The Association Between Adherence to Positive Airway Pressure Therapy and Long-Term Outcomes in Patients With Obesity Hypoventilation Syndrome: A Prospective Observational Study

Abstract

Title: PAP Therapy in Patients With Obesity Hypoventilation Syndrome, Registry: ClinicalTrials.gov, Identifier: NCT03449641, URL: https://clinicaltrials.gov/ct2/show/NCT03449641.

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

“…Similar levels of adherence are reported with CPAP and NIV, of 5 to 6 h/night. Previous work has suggested adherence is an important modifiable predictor of hypercapnia in OHS (55,63).…”

“…Observational studies and RCTs have reported improvements in awake respiratory failure, symptoms, and quality of life to a similar degree in both CPAP-and NIV-treated individuals with OHS (11,20,22,55,58,63,(77)(78)(79)(80). Although CPAP does not increase alveolar ventilation, it can improve awake respiratory failure by facilitating the unloading of CO 2 accumulated during complete or partial airflow obstruction during sleep (81,82).…”

“…The current treatment of patients with OHS focuses mainly on treating SDB with PAP and not on addressing the underlying obesity or reducing overall cardiovascular risk profile. Despite adequate adherence to PAP, however, important cardiovascular and metabolic risk factors related to severe obesity persist (11,21,22), and cardiovascular morbidity and mortality rates remain high (3,20,55).…”

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

“…Most hospitalizations and deaths in untreated patients with OHS seem to be caused by respiratory complications such as acute-on-chronic respiratory chestjournal.org failure and pulmonary embolism. 11,28,29 However, in cohorts of patients with OHS undergoing long-term NIV therapy, 4,30 and in our long-term results for patients with severe OSA, 55% of the deaths were of cardiovascular etiology. 19 This finding suggests that PAP may reduce morbidity and mortality because of respiratory causes but has less impact on cardiovascular outcomes.…”

Obesity Hypoventilation Syndrome: Will Early Detection and Effective Therapy Improve Long-Term Outcomes?

“…This interest is reflected in the studies by Sivam and colleagues and Bouloukaki and colleagues published in this issue of the Journal of Clinical Sleep Medicine. 1,2 Sivam and colleagues investigate the prevalence of isolated nocturnal hypercapnia in obese patients referred to an outpatient sleep unit for suspected sleep-disordered breathing. 1 This study relies on a premise that OHS represents a clinical spectrum, whereby patients with isolated nocturnal hypoventilation may go on to develop daytime hypoventilation.…”