Neural respiratory drive and cardiac function in patients with obesity hypoventilation syndrome following initiation of non-invasive ventilation

Onofri, Angelo; Patout, Maxime; Kaltsakas, Georgios; Lhuillier, Elodie; Mushemi-Blake, Sitali; Arbane, Gill; Pengo, Martino F.; Marino, Phillip; Steier, Joerg

doi:10.21037/jtd.2017.12.129

Cited by 15 publications

(11 citation statements)

References 40 publications

(29 reference statements)

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“…5,33,41,42 Additionally, CPAP is more cost-effective than BPAP and other modes of NIV. 43 Therefore, CPAP should be the initial treatment 31 On the other hand, in a longterm prospective observational study, Bouloukaki et al reported that patients using BPAP adhered better to therapy than patients using CPAP [40]. 35 However, this study included OHS patients with mild, moderate, and severe OSA.…”

Section: Discussionmentioning

confidence: 95%

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Long-Term Adherence to Positive Airway Pressure Therapy in Saudi Ambulatory Patients with Obesity Hypoventilation Syndrome and Severe Obstructive Sleep Apnea: A One-Year Follow-Up Prospective Observational Study

Almeneessier¹,

Aleissi²,

Olaish³

et al. 2021

NSS

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Long-term studies assessing positive airway pressure (PAP) therapy adherence in patients with obesity hypoventilation (OHS) are limited. The aim of this study was to assess PAP therapy adherence in Arab (Saudi) patients with OHS and an apnea-hypopnea index (AHI) >30/h. Methods: A prospective cohort study of consecutive adult patients diagnosed with OHS between March 2010 and September 2019 was conducted. During the therapeutic sleep study, all OHS patients were started on continuous PAP (CPAP). Patients who failed to maintain oxygen saturation ≥88% despite the elimination of obstructive respiratory events were shifted to bi-level PAP (BPAP). Objective assessment of adherence was performed at 1, 6, and 12 months after initiating PAP therapy. We adopted the American-Thoracic-Society criteria for PAP adherence. Results: The study included 101 patients (women = 65 patients) with OHS, an AHI ≥30/h, and a mean age of 54.9 ± 12.7 years. Successful titration on CPAP was achieved in 64.4% of the patients and BPAP was required for 35.6% of the patients who failed CPAP titration. At the end of the study, 43.6% of the patients used PAP therapy in an acceptable manner. Adherence after 1 and 6 months was the only independent predictors of adherence at 12 months. Conclusion: PAP adherence among Saudi patients with OHS and severe obstructive sleep apnea was relatively low. Almost two-thirds of patients tolerated CPAP titration with the elimination of respiratory events and desaturation. Early adherence to PAP therapy was the only predictor of PAP therapy adherence at the end of the study.

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Section: Discussionmentioning

confidence: 95%

“…39 Moreover, increased lung volume reduces airway resistance and flow limitations, leading to reduced work of breathing, particularly when in the recumbent position. 40 In general, 50-80% of ambulatory stable OHS patients with comorbid OSA respond to CPAP. 5,33,41,42 Additionally, CPAP is more cost-effective than BPAP and other modes of NIV.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Adherence to Positive Airway Pressure Therapy in Saudi Ambulatory Patients with Obesity Hypoventilation Syndrome and Severe Obstructive Sleep Apnea: A One-Year Follow-Up Prospective Observational Study

Almeneessier¹,

Aleissi²,

Olaish³

et al. 2021

NSS

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“…One randomised controlled trial and two series showed near normalisation of pulmonary haemodynamics after 3-6 months with NIV (63)(64)(65). One further study on 14 patients with obesity-related hypercapnic respiratory failure reviewed echocardiography features of PH preand post-NIV treatment (6 patients with >4 hours adherence with therapy) and found no difference from baseline at 3 months (66). A positive treatment effect from NIV on the respiratory system was demonstrated by neural respiratory drive assessment despite there being no significant effect on the cardiovascular system in the short term.…”

Section: Ohsmentioning

confidence: 99%

Narrative review of sleep and pulmonary hypertension

2020

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Pulmonary hypertension (PH) is a condition of raised pulmonary artery pressure (PAP), which may be secondary to a number of causes, one of which is sleep disordered breathing (SDB). When PH complicates SDB, it carries a significant burden of morbidity and mortality due to the risk of progression to right ventricular failure over time. This narrative review will cover the definition and classification of PH, and explore the epidemiology of PH in SDB. The mechanisms by which the two conditions are linked will be reviewed. Repetitive hypoxia with or without hypercapnia alongside frequent arousals can result in important metabolic and pulmonary vascular consequences for the left and right heart. MEDLINE was used to search for all relevant articles and abstracts published from January 1960 to October 2019 inclusive (in all languages). Current best practice in the investigation and management of PH complicating SDB will be reviewed. Important diagnostic investigations and when to consider and screen further for PH in patients with SDB will be discussed. Optimal disease management must include control of SDB with therapy.Additional treatment options will be reviewed. Areas for further research will be highlighted.

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“…The baseline demographics did not significantly change for this cohort over the course of the decade (p-trend=0.65). Patients were mildly sleepy with an ESS of 9 [4][5][6][7][8][9][10][11][12][13][14][15] points. The clinical observations (heart rate, respiratory rate, systolic and diastolic blood pressure) of the entire cohort recorded at discharge following their HMV setup remained stable over the entire decade.…”

Section: Demographics Of Non-adherent Patientsmentioning

confidence: 99%

“…Continuous Positive Airway Pressure (CPAP) therapy is the treatment of choice for normocapnic SDB (13). However, Home Mechanical Ventilation (HMV) is the preferred choice for SDB that is accompanied by chronic hypercapnic respiratory failure (HRF), as it improves clinical outcomes in OSA (9,14) and Obesity Hypoventilation Syndrome (15) (OSA/OHS), Neuromuscular Disease (NMD) (16) and chronic obstructive pulmonary disease (COPD) (17,18).…”

Section: Introductionmentioning

confidence: 99%

Long-term adherence to home mechanical ventilation: a 10-year retrospective, single-centre cohort study

et al. 2020

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Background: Sleep-disordered breathing (SBD) can be associated with hypercapnic respiratory failure (HRF). Home Mechanical Ventilation (HMV) is the preferred long-term treatment for patients with chronic HRF. We reviewed the database of a large tertiary referral centre for HMV to study the long-term adherence to HMV in chronic hypercapnic patients. Methods: Data on adherence and characteristics of patients who received HMV for the treatment of SDB were collected over a decade using electronic patient records. The primary outcome parameter in this study was annual non-adherence rate (patients with HMV usage of <4 hours/night in the service divided by the number of all new patients of the same year), secondary outcomes were patients' characteristics and reasons for low adherence. HMV adherence clinics were established to improve uptake. Results: Two thousand and two hundred twenty-eight patients with HRF were under active follow-up on HMV at the end of the recording period. In contrast, a total of 1,900 patients had their HMV contracts terminated over the course of a decade (due to non-adherence, transfer to other services or death). Out of those, 222 patients {62 [52-72] years, body-mass index, BMI 40 [35][36][37][38][39][40][41][42][43] kg/m 2 , 58.1% male, Epworth Sleepiness Scale, ESS 9 [4-15] points, 4% oxygen desaturation index, 4%ODI 32 [20-71] × hour −1 , TcCO 2 6.6 [6.0-7.2] kPa} met the non-adherence criteria (nocturnal usage 0-4 hours). The annual non-adherence rate was 25.5% of all new setups in 2010, and declined to 3.4% in 2019 (relative reduction of 86%, P<0.001). Patients with Obstructive Sleep Apnoea/Obesity Hypoventilation Syndrome (58.2%), Neuromuscular Diseases (NMD) (26.8%) and COPD (13.6%) accounted for most cases of this non-adherent cohort. The vast majority of the patients (96.1%) were established on full-face masks. In 23.4% of patients, substantial weight loss (>10%) was the most common reason for low adherence; general displeasure (21.3%), uncontrolled symptoms (12.8%), claustrophobia (6.7%), mood (4.8%) and mask intolerance (4.3%) caused problems as well. Conclusions: Non-adherence to HMV in patients with chronic HRF can affect significant proportions of patients. However, the non-adherent rate substantially decreases when individual treatment solutions are offered in multi-disciplinary clinics.

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Neural respiratory drive and cardiac function in patients with obesity hypoventilation syndrome following initiation of non-invasive ventilation

Cited by 15 publications

References 40 publications

Long-Term Adherence to Positive Airway Pressure Therapy in Saudi Ambulatory Patients with Obesity Hypoventilation Syndrome and Severe Obstructive Sleep Apnea: A One-Year Follow-Up Prospective Observational Study

Long-Term Adherence to Positive Airway Pressure Therapy in Saudi Ambulatory Patients with Obesity Hypoventilation Syndrome and Severe Obstructive Sleep Apnea: A One-Year Follow-Up Prospective Observational Study

Narrative review of sleep and pulmonary hypertension

Long-term adherence to home mechanical ventilation: a 10-year retrospective, single-centre cohort study

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