Long-term Noninvasive Ventilation in Obesity Hypoventilation Syndrome Without Severe OSA

Masa, Juan F.; Benítez, Iván D.; Sánchez-Quiroga, M-Ángeles; Terreros, F.J. Gómez de; Corral, Jaime; Romero, Odile; Caballero-Eraso, Candela; Alonso-Álvarez, María Luz; Ordax-Carbajo, Estrella; Gómez-García, Teresa; 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; Mokhlesi, Babak; Riesco, Juan Antonio; González-Mangado, Nicolás; Troncoso, María F.; Martinez-Martinez, Maria A.; Ojeda-Castillejo, Elena; López-Padilla, Daniel; Carrizo, Santiago; Gallego, Begoña Carazo; Pallero, Mercedes; Romero, Odile; Ramón, María Antonia; Arias, Eva; Muñoz-Méndez, Jesús; Senent, Cristina; Sancho-Chust, José N.; Navarro-Soriano, Nieves B.; Barrot, Emilia; Benítez, José María; Sánchez-Gómez, Jesús; Golpe, Rafael; Gómez-Mendieta, M.A.; Gómez, Sílvia; Bengoa, Mónica

doi:10.1016/j.chest.2020.03.068

Cited by 28 publications

(30 citation statements)

References 34 publications

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“…LTV for OHS is associated with a reduced mortality (5-year survival 77.3%) than in untreated OHS [ 8 ]. High NIV adherence results in less hospital admission, and improved mortality [ 9 ]. We postulate that due to the rapid progression and reduced life expectancy in MND, the time period on LTV may be short, with lower lifetime antibiotic exposure and less time for acquisition of Pa .…”

Section: Discussionmentioning

confidence: 99%

An observational study of Pseudomonas aeruginosa in adult long-term ventilation

et al. 2022

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IntroductionPseudomonas aeruginosa increases morbidity and mortality in respiratory disease. To date the long-term ventilation population does not have clear guidelines regarding its management.MethodWe undertook a retrospective observational study in a regional long-term ventilation population (837 patients). We defined the primary outcome as P. aeruginosa isolation. In addition positive cultures for copathogens (Serratia, Proteus species, Stenotrophomonas, Burkholderia cepacia complex and nontuberculous mycobacteria) were recorded. Logistic regression and odds ratios were calculated.Results17.6% of the cohort isolated P. aeruginosa, and this pathogen was cultured more frequently in patients with a tracheostomy (logistic regression coefficient 2.90, p≤0.0001) and cystic fibrosis/bronchiectasis (logistic regression coefficient 2.48, p≤0.0001). 6.3% of patients were ventilated via tracheostomy. In the P. aeruginosa positive cohort 46.9% of patients were treated with a long-term macrolide, 36.7% received a nebulised antibiotic and 21.1% received both. Tracheostomised P. aeruginosa positive patients received a nebulised antibiotic more frequently (OR 2.63, 95% CI 1.23–5.64, p=0.013). Copathogens were isolated in 33.3% of the P. aeruginosa cohort. In this cohort patients with a tracheostomy grew a copathogen more frequently than those without (OR 2.75, 95% CI 1.28–5.90).ConclusionsP. aeruginosa isolation is common within the adult long-term ventilation population and is significantly associated with tracheostomy, cystic fibrosis and bronchiectasis. Further research and international guidelines are needed to establish the prognostic impact of P. aeruginosa and to guide on antimicrobial management. The increased risk of P. aeruginosa should be considered when contemplating long-term ventilation via tracheostomy.

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Section: Discussionmentioning

confidence: 99%

An observational study of Pseudomonas aeruginosa in adult long-term ventilation

et al. 2022

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“… 15 , 36 A randomized-controlled trial showed an improvement in parameters of respiratory failure in patients on NIV when compared to patients on lifestyle modifications. 5 However, no study has addressed the success of CPAP titration and short-term adherence in this group of patients with OHS.…”

Section: Discussionmentioning

confidence: 99%

“… 4 Two phenotypes of OHS have been described, OHS with severe OSA and OHS without severe OSA, with an apnea-hypopnea index (AHI) of <30 events/h. 5 OSA occurs in approximately 90% of OHS patients, and severe OSA in 73% of OHS patients. 6 The pure hypoventilation phenotype occurs in 10–15% of patients.…”

Section: Introductionmentioning

confidence: 99%

Results of CPAP Titration and Short-Term Adherence Rates in Patients with Obesity Hypoventilation Syndrome and Mild/Moderate Obstructive Sleep Apnea

BaHammam¹,

Aleissi²,

Nashwan³

et al. 2022

NSS

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Purpose No study has assessed the titration success of CPAP therapy in patients with obesity hypoventilation syndrome (OHS) and an apnea-hypopnea index (AHI) <30 event/h. This study aimed to assess the titration success of CPAP therapy under polysomnography and subsequent short-term adherence (1 month) in patients with OHS and an AHI <30 event/h. Methods Consecutive OHS patients with an AHI <30 events/h between 2010 and 2019 were included (n=54). All OHS patients were first started on CPAP during the therapeutic sleep-study. If the therapeutic-study showed that the SpO2 remained < 90% for 20% of the total sleep time, a second therapeutic study was arranged with bi-level PAP (BPAP). Thirty patients agreed to participate in the 1-month follow-up adherence study. We applied the American-Thoracic-Society criteria for PAP adherence. Results The mean age was 54.8±14.6 years, and the mean BMI was 45.9±12.2 kg/m 2 . Successful titration on CPAP was attained in 36 (66.7%) patients, and 18 (33.3%) required BPAP. Patients who failed the CPAP trial had a significantly higher PaCO2 and bicarbonate, a more restrictive respiratory pattern on spirometry, and a significantly higher time with SpO2<90% (mins) during sleep. The only independent correlate of CPAP-titration success on the multivariable regression analysis was the desaturation index (OR: 1.33 [1.033–1.712]). More than 80% of the participants were using CPAP therapy after one-month with no differences in adherence between the CPAP and BPAP groups. Conclusions The current results suggest that CPAP therapy could be an acceptable alternative therapy to BPAP in patients with OHS without severe OSA.

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“…In OHS without concomitant severe OSA, Masa et al 16 found VAPS therapy to be more effective than lifestyle modification in improving blood gas parameters, a health-related quality of life measure (physical component of the 36-item Short Form Health Survey), and daytime sleepiness. 7 VAPS therapy led to lower ED visits, and post hoc analysis of adherence subgroups showed that higher level of adherence to VAPS therapy was associated with reduced ED visits and mortality.…”

Section: Benefits Of Bpap or Vaps Over Lifestylementioning

confidence: 99%

“…22 In patients with OHS without co-existing severe OSA, the only randomized controlled study to date used the VAPS mode with a backup rate and compared it vs lifestyle modification, thereby supporting use of a backup rate until additional data emerge for the subset of OHS patients without concomitant severe OSA. 16 The ATS Clinical Practice Guidelines identified 10 observational studies that included hospitalized patients with acute-on-chronic respiratory failure with OHS or suspected of having OHS. 10,11 In seven studies, NIV was prescribed at hospital discharge.…”

Section: Benefits Of Bpap or Vaps Over Lifestylementioning

confidence: 99%

Optimal NIV Medicare Access Promotion: Patients With Hypoventilation Syndromes

Mokhlesi

Won

Make

et al. 2021

Chest

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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 OSA as the cause of sustained hypoxemia; (4) need for spirometry; (5) need to show bilevel positive airway pressure (BPAP) without a backup rate failure to qualify for BPAP spontaneous/timed; and (6) qualifying hospitalized patients for home NIV therapy at the time of discharge. Critical evidence support for changes to current policies includes randomized controlled trial evidence and clinical practice guidelines. To decrease morbidity and 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 PCO 2 and venous blood gases in lieu of arterial blood gases; (2) not requiring PCO 2 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; and (5) not requiring BPAP without a backup rate failure to approve BPAP spontaneous/timed. 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, for the right type of patient with hypoventilation syndromes, at the right time.

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Long-term Noninvasive Ventilation in Obesity Hypoventilation Syndrome Without Severe OSA

Cited by 28 publications

References 34 publications

An observational study of Pseudomonas aeruginosa in adult long-term ventilation

An observational study of Pseudomonas aeruginosa in adult long-term ventilation

Results of CPAP Titration and Short-Term Adherence Rates in Patients with Obesity Hypoventilation Syndrome and Mild/Moderate Obstructive Sleep Apnea

Optimal NIV Medicare Access Promotion: Patients With Hypoventilation Syndromes

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