Randomised trial of CPAP vs bilevel support in the treatment of obesity hypoventilation syndrome without severe nocturnal desaturation

Piper, Amanda J.; Wang, David; Yee, Brendon J.; Barnes, David J.; Grunstein, Ronald R.

doi:10.1136/thx.2007.081315

Cited by 265 publications

(204 citation statements)

References 25 publications

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“…BMI also decreased slightly. Similar to our previous report, 31 no difference was found between the options of CPAP and BPAP in improving awake pCO 2 (p = 0.27) and SpO 2 nadir during sleep (p = 0.62) in the present study. EEG spectral analyses showed that the D/A ratio of EEG was significantly reduced during both sleeping and waking periods, indicating a generally faster, more activated EEG spectral profile following treatment ( Table 2).…”

Section: Resultssupporting

confidence: 81%

Hypercapnia is a Key Correlate of EEG Activation and Daytime Sleepiness in Hypercapnic Sleep Disordered Breathing Patients

Wang

Piper

Yee

et al. 2014

Journal of Clinical Sleep Medicine

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Background:The key determinants of daytime drowsiness in sleep disordered breathing (SDB) are unclear. Hypercapnia has not been examined as a potential contributor due to the lack of reliable measurement during sleep. To overcome this limitation, we studied predominantly hypercapnic SDB patients to investigate the role of hypercapnia on EEG activation and daytime sleepiness. Methods: We measured overnight polysomnography (PSG), arterial blood gases, and Epworth Sleepiness Scale in 55 severe SDB patients with obesity hypoventilation syndrome or overlap syndrome (COPD+ obstructive sleep apnea) before and ~3 months after positive airway pressure (PAP) treatment. Quantitative EEG analyses were performed, and the Delta/ Alpha ratio was used as an indicator of EEG activation. Results: After the PAP treatment, these patients showed a signifi cant decrease in their waking pCO 2 , daytime sleepiness, as well as all key breathing/oxygenation parameters during sleep. Overnight Delta/Alpha ratio of EEG was signifi cantly reduced. There is a signifi cant cross-correlation between a reduced wake pCO 2 , a faster (more activated) sleep EEG (reduced Delta/Alpha ratio) and reduced daytime sleepiness (all p < 0.05) with PAP treatment. Multiple regression analyses showed the degree of change in hypercapnia to be the only signifi cant predictor for both ESS and Delta/ Alpha ratio. Conclusions: Hypercapnia is a key correlate of EEG activation and daytime sleepiness in hypercapnic SDB patients. The relationship between hypercapnia and sleepiness may be mediated by reduced neuro-electrical brain activity.

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Section: Resultssupporting

confidence: 81%

Hypercapnia is a Key Correlate of EEG Activation and Daytime Sleepiness in Hypercapnic Sleep Disordered Breathing Patients

Wang

Piper

Yee

et al. 2014

Journal of Clinical Sleep Medicine

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“…There is considerable evidence that CPAP use reduces cardiovascular morbidity, mortality, and road traffic accidents traffic consequences in patients with OSA. [18][19][20][21][22] Despite the severity of the consequences of OHS, CPAP may improve the symptoms and selected clinical variables of the disease [23][24][25][26] ; however, data showing positive effects on prospective cardiovascular or other variables are limited and prospective studies are awaited.…”

mentioning

confidence: 99%

Morbidity prior to a Diagnosis of Sleep-Disordered Breathing: A Controlled National Study

Jennum

Ibsen²,

Kjellberg³

2013

Journal of Clinical Sleep Medicine

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“…No significant difference was seen in daytime PaCO 2 , weight loss, adherence to therapy or daytime sleepiness. The bi-level PAP therapy group reported better subjective sleep quality and performed better on a psychomotor vigilance task than the CPAP group [70].…”

Section: Bi-level Papmentioning

confidence: 99%

“…[50,[74][75][76] Bi-level PAP therapy is beneficial in preventing obstructive events, improving expiratory flow limitation and also improves tidal volume by providing inspiratory pressure support. Bilevel therapy when used long term has been shown to improve blood gases, quality of life and ventilator responsiveness to CO 2 [50,70,[77][78][79][80][81]. Bi-level PAP therapy unloads inspiratory muscles and has been shown to reduce diaphragmatic effort by nearly 40% [34].…”

Section: Bi-level Papmentioning

confidence: 99%

“…Additionally, PAP therapy opens up the smaller airways and thereby decreases ventilation perfusion mismatch and consequently improves oxygenation. Following initiation of therapy over a period of few months, improvement in other physiological parameters such as gas exchange during wakefulness [69,70] and ventilatory response to hypoxia and hypercapnia [49,51,52] and also improvement in symptoms [71] and health-related quality of life [70,71] has been reported following use of CPAP in OHS. Most studies that demonstrated the efficacy of CPAP therapy in OHS patients have been small and retrospective in nature.…”

Section: Positive Airway Pressure (Pap) Therapymentioning

confidence: 99%

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Obesity Hypoventilation Syndrome

2010

IJPM

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Obesity hypoventilation syndrome is a respiratory consequence of morbid obesity that is characterized by alveolar hypoventilation during sleep and wakefulness. The disorder involves a complex interaction between impaired respiratory mechanics, ventilatory drive and sleepdisordered breathing. Early diagnosis and treatment is important, because delay in treatment is associated with significant mortality and morbidity. Available treatment options include noninvasive positive airway pressure (PAP) therapies and weight loss. There is limited long-term data regarding the effectiveness of such therapies. This review outlines the current concepts of clinical presentation, diagnostic and management strategies to help identify and treat patients with obesityhypoventilation syndromes.

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Randomised trial of CPAP vs bilevel support in the treatment of obesity hypoventilation syndrome without severe nocturnal desaturation

Abstract: ABSTRACT

Cited by 265 publications

References 25 publications

Hypercapnia is a Key Correlate of EEG Activation and Daytime Sleepiness in Hypercapnic Sleep Disordered Breathing Patients

Hypercapnia is a Key Correlate of EEG Activation and Daytime Sleepiness in Hypercapnic Sleep Disordered Breathing Patients

Morbidity prior to a Diagnosis of Sleep-Disordered Breathing: A Controlled National Study

Obesity Hypoventilation Syndrome

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