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

Abstract

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.

AVAPS‐AE versus ST mode: A randomized controlled trial in patients with obesity hypoventilation syndrome

“…This increased cost was mainly driven by inpatient costs required for NIV titration. However, CPAP can fail as a first‐line treatment or as a second‐line treatment in patients with OHS . In our study, despite a mild baseline hypercapnia and despite a significant improvement of the AHI, mean time spent with an oxygen saturation <90% was high at 2 months (31% and 33% in the AVAPS‐AE and ST groups, respectively).…”

A network meta‐analysis of different positive airway pressure interventions in obesity hypoventilation syndrome

“…However, the present network meta‐analysis found no significant inter‐PAP difference in the reduction of hospital or ED admissions. Given that CPAP has been shown to be more cost‐effective than other forms of NIV (Masa et al., 2019), and that at least one study (Arellano‐Maric et al., 2019) has shown that it is feasible to switch most stable patients with OHS from NIV to CPAP therapy, CPAP definitely has the potential to significantly reduce healthcare costs at the population level. However, in reality in the clinical setting, faced with the pressing issue of the degree of hypercapnia, patient preference, multiple PAP options and the ease of getting a PAP device covered by insurance, clinicians are likely to take a more personalised approach.…”

Step‐down from non‐invasive ventilation to continuous positive airway pressure: A better phenotyping is required

“…Arellano-Maric et al report that patients with obesity hypoventilation syndrome (OHS) treated with noninvasive ventilation (NIV) can be safely switched to continuous positive airway pressure (CPAP) in a recent publication in Respirology. 1 The results of their study suggest that CPAP is preferred over NIV in a majority of patients. However, a sizeable minority of patients (12; 29%) included in their observational trial failed to step-down from NIV to CPAP.…”