime and Night-time Titration in Patients with Obesity Hypoventilation Syndrome: A Randomized Controlled Trial. Sleep Sci 2023; 16:e278-e283. [PMID: 38196766 PMCID: PMC10773497 DOI: 10.1055/s-0043-1773790] [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: 12/14/2021] [Accepted: 10/10/2022] [Indexed: 01/11/2024] Open
Abstract
Objectives The aim of the present study was to investigate the improvements of gas exchange and excessive daytime sleepiness in patients with obesity hypoventilation syndrome (OHS) in daytime and night-time split polysomnography (DSPSG and NSPSG). Materials and Methods In the present randomized controlled trial, patients with OHS were enrolled in two DSPSG (51 patients) and NSPSG (50 patients) groups in the Bamdad respiratory and sleep research center in Isfahan, Iran. In both groups, the diagnostic polysomnography (PSG) and titration were conducted in one session according to the guidelines of NSPSG. SpO2, PaCO2, and the Epworth Sleepiness Scale (ESS), were measured initially and 12 weeks after treatment. Furthermore, the PSG parameters and the type of treatments for the two groups were recorded and analyzed. Results A total of 101 OHS patients (age: 62.02 ± 12.4 year old; 61 females [60.4%]) were evaluated. There were no significant differences regarding BMI, gender, and AHI between groups ( p > 0.05). Primary SpO2, PaCO2, and ESS were not significantly different between the two groups. After 12 weeks of treatment by continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP), there were significant improvement of SpO2, PaCO2, and ESS score ( p < 0.001). The amount of change of these variables was not different between groups. Among all variables, only the lower SpO2 and higher PaCO2 were associated with response to BiPAP. Discussion There were no significant differences in the number of changes of SpO2, PaCO2, and ESS by treatment in the DSPSG and NSPSG groups. Therefore, DSPSG may be considered as a valuable alternative method for the diagnosis and titration in OHS patients. Clinical Trials IRCT20170512033930N2.
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Affiliation(s)
- Babak Amra
- Pulmonary Division, Department of Internal Medicine, Bamdad Respiratory and Sleep Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Ghasemi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Pulmonary Division, Department of Internal Medicine, Bamdad Respiratory and Sleep Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrzad Salmasi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Agossou M, Simo-Tabué N, Dufeal M, Awanou B, Provost M, Smith K, Badaran E, Zouzou A, Ahouansou N, Tabué-Teguo M, Dramé M. Profiles of Elderly Patients with Obesity Hypoventilation Syndrome in Martinique: A Single-Center Study. J Pers Med 2023; 13:1089. [PMID: 37511702 PMCID: PMC10381235 DOI: 10.3390/jpm13071089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity hypoventilation syndrome (OHS) is a form of chronic respiratory insufficiency related to obesity that affects young and old people. Age appears to be associated with poorer response to treatment by nighttime ventilation. This study aimed to describe the characteristics of elderly subjects (>65 years) with OHS compared to younger patients, with a view to adapting therapy in older individuals. We conducted a retrospective study comparing socio-demographic, clinical, functional characteristics as well as treatment and outcomes between young (<65 years) and older (65 years and older) individuals with OHS at the University Hospital of Martinique. We included 143 patients (114 women), of whom 82 were 65 years or older (57%). Charlson index was higher in the older group. Patients in ≥65 years group were less frequently obese, but more frequently had diabetes mellitus, cardiac arrythmia and arterial hypertension compared to younger patients. There was no difference in the circumstances of diagnosis or arterial blood gas at diagnosis. At follow up, partial pressure of carbon dioxide (pCO2) was higher in ≥65 years group. Despite comparable NIV settings, apart from lower expiratory positive airway pressure (EPAP) with higher apnea-hypopnea index (AHI), patients in the ≥65-year-old group remained more frequently hypercapnic. In conclusion, over half (57%) of patients with OHS in our cohort were aged over 65 years. Older patients developed OHS at lower BMI levels than their younger counterparts, and more frequently, had comorbidities such as diabetes, hypertension and cardiac arrhythmia. Increased Charlson index, lower BMI and female sex were independent factors associated with OHS in the elderly.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Nadine Simo-Tabué
- Department of Geriatrics, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Marion Dufeal
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Bérénice Awanou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Mathilde Provost
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Ketty Smith
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Elena Badaran
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Adel Zouzou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Nelly Ahouansou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Maturin Tabué-Teguo
- Department of Geriatrics, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Moustapha Dramé
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
- Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France
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8
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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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9
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Effect of different modes of positive airway pressure treatment on obesity hypoventilation syndrome: a systematic review and network meta-analysis. Sleep Med 2022; 91:51-58. [DOI: 10.1016/j.sleep.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/27/2021] [Accepted: 01/05/2022] [Indexed: 11/20/2022]
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10
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Thille AW, Coudroy R, Nay MA, Gacouin A, Decavèle M, Sonneville R, Beloncle F, Girault C, Dangers L, Lautrette A, Levrat Q, Rouzé A, Vivier E, Lascarrou JB, Ricard JD, Mekontso-Dessap A, Barberet G, Lebert C, Ehrmann S, Massri A, Bourenne J, Pradel G, Bailly P, Terzi N, Dellamonica J, Lacave G, Robert R, Frat JP, Ragot S. Beneficial Effects of Non-Invasive Ventilation After Extubation in Obese or Overweight Patients: A Post-Hoc Analysis of a Randomized Clinical Trial. Am J Respir Crit Care Med 2021; 205:440-449. [PMID: 34813391 DOI: 10.1164/rccm.202106-1452oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Whereas non-invasive ventilation (NIV) may prevent reintubation in patients at high-risk of extubation failure in intensive care units (ICUs), this oxygenation strategy has not been specifically assessed in obese patients. OBJECTIVES We hypothesized that NIV may decrease the risk of reintubation in obese patients compared with high-flow nasal oxygen (HFNO). METHODS Post-hoc analysis of a multicenter, randomized, controlled trial (not pre-specified) comparing NIV alternating with HFNO versus HFNO alone after extubation, with the aim of assessing NIV effects according to patient body-mass index (BMI). MEASUREMENTS AND MAIN RESULTS Among 623 patients at high-risk of extubation failure, 206 (33%) were obese (BMI≥30 kg/m2), 204 (33%) were overweight (25≤BMI<30), and 213 (34%) were normal or underweight (BMI<25). Significant heterogeneity of NIV effects on the rate of reintubation was found according to BMI (Pinteraction=0.007). Reintubation rates at day 7 were significantly lower with NIV alternating with HFNO than with HFNO alone in obese or overweight patients: 7% (15/204) vs. 20% (41/206); difference, -13%; [95% CI, -19 to -6]; P=0.0002; whereas it did not significantly differ in normal or underweight patients. In-ICU mortality was significantly lower with NIV than with HFNO alone in obese or overweight patients (2% vs. 9%; difference, -6%; [95% CI, -11 to -2]; P=0.006). CONCLUSIONS Prophylactic NIV alternating with HFNO immediately after extubation significantly decreased the risk of reintubation and death as compared with HFNO alone in obese or overweight patients at high-risk of extubation failure. By contrast, NIV was not effective in normal or underweight patients.
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Affiliation(s)
- Arnaud W Thille
- Centre Hospitalier Universitaire de Poitiers, 36655, Médecine Intensive Réanimation, Poitiers, France.,University of Poitiers, 27077, INSERM CIC 1402, ALIVE research group, Poitiers, France;
| | - Rémi Coudroy
- Centre Hospitalier Universitaire de Poitiers, 36655, Médecine Intensive Réanimation, Poitiers, France.,University of Poitiers, 27077, INSERM CIC 1402, ALIVE research group, Poitiers, France
| | - Mai-Anh Nay
- Centre Hospitalier Regional d'Orleans, 52817, Orleans, France
| | - Arnaud Gacouin
- Centre Hospitalier Universitaire de Rennes, 36684, Hôpital Ponchaillou, Service des Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Maxens Decavèle
- Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, 55577, Médecine Intensive Réanimation, Paris, France
| | - Romain Sonneville
- APHP, 26930, Hôpital Bichat - Claude Bernard, Médecine Intensive Réanimation, Université Paris Diderot, Paris, France
| | - François Beloncle
- Centre Hospitalier Universitaire d'Angers, 26966, Département de Médecine Intensive Réanimation, Université d'Angers, Angers, France
| | - Christophe Girault
- Centre Hospitalier Universitaire de Rouen, 55052, Médecine Intensive Réanimation, Normandie University, UNIROUEN, EA 3830, Rouen, France
| | - Laurence Dangers
- Centre Hospitalier Universitaire Félix Guyon, 375276, Service de Réanimation Polyvalente, Saint-Denis, Réunion
| | - Alexandre Lautrette
- Centre Hospitalier Universitaire de Clermont-Ferrand, 55174, Hôpital Gabriel Montpied, Service de Réanimation Médicale, Clermont-Ferrand, France
| | - Quentin Levrat
- Centre hospitalier de la Rochelle, 26970, Service de Réanimation, La Rochelle, France
| | - Anahita Rouzé
- Centre Hospitalier Universitaire de Lille, 26902, Centre de Réanimation, Université de Lille, Lille, France
| | - Emmanuel Vivier
- Centre Hospitalier Saint Joseph Saint Luc, 149919, Rhône, Lyon, France
| | | | - Jean-Damien Ricard
- APHP, 26930, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation,Université de Paris, INSERM, UMR IAME 1137 , Paris, France
| | - Armand Mekontso-Dessap
- APHP, 26930, Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive Réanimation, Université Paris Est Créteil, Groupe de recherche clinique CARMAS, Paris, France
| | - Guillaume Barberet
- Groupe Hospitalier Régional Mulhouse Sud-Alsace, site Emile Muller, Service de Réanimation Médicale, Mulhouse, France
| | - Christine Lebert
- Centre Hospitalier Departemental Vendee, 37092, La Roche-sur-Yon, France
| | - Stephan Ehrmann
- Centre Hospitalier Régional Universitaire de Tours, 26928, Médecine Intensive Réanimation, CIC 1415, Réseau CRICS-Trigger SEP, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Alexandre Massri
- Centre Hospitalier de Pau, 37101, Service de Réanimation, Pau, France
| | - Jeremy Bourenne
- APHM, 36900, Centre Hospitalier Universitaire La Timone 2, Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université, Marseille, France
| | - Gael Pradel
- Centre Hospitalier Henri Mondor d'Aurillac, 91532, Service de Réanimation, Aurillac, France
| | - Pierre Bailly
- Centre Hospitalier Universitaire de Brest, 26990, Médecine Intensive Réanimation, Brest, France
| | - Nicolas Terzi
- Centre Hospitalier Universitaire Grenoble Alpes, 36724, Médecine Intensive Réanimation, INSERM, Université Grenoble-Alpes, U1042, HP2, Grenoble, France
| | - Jean Dellamonica
- Centre Hospitalier Universitaire de Nice, 37045, Médecine Intensive Réanimation, Archet 1, Université Cote d'Azur, Nice, France
| | - Guillaume Lacave
- Centre Hospitalier de Versailles, 26938, Service de Réanimation Médico-Chirurgicale, Le Chesnay, France
| | - René Robert
- Centre Hospitalier Universitaire de Poitiers, 36655, Médecine Intensive Réanimation, Poitiers, France.,University of Poitiers, 27077, INSERM CIC 1402, ALIVE research group, Poitiers, France
| | - Jean-Pierre Frat
- Centre Hospitalier Universitaire de Poitiers, 36655, Médecine Intensive Réanimation, Poitiers, France.,University of Poitiers, 27077, INSERM CIC 1402, ALIVE research group, Poitiers, France
| | - Stéphanie Ragot
- University of Poitiers, 27077, INSERM CIC 1402, ALIVE research group, Poitiers, France
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11
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Mokhlesi B, Won CH, Make BJ, Selim BJ, Sunwoo BY. Optimal Noninvasive Medicare Access Promotion: Patients with Hypoventilation Syndromes A Technical Expert Panel Report from the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society. Chest 2021; 160:e377-e387. [PMID: 34339686 DOI: 10.1016/j.chest.2021.06.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/27/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022] Open
Abstract
The existing coverage criteria for home noninvasive ventilation (NIV) do not recognize the diversity of hypoventilation syndromes and advances in technologies. This document summarizes the work of the Hypoventilation Syndromes Technical Expert Panel working group. The most pressing current coverage barriers identified were: 1) overreliance on arterial blood gases (particularly during sleep); 2) need to perform testing on prescribed oxygen; 3) requiring a sleep study to rule out obstructive sleep apnea as the cause of sustained hypoxemia; 4) need for spirometry; 5) need to demonstrate BPAP without a backup rate failure to qualify for BPAP S/T; and 6) qualifying hospitalized patients for home NIV therapy at the time of discharge. Critical evidence support for changes to current policies include randomized clinical trial evidence and clinical practice guidelines. In order to decrease morbidity-mortality by achieving timely access to NIV for patients with hypoventilation, particularly those with obesity hypoventilation syndrome, we make the following key suggestions: 1) Given the significant technological advances, we advise acceptance of surrogate noninvasive end tidal and transcutaneous PCO2 and venous blood gases in lieu of arterial blood gases,; 2) Not requiring PCO2 measures while on prescribed oxygen; 3) Not requiring a sleep study to avoid delays in care in patients being discharged from the hospital; 4) Remove spirometry as a requirement; 5) Not requiring BPAP without a backup rate failure to approve BPAP S/T. The overarching goal of the Technical Expert Panel is to establish pathways that improve clinicians' management capability to provide Medicare beneficiaries access to appropriate home NIV therapy. Adoption of these proposed suggestions would result in the right device, at the right time, for the right type of patients with hypoventilation syndromes.
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12
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Ainge-Allen HW, Yee BJ, Ip MSM. Contemporary Concise Review 2020: Sleep. Respirology 2021; 26:700-706. [PMID: 34018277 DOI: 10.1111/resp.14084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnoea (OSA) now affects one-seventh of the world's population. Treatment of even mild OSA can improve daytime sleepiness and quality of life. Recent modifications to uvulopalatopharyngoplasty may make it a more widely applicable treatment option in selected patients with OSA. Diet and exercise have effects on sleep apnoea severity independent of weight loss. Insomnia has become increasingly common during the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Henry W Ainge-Allen
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory Medicine, Dubbo Health Service, Dubbo, New South Wales, Australia
| | - Brendon J Yee
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mary S M Ip
- Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Hong Kong, Hong Kong.,Respiratory Division, University of Hong Kong Shenzhen Hospital, Shenzhen, China
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13
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Selim B, Ramar K. Sleep-Related Breathing Disorders: When CPAP Is Not Enough. Neurotherapeutics 2021; 18:81-90. [PMID: 33150546 PMCID: PMC8116389 DOI: 10.1007/s13311-020-00955-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Three decades ago, continuous positive airway pressure (CPAP) was introduced to treat obstructive sleep apnea (OSA). Shortly after, bilevel positive airway pressure devices (BPAP) that independently adjusted inspiratory and expiratory positive airway pressure were developed to treat complex sleep-related breathing disorders unresponsive to CPAP. Based on the bilevel positive airway pressure platform (hardware) governed by propriety algorithms (software), advanced modes of noninvasive ventilation (NIV) were developed to address complex cardiorespiratory pathophysiology beyond OSA. This review summarizes key aspects of different bilevel PAP therapies (BPAP with/without backup rate, adaptive servoventilation, and volume-assured pressure support) to treat common sleep-related hypoventilation disorders, treatment-emergent central sleep apnea, and central sleep apnea syndromes.
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Affiliation(s)
- Bernardo Selim
- Pulmonary and Critical Care Division, Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Kannan Ramar
- Pulmonary and Critical Care Division, Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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14
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Wearn J, Akpa B, Mokhlesi B. Adherence to Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome. Sleep Med Clin 2020; 16:43-59. [PMID: 33485531 DOI: 10.1016/j.jsmc.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because of the prevalence of extreme obesity in the United States, there has been an increase in prevalence of obesity hypoventilation syndrome (OHS). There is limited information on the characteristics and pattern of positive airway pressure (PAP) adherence in patients with OHS compared with eucapnic patients with obstructive sleep apnea (OSA). This article discusses in detail the impact of PAP therapy on outcomes in patients with OHS, compares adherence between continuous PAP and noninvasive ventilation in OHS, and compares PAP adherence in patients with OHS to patients with moderate to severe OSA enrolled in clinical trials designed to improve CPAP adherence.
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Affiliation(s)
- Jeremy Wearn
- Sleep Medicine and Internal Medicine, Oregon Health & Science University and Portland VAMC, 3710 SW US Veterans Hospital Rd, PULM3/Sleep, Portland OR 97239, USA
| | - Bimaje Akpa
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, 420 Delaware Street SE, MMC 276, Minneapolis, MN 55455, USA
| | - Babak Mokhlesi
- Sleep Disorders Center, University of Chicago, 5841 South Maryland Avenue, MC6076/Room M630, Chicago, IL 60637, USA.
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15
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Foster BE, Diaz-Abad M, Hudson AJ, Bedocs P, Doll DM, Lopez SA, Mares J, Hutzler J, Robertson BD. Invasive mechanical ventilation using a bilevel PAP ST device in a healthy swine model. Sleep Breath 2020; 24:1645-1652. [PMID: 32761535 PMCID: PMC7406961 DOI: 10.1007/s11325-020-02141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The Coronavirus Disease 2019 (COVID-19) pandemic may cause an acute shortage of ventilators. Standard noninvasive bilevel positive airway pressure devices with spontaneous and timed respirations (bilevel PAP ST) could provide invasive ventilation but evidence on their effectiveness in this capacity is limited. We sought to evaluate the ability of bilevel PAP ST to effect gas exchange via invasive ventilation in a healthy swine model. METHODS Two single limb respiratory circuits with passive filtered exhalation were constructed and evaluated. Next, two bilevel PAP ST devices, designed for sleep laboratory and home use, were tested on an intubated healthy swine model using these circuits. These devices were compared to an anesthesia ventilator. RESULTS We evaluated respiratory mechanics, minute ventilation, oxygenation, and presence of rebreathing for all of these devices. Both bilevel PAP ST devices were able to control the measured parameters. There were noted differences in performance between the two devices. Despite these differences, both devices provided effective invasive ventilation by controlling minute ventilation and providing adequate oxygenation in the animal model. CONCLUSIONS Commercially available bilevel PAP ST can provide invasive ventilation with a single limb respiratory circuit and in-line filters to control oxygenation and ventilation without significant rebreathing in a swine model. Further study is needed to evaluate safety and efficacy in clinical disease models. In the setting of a ventilator shortage during the COVID-19 pandemic, and in other resource-constrained situations, these devices may be considered as an effective alternative means for invasive ventilation.
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Affiliation(s)
- Brian E Foster
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Montserrat Diaz-Abad
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Arlene J Hudson
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Peter Bedocs
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
| | - Darius M Doll
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Steven A Lopez
- University of New Mexico Sleep Disorders Center, Albuquerque, NM, USA
| | - John Mares
- Henry M Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
| | - Justin Hutzler
- Henry M Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
| | - Brian D Robertson
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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16
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Overlooking Obesity Hypoventilation Syndrome: The Need for Obesity Hypoventilation Syndrome Staging and Risk Stratification. Ann Am Thorac Soc 2020; 17:1211-1212. [PMID: 33000959 PMCID: PMC7640632 DOI: 10.1513/annalsats.202006-683ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Iftikhar IH, Greer M, Wigger GW, Collop NA. A network meta-analysis of different positive airway pressure interventions in obesity hypoventilation syndrome. J Sleep Res 2020; 30:e13158. [PMID: 32789956 DOI: 10.1111/jsr.13158] [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: 04/28/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
Abstract
Continuous positive airway pressure (CPAP) and different types of non-invasive ventilation (NIV) have been studied in obesity hypoventilation syndrome such as bi-level PAP with back-up rate (BPAP-BUR), BPAP without BUR, and the new hybrid devices that target a pre-set volume by adjustment of pressure support (VT-PS). Although several studies have compared one PAP intervention with the other, none has compared all four in a head-to-head design, which formed the basis of this network meta-analysis. PubMed and Web of Science were searched for potentially includable randomised active comparator trials. Changes in partial pressure of carbon dioxide (PaCO2 ) and Epworth Sleepiness Score (ESS) were the primary outcomes of interest. Network meta-analysis was done in R program using the 'frequentist' framework. A total of seven trials were included. Only VT-PS and BPAP-BUR showed statistically significant reductions in PaCO2 compared to control, with no significant inter-PAP differences except for the comparison between VT-PS and CPAP. Only VT-PS showed a statistically significant improvement in ESS as compared to control, with no other significant inter-PAP differences. P-score ranking (based on effect size and standard errors) and Hasse diagram ranked VT-PS and BPAP as superior to other PAPs for both primary outcomes. There were no significant differences between the different PAP interventions for hospital or emergency department admissions. The results of this network meta-analysis suggest superiority of VT-PS and BPAP over other PAP interventions at least for daytime hypercapnia and subjective daytime somnolence.
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Affiliation(s)
- Imran H Iftikhar
- Emory University Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Meredith Greer
- Emory University Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory W Wigger
- Emory University Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy A Collop
- Emory University Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
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18
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Sunwoo BY, Schmickl CN, Malhotra A. Contemporary Concise Review 2019: Sleep and ventilation. Respirology 2020; 25:552-558. [PMID: 32048407 PMCID: PMC7162714 DOI: 10.1111/resp.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Bernie Y Sunwoo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
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