Abstract. Budweiser S, Riedl SG, Jörres RA, Heinemann F, Pfeifer M (Centre for Pneumology, Hospital Donaustauf, Donaustauf, Germany; Institute and Outpatient Clinic for Occupational and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany; Department of Internal Medicine II, University of Regensburg, Regensburg, Germany). Mortality and prognostic factors in patients with obesity-hypoventilation syndrome undergoing noninvasive ventilation. J Intern Med 2007; 261: 375-383.Objectives. The incidence of obesity-hypoventilation syndrome (OHS) has greatly increased over time, but data on long-term outcome are limited. We investigated survival and prognostic factors in these patients undergoing noninvasive positive pressure ventilation (NPPV).Design. Retrospective descriptive analysis of patients with OHS and NPPV up to 10 years.Methods. Long-term mortality and predictors of survival were assessed. Additionally, we evaluated changes in lung function, blood gas and laboratory parameters 5.7 ± 2.5 months after initiation of NPPV.Results. 126 patients (BMI 44.6 ± 7.8 kg m )2 ; PaCO 2 55.5 ± 7.7 mmHg) were followed for 41.3 ± 27.6 months. Upon follow-up, blood gases (daytime and nighttime), as well as pulmonary function improved, whilst haemoglobin and BMI decreased (P < 0.001 each). Adherence to NPPV was high (94.5% continuing NPPV 6.5 ± 2.3 h day )1 ).All-cause mortality was 12.7%, with 1-, 2-and 5-year survival of 97.1%, 92.0% and 70.2%, respectively. In univariate analysis, patients with PaO 2 <50 mmHg, C-reactive protein ‡ 5.1 mg L )1 , leucocytes ‡ 7.8 · 10 3 ll )1 , or pH ‡ 7.44 at baseline had poor prognosis (P < 0.05 each). In Cox multivariate analysis, PaO 2 , pH and leucocytes were independent predictors of mortality. Reduction in nocturnal PaCO 2 by ‡23.0% and haemoglobin at follow-up was associated with improved survival (P < 0.05 each) whilst a decrease in pH was a predictor of increased mortality. In contrast, neither baseline BMI nor its change was linked to survival. Conclusion.Gas exchange and lung function in OHS were improved after initiation of NPPV. Hypoxemia, high pH and elevated inflammation markers predicted poor survival. Overall, NPPV was well tolerated and survival was excellent when compared with data from historical matched controls.
Introduction Obstructive sleep apnea (OSA) has been linked with erectile dysfunction (ED), but it is unknown whether this association is maintained in the presence of other risk factors for ED. Aim The aim of this study was to evaluate the relationship between ED/sexual dysfunction and polysomnographic measures of sleep apnea in patients with known risk factors for ED. Methods Prospective cross-sectional analysis of 401 male patients undergoing in-lab polysomnography for suspected OSA. Erectile (EF) and sexual function were assessed by the 15-item International Index of Erectile Function (IIEF-15) questionnaire. Main Outcome Measures Severity of OSA via apnea–hypopnea index (AHI) and mean/lowest nocturnal oxygen saturation (SaO2). The IIEF-15 including the sexual domains: EF, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Results OSA (AHI > 5/h) was diagnosed in 92% of patients. ED (EF subdomain ≤ 25) was present in 69% of patients with, and 34% of patients without OSA (P < 0.001). Multivariate stepwise regression analyses including known risk factors for ED, such as age, obesity, coronary heart disease, peripheral occlusive disease, hypertension, diabetes, prostate surgery, and β-blocker treatment, and measures of sleep apnea identified mean nocturnal SaO2 as independently associated with ED (P = 0.002; mean [95% CI] normalized slope 0.126 [0.047; 0.205]). Age (P < 0.001), peripheral occlusive disease (P = 0.001), prostate surgery (P = 0.018), and hypertension (P = 0.021) were confirmed as risk factors for ED, but did not abolish the sleep apnea-associated risk. Similar results were obtained for sexual dysfunction. Logistic regression analysis using the diagnosis of ED (EF subdomain ≤ 25) as binary dependent variable confirmed that mean nocturnal SaO2 (P = 0.012), as well as age (P < 0.001) were independently associated with ED. Conclusions ED and overall sexual dysfunction were highly prevalent in patients with suspected OSA. Irrespective of known risk factors, mean nocturnal SaO2 was an additional, independent correlate of these dysfunctions, suggesting that OSA-related intermittent nocturnal hypoxemia specifically contributes to their development.
In patients with severe chronic hypercapnic COPD receiving NIV at high inspiratory pressure levels and showing high adherence to this therapy, long-term survival was significantly higher than in non-ventilated patients. Patients displaying more severe disease according to known risk factors seemed to benefit most from long-term NIV.
Long-term domiciliary NPPV normalizes hypercapnia and markedly improves hypoxemia as well as polycythemia in OHS patients. In addition, NPPV leads to a significant reduction in restrictive ventilatory disturbance, predominantly by increasing ERV. Application of high inspiratory pressures and good adherence to therapy are presumed to be the basis for the beneficial effects of NPPV in OHS.
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