Continuous positive airway pressure in clinically stable patients with mild‐to‐moderate obesity hypoventilation syndrome and obstructive sleep apnoea

Salord, Neus; Mayos, Mercedes; Miralda, R.; Farré, A.; Carreras, Montserrat; Sust, Rosa; Masuet-Aumatell, Cristina; Rodrı́guez, José Luis; Pérez, Antonio Montes

doi:10.1111/resp.12131

Cited by 43 publications

(28 citation statements)

References 30 publications

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“…In an unselected cohort of patients with OSA, Schafer et al found that those with morbid obesity and impaired awake blood gas values were more likely to fail CPAP therapy [15]. Indeed, early CPAP failure was observed among ~24% of patients with the obesity hypoventilation syndrome, and those patients with worse night-time saturation while on CPAP and higher daytime PaCO 2 at 1 month were more likely to fail CPAP treatment [16]. In the present cohort of patients with OSA and concurrent COPD, the BMI was predictive of early CPAP failure in univariate analysis, which was in agreement with previous findings [16].…”

Section: Discussionmentioning

confidence: 95%

“…Indeed, early CPAP failure was observed among ~24% of patients with the obesity hypoventilation syndrome, and those patients with worse night-time saturation while on CPAP and higher daytime PaCO 2 at 1 month were more likely to fail CPAP treatment [16]. In the present cohort of patients with OSA and concurrent COPD, the BMI was predictive of early CPAP failure in univariate analysis, which was in agreement with previous findings [16]. Importantly, CT90% and PCO 2 while awake predicted CPAP failure independently of BMI, OSA severity and of other confounders in a multivariate analysis in the present OSA-COPD overlap patients.…”

Section: Discussionmentioning

confidence: 98%

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Severity of nocturnal hypoxia and daytime hypercapnia predicts CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

et al. 2017

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Severity of nocturnal hypoxia and daytime hypercapnia predicts CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

et al. 2017

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“…If some studies have attempted to determine different OHS’s phenotypes to predict the outcome of CPAP therapy [8–10]; only two studies prospectively compared NIV and CPAP treatment in OHS [5, 11]. To date, the superiority of NIV over CPAP in the treatment of OHS has not been proven.…”

Section: Introductionmentioning

confidence: 99%

Switch of noninvasive ventilation (NIV) to continuous positive airway pressure (CPAP) in patients with obesity hypoventilation syndrome: a pilot study

et al. 2017

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BackgroundObesity is a major worldwide public health issue. The main respiratory complication stemming from obesity is obesity hypoventilation syndrome (OHS). Most of the OHS patients diagnosed during an exacerbation are treated with non invasive ventilation (NIV). Up to date, no prospective study has demonstrated in real life conditions the feasibility of a systematic protocoled switch of NIV to continuous positive airway pressure (CPAP), once stability is achieved.MethodsIn this prospective study, we included stable patients with OHS, with moderate to severe concomitant obstructive sleep apnea (OSA) and without obstructive pulmonary disease, who had been undergoing NIV for more than 2 months. The following measurements were performed, first with NIV and then after the switch to CPAP: diurnal arterial blood gas measurements; nocturnal oximetry and capnometry; mean compliance and AHI; measures of quality of life and quality of sleep.Results22/30 patients accepted to participate in the study and 15/22 patients completed the study. There were no significant differences for pooled data in diurnal alveolar blood gases, nocturnal capnometry (p = 0.534), nocturnal oximetry (p = 0.218), mean compliance (p = 0.766), mean AHI (p = 0.334), quality of life or quality of sleep. Eighty percent of the patients treated in this study favored CPAP over NIV.ConclusionThis pilot study showed in real life conditions the possibility of a systematic switch of NIV to CPAP, in most stable patients with OHS, with similar efficacy on diurnal and nocturnal alveolar gas exchange, quality of life and quality of sleep.Trial registration ISRCTN13981084. Registered: 27 February 2017 (retrospectively registered)

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“…One of them was randomized clinical trial (RCT) [19], the remaining studies were observational [20][21][22][23][24][25][26][27][28][29]. One study [27] reported results separately for obese group and non-obese group.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Effect of Continuous Positive Airway Pressure on Adiponectin in Patients With Obstructive Sleep Apnea: A Meta-analysis

Chen

Lin

Liu

2016

Chest

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ObjectiveObstructive sleep apnea (OSA) has been suggested to be associated with low levels of adiponectin. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; however, previous studies assessing the effect of CPAP on adiponectin in patients with OSA yielded conflicting results. The present meta-analysis was performed to determine whether CPAP therapy could increase adiponectin levels. MethodsTwo reviewers independently searched PubMed, Cochrane library, Embase and Web of Science before February 2015. Information on characteristics of subjects, study design and pre-and post-CPAP treatment of serum adiponectin was extracted for analysis. Standardized mean difference (SMD) was used to analyze the summary estimates for CPAP therapy. ResultsEleven studies involving 240 patients were included in this meta-analysis, including ten observational studies and one randomized controlled study. The meta-analysis showed that there was no change of adiponectin levels before and after CPAP treatment in OSA patients (SMD = 0.059, 95% confidence interval (CI) = −0.250 to 0.368, z = 0.37, p = 0.710). Subgroup analyses indicated that the results were not affected by age, baseline body mass index, severity of OSA, CPAP therapy duration, sample size and racial differences.

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Continuous positive airway pressure in clinically stable patients with mild‐to‐moderate obesity hypoventilation syndrome and obstructive sleep apnoea

Abstract: CPAP treatment improves night-time oxygenation and daytime hypoventilation in selected clinically stable OHS patients who also have OSA. Patients with worse night-time saturation while on CPAP and higher daytime PaCO(2) at 1 month were more likely to fail CPAP treatment.

Cited by 43 publications

References 30 publications

Severity of nocturnal hypoxia and daytime hypercapnia predicts CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

Severity of nocturnal hypoxia and daytime hypercapnia predicts CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

Switch of noninvasive ventilation (NIV) to continuous positive airway pressure (CPAP) in patients with obesity hypoventilation syndrome: a pilot study

Effect of Continuous Positive Airway Pressure on Adiponectin in Patients With Obstructive Sleep Apnea: A Meta-analysis

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