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

Masa, Juan F.; Mokhlesi, Babak; Benítez, Iván D.; Terreros, F.J. Gómez de; Sánchez-Quiroga, M-Ángeles; Romero, Odile; Caballero-Eraso, Candela; Terán-Santos, Joaquín; Alonso-Álvarez, María Luz; Troncoso, María F.; González, Mónica; López-Martín, Soledad; Marı́n, José Marı́a; Martí, Sergi; Díaz-Cambriles, Trinidad; Chiner, Eusebi; Egea, Carlos; Barca, Javier; Polo, Francisco José Vázquez; Negrín, Miguel Ángel; Martel–Escobar, María; Barbé, Ferrán; Corral, Jaime; Fernández, Galo; Ordax-Carbajo, Estrella; González-Mangado, Nicolás; Gómez-García, Teresa; Martínez-Martínez, María-Ángeles; Ojeda-Castillejo, Elena; Padilla, Daniel López; Carrizo, Santiago; Gallego, Begoña Carazo; Pallero, Mercedes; Romero, Odile; Ramón, María Antonia; Arias, Eva; Muñoz-Méndez, Jesús; Senent, Cristina; Sancho-Chust, José N.; Soriano, Nieves Belén Navarro; Barrot, Emilia; Benítez, José María; Sánchez-Gómez, Jesús; Golpe, Rafael; Santiago-Recuerda, Ana; Gómez, Sílvia; Bengoa, Mónica

doi:10.1016/s0140-6736(18)32978-7

Cited by 140 publications

(151 citation statements)

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“…Furthermore, as a consequence of central fat distribution, OHS patients present with reduced lung volumes, decreased chest wall compliance and increased work of breathing . There is evidence that if these alterations are mild to moderate, CPAP can effectively reverse hypoventilation after a few weeks . Furthermore, a blunted ventilatory drive response to hypoxaemia and hypercapnia has been identified in OHS patients .…”

Section: Discussionmentioning

confidence: 99%

“…It can be administered as either continuous positive airway pressure (CPAP) or non‐invasive ventilation (NIV), with both therapies aiming to restore upper airway patency and reverse alveolar hypoventilation . Importantly, selection of the therapy mode is a matter that must be carefully addressed, given its relevant economic implications; indeed, the price of a CPAP device is approximately one‐third of that of an NIV device (Appendix S1 in Supplementary Information) . Moreover, a CPAP device is easier to use, smaller and less noisy.…”

Section: Introductionmentioning

confidence: 99%

“…Three randomized controlled trials comparing the efficacy of CPAP and NIV in patients with mild to moderate OHS have showed that both therapy modes yielded similar improvements in gas exchange, diurnal symptoms and sleep architecture …”

Section: Introductionmentioning

confidence: 99%

“…10,11 Importantly, selection of the therapy mode is a matter that must be carefully addressed, given its relevant economic implications; indeed, the price of a CPAP device is approximately one-third of that of an NIV device (Appendix S1 in Supplementary Information). 12 Moreover, a CPAP device is easier to use, smaller and less noisy.…”

Section: Introductionmentioning

confidence: 99%

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Obesity hypoventilation syndrome treated with non‐invasive ventilation: Is a switch to CPAP therapy feasible?

et al. 2019

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Background and objective Obesity hypoventilation syndrome (OHS) can be treated with either continuous positive airway pressure (CPAP) or non‐invasive ventilation (NIV) therapy; the device choice has important economic and operational implications. Methods This multicentre interventional trial investigated the safety and short‐term efficacy of switching stable OHS patients who were on successful NIV therapy for ≥3 months to CPAP therapy. Patients underwent an autotitrating CPAP night under polysomnography (PSG); if the ensuing parameters were acceptable, they were sent home on a fixed CPAP for a 4–6‐week period. It was hypothesized that blood gas analysis, PSG parameters and lung function tests would remain unchanged. Results A total of 42 OHS patients were recruited, of whom 37 patients were switched to CPAP therapy. All patients had a history of severe obstructive sleep apnoea syndrome; chronic obstructive pulmonary disease (COPD) (Global Initiative for Obstructive Lung Disease (GOLD) I/II) was present in 52%. Regarding the primary outcome, 30 of 42 patients (71%, 95% CI: 55–84%) maintained daytime partial pressure of carbon dioxide (PaCO2) levels ≤45 mm Hg after the home CPAP period. There was no further impairment in quality of life, sleep parameters or lung function. Interestingly, 24 patients (65%) preferred CPAP as their long‐term therapy, despite the high pressure levels used (mean: 13.8 ± 1.8 mbar). After the CPAP period, 7 of 37 patients were categorized as CPAP failure, albeit only due to mild hypercapnia (mean: 47.9 ± 2.7 mm Hg). Conclusion It is feasible to switch most stable OHS patients from NIV to CPAP therapy, a step that could significantly reduce health‐related costs. The auto‐adjusted CPAP device, used in combination with the analysis of the PSG and capnometry, is a valid titration method in OHS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Obesity hypoventilation syndrome treated with non‐invasive ventilation: Is a switch to CPAP therapy feasible?

et al. 2019

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“…discuss the roles of CPAP and NIV in patients with obesity‐related respiratory failure and how the presence of concurrent COPD and/or obstructive sleep apnoea (OSA) may influence the mode of therapy used. Not all patients with chronic hypercapnia require NIV, with CPAP being effective for many when OSA is present . While the importance of therapy titration to correct sleep disordered breathing is emphasized by the authors, timely access to overnight supervised monitoring and therapy titration can be a challenge for some centres and regions.…”

mentioning

confidence: 99%