Impact of Adherence With Positive Airway Pressure Therapy on Hypercapnia in Obstructive Sleep Apnea

Mokhlesi, Babak; Tulaimat, Aiman; Evans, Arthur T.; Wang, Yue; Itani, Abed-Alrahman; Hassaballa, Hesham A.; Herdegen, James J.; Stepanski, Edward J.

doi:10.5664/jcsm.26436

Cited by 137 publications

(78 citation statements)

References 41 publications

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“…Correction of nocturnal oxygenation and reversal of daytime hypercapnia by effective treatment of obstructed breathing during sleep (4,55,68,71) provide strong clinical support for the notion that upper airway obstruction and flow limitation play an important role in the development of OHS. On the other hand, the frequency and severity of apneic events during sleep are similar in patients with eucapnic OSAS and those with OHS (2,23).…”

Section: Sleep-breathing Disorders and Ohsmentioning

confidence: 99%

Big breathing: the complex interaction of obesity, hypoventilation, weight loss, and respiratory function

Piper

Grunstein

2010

Journal of Applied Physiology

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Obesity places a significant load on the respiratory system, affecting lung volumes, respiratory muscle function, work of breathing, and ventilatory control. Despite this, most morbidly obese individuals maintain eucapnia. However, a subgroup of morbidly obese individuals will develop chronic daytime hypercapnia, described as the obesity hypoventilation syndrome (OHS). While obesity is obviously a crucial component of this syndrome, the relationship between excess fat accumulation and the development of awake hypercapnia is complex and extends beyond simply impairments of pulmonary mechanics and lung volumes as a consequence of obesity. Various compensatory mechanisms operate to maintain eucapnia even in the presence of extreme obesity. However, if compensation is impaired, hypoventilation will ensue. While obesity alone does not account for the development of hypoventilation, weight loss will produce significant improvements in lung function and awake gas exchange. Such improvements have the potential to substantially reduce morbidity and mortality in these individuals. Nevertheless, many individuals remain overweight despite substantial weight loss, with persistence of upper airway obstruction. Attention to this residual abnormality is important given the high incidence of cardiovascular abnormalities, including pulmonary hypertension, in individuals with OHS.

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Section: Sleep-breathing Disorders and Ohsmentioning

confidence: 99%

Big breathing: the complex interaction of obesity, hypoventilation, weight loss, and respiratory function

Piper

Grunstein

2010

Journal of Applied Physiology

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“…The choice of nocturnal CPAP or NIV is often based on the underlying sleep-related respiratory abnormality encountered. 82 CPAP is efficient in reversing diurnal hypoventilation [82][83][84][85] in OHS patients presenting mainly OSA-related hypoventilation. Piper et al 85 have shown that more than 60% of OHS patients who exhibited an incomplete initial response to CPAP have a good response after 3 months of CPAP, suggesting that incomplete immediate response to CPAP does not preclude midterm efficacy.…”

Section: Positive Airway Pressure Therapies To Abolish Sleep-breathinmentioning

confidence: 99%

“…Piper et al 85 have shown that more than 60% of OHS patients who exhibited an incomplete initial response to CPAP have a good response after 3 months of CPAP, suggesting that incomplete immediate response to CPAP does not preclude midterm efficacy. However, some OHS patients continue to exhibit sleep hypoventilation, 82,83,85,86 particularly in REM, 25,35 even though upper airway obstruction is abolished with CPAP, and require NIV to overcome this central hypoventilation. In contrast to CPAP, NIV is more expensive and more complex to set up a large range of ventilatory parameters (ventilatory mode, inspiratory and expiratory pressures, back-up respiratory rate, triggering sensitivity, pressurization slope).…”

Section: Positive Airway Pressure Therapies To Abolish Sleep-breathinmentioning

confidence: 99%

Obesity hypoventilation syndrome: From sleep‐disordered breathing to systemic comorbidities and the need to offer combined treatment strategies

Borel

Monneret

et al. 2012

Respirology

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Obesity hypoventilation syndrome (OHS) is defined as a combination of obesity (body mass index Ն 30 kg/m2 ), daytime hypercapnia (partial arterial carbon dioxide concentration Ն45 mm Hg) and sleepdisordered breathing after ruling out other disorders that may cause alveolar hypoventilation. Through the prism of the International Classification of Functioning, OHS is a chronic condition associated with respiratory, metabolic, hormonal and cardiovascular impairments, leading to a decrease in daily life activities, a lack of social participation and high risk of hospitalization and death. Despite its severity, OHS is largely underdiagnosed and the health-related costs are higher than those of apnoeic or obese eucapnic patients. The present review discusses the definition, epidemiology, physiopathology and treatment modalities of OHS. Although nocturnal positive airway pressure therapies represent first-line treatment and are effective in improving patient outcomes, there is a need to offer combined treatment strategies and to assess the effect of multimodal therapeutic strategies on morbidity and mortality.The Authors: Jean-Christian Borel, PhD, is the Head of the Research and Development Department at 'AGIR à dom', a non-profit home care provider. He has developed an expertise in the field of non-invasive ventilation, home-based training programmes and integrated care. He carried out his PhD thesis at the Hypoxia Pathophysiology Laboratory (HP2) on the clinical and cardiovascular consequences of the obesity hypoventilation syndrome, followed by a postdoctoral fellowship on the pathophysiology of the sleep apnoea syndrome in Dr Frederic Series' team at the Quebec Heart and Lung Institute.Anne-Laure Borel, MD, PhD from Grenoble University Hospital, France, has completed a postdoctoral fellowship in Quebec, Canada in Dr Jean-Pierre Despres' team of the Quebec Heart and Lung Institute. She is an endocrinologist with a clinical activity focused on obesity and type 2 diabetes. Her research interests are in the field of the cardiometabolic complications of an excess visceral adiposity and more specifically, the association between sleep-disordered breathing, excess visceral fat and metabolic abnormalities.Denis Monneret, MSc, PhD, is a pharmacist with a diploma of medical biology from Lille Faculty of Pharmacy, France. His MSc and PhD degrees specialized in biology of obstructive sleep apnoea and obesity hypoventilation syndrome. After working as Assistant Professor in the Biochemistry and Hormonology Unit at Grenoble University Hospital, he joined the HP2 Laboratory where he works on oxidative stress and metabolic biomarkers of obstructive sleep apnoea, and obesity hypoventilation syndrome.Renaud Tamisier, MD, PhD, is an Associate Professor of Physiology at Grenoble University School of Medicine, France. He works in the HP2 Laboratory and has been involved in both research and clinical studies in sleep-disordered breathing for the last 15 years. His research interests are mainly on the cardiovascular consequence...

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“…34 Good compliance with NIV is essential to improve clinical outcomes and blood gases. [35][36][37] Telemonitoring of compliance from the home ventilator is reliable and clinically useful. Intermittent use may reflect poor tolerance of the system or discomfort.…”

Section: Connectivity Via External Plugin §mentioning

confidence: 99%

Technological advances in home non‐invasive ventilation monitoring: Reliability of data and effect on patient outcomes

2019

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Home non‐invasive mechanical ventilation (NIV) has become a well‐established treatment for patients with chronic hypercapnic respiratory failure. NIV monitoring has been developed to evaluate the effectiveness of mechanical ventilation on patient outcomes, with built‐in systems providing data on compliance, leaks and respiratory parameters. Although these data seem intuitively useful, two main concerns have been raised in the literature: (i) are they reliable and (ii) to what extent does their use improve patient outcomes. These two concerns are currently relevant since the very recent development of telemonitoring provides the possibility of adjusting ventilator settings remotely, based on the longitudinal assessment of NIV parameters and respiratory variables provided by the system. This may influence the future management strategies of health organizations for patients under home NIV. This narrative review describes technological advances in patient monitoring using home mechanical ventilation with a main focus on data provided by built‐in NIV monitoring systems. The use of these systems is discussed, including their advantages and limitations in different clinical situations, and perspectives for long‐term patient monitoring are discussed.

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Impact of Adherence With Positive Airway Pressure Therapy on Hypercapnia in Obstructive Sleep Apnea

Cited by 137 publications

References 41 publications

Big breathing: the complex interaction of obesity, hypoventilation, weight loss, and respiratory function

Big breathing: the complex interaction of obesity, hypoventilation, weight loss, and respiratory function

Obesity hypoventilation syndrome: From sleep‐disordered breathing to systemic comorbidities and the need to offer combined treatment strategies

Technological advances in home non‐invasive ventilation monitoring: Reliability of data and effect on patient outcomes

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