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

Orfanos, S.; Jaffuel, Dany; Perrin, Christophe; Molinari, Nicolas; Chanez, Pascal; Palot, A.

doi:10.1186/s12890-017-0391-9

Cited by 27 publications

(24 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, BPAP set up and maintenance requires adjustment of more variables and is more expensive than CPAP. 17 However, patients with severe OSA requiring high pressures on CPAP empirically find BPAP a more physiological breathing pattern and, thus, easier to tolerate.…”

Section: Summary At a Glancementioning

confidence: 99%

“…An alternative to CPAP therapy is bilevel positive airway pressure (BPAP); however, BPAP is frequently overlooked as it employs similar features to CPAP including a facial mask and positive pressures for ventilation. Furthermore, BPAP set up and maintenance requires adjustment of more variables and is more expensive than CPAP . However, patients with severe OSA requiring high pressures on CPAP empirically find BPAP a more physiological breathing pattern and, thus, easier to tolerate.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

et al. 2019

View full text Add to dashboard Cite

Background and objective Continuous positive airway pressure (CPAP) is the most common treatment for obstructive sleep apnoea (OSA), but many patients fail long‐term therapy. Bilevel positive airway pressure (BPAP) is a potential alternative. We hypothesized that BPAP could improve treatment adherence and outcomes in patients who cannot tolerate CPAP. Methods Patients with OSA who failed CPAP (usage < 4 h/day) and were referred to a tertiary sleep centre between 2014 and 2017 for BPAP were included. Age, gender, body mass index (BMI), co‐morbidities, CPAP use and reasons for failure, Epworth Sleepiness Scale (ESS), sleep study data, spirometry data and average maximum nightly compliance were recorded. Results A total of 52 patients with OSA requiring CPAP > 15 cm H2O (71% male, age: 58 (15) years, BMI: 42.6 (10.1) kg/m2, apnoea–hypopnoea index (AHI): 51.1 (30.4)/h) were studied; 62% had respiratory co‐morbidities affecting nocturnal breathing including obesity hypoventilation syndrome and COPD; 25% had neuromuscular conditions; and 17% had cardiovascular disease. CPAP was used for 199 (106–477) days prior to referral for BPAP. Reasons for CPAP failure were intolerant pressures (23%), uncontrolled symptoms (23%), mask problems (21%), adverse effects (13%), claustrophobia (8%), co‐morbidities (8%) and other issues (4%). Lower expiratory positive airway pressures were needed with BPAP compared to CPAP (10 (8–12) vs 16.8 (15.7–19.2) cm H2O, P = 0.001); patients achieved better adherence to BPAP (7.0 (4.0–8.5) vs 2.5 (1.6–6.7) h/night, P = 0.028) and better symptom control (ESS: 4.0 (1.0–7.0) vs 10.0 (6.0–17.0) points, P = 0.039). Conclusion In patients with moderate–severe OSA who fail CPAP therapy due to low adherence, BPAP is well tolerated and achieves sufficient control of sleep‐disordered breathing and its symptoms.

show abstract

Section: Summary At a Glancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…A pilot study that probed the feasibility of switching 15 OHS patients from NIV to CPAP also reported positive results . However, the patients in that study only had mild OHS.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

“…Once these patients achieve clinical stability with resolution of respiratory failure, consideration can be given to switching the patients from NIV to CPAP therapy. This has been shown to be safe with no detriment in the control of sleep‐disordered breathing (oximetry‐capnography), respiratory failure (arterial blood gases), subjective sleep quality (Pittsburgh sleep quality index), daytime hypersomnolence (Epworth sleepiness score) or health‐related quality of life (severe respiratory insufficiency questionnaire) in the short term …”

Section: Management Of Obesity‐related Respiratory Failurementioning

confidence: 99%

“…This has been shown to be safe with no detriment in the control of sleep-disordered breathing (oximetry-capnography), respiratory failure (arterial blood gases), subjective sleep quality (Pittsburgh sleep quality index), daytime hypersomnolence (Epworth sleepiness score) or health-related quality of life (severe respiratory insufficiency questionnaire) in the short term. 54 While much data exist that fail to demonstrate the clear superiority of NIV over CPAP therapy in patients with OHS and severe OSA, it must be appreciated that none were non-inferiority trials due to the powering and trial design. To illustrate this point, if the findings of the study by Howard et al are examined, although there is no difference in treatment failure between groups, the 95% CI provides an estimate of 13 fewer to 34 more patients per 100 achieving treatment success.…”

Section: Ohs With Significant Osamentioning

confidence: 99%

Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

2019

View full text Add to dashboard Cite

Obesity‐related respiratory failure is increasingly common but remains under‐diagnosed and under‐treated. There are several clinical phenotypes reported, including severe obstructive sleep apnoea (OSA), isolated nocturnal hypoventilation with or without severe OSA and OSA complicating chronic obstructive pulmonary disease (COPD). The presence of hypercapnic respiratory failure is associated with poor clinical outcomes in each of these groups. While weight loss is a core aim of management, this is often unachievable, and treatment of sleep‐disordered breathing with positive airway pressure (PAP) therapy is the mainstay of clinical practice. Although there are few long‐term clinical efficacy trials, the lack of equipoise would prevent the utilization of an untreated control group. The current data support the use of PAP therapy to improve respiratory failure and is associated with improvements in health‐related quality of life, reduced healthcare utilization and reduced mortality. Both continuous PAP (CPAP) and non‐invasive ventilation (NIV) appear safe and effective in patients with obesity‐related respiratory failure and OSA, with or without COPD, and the current evidence would not support a single therapy choice in all patients. There are no studies of CPAP in patients with isolated nocturnal hypoventilation, and NIV would be the current recommendation in this patient group. Whichever starting therapy is used, titration should be performed to correct sleep‐disordered breathing and reverse chronic respiratory failure, with consideration of step‐down of the treatment based on a clinical re‐evaluation. In contrast, failure to reach physiological and clinical treatment targets should lead to the consideration of treatment escalation.

show abstract

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

Cited by 27 publications

References 26 publications

BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

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

Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

Contact Info

Product

Resources

About