The Role of Positive Airway Pressure Therapy in Adults with Obesity Hypoventilation Syndrome. A Systematic Review and Meta-Analysis

Afshar, Majid; Brožek, Jan; Soghier, Israa; Kakazu, Maximiliano Tamae; Wilson, Kevin C.; Masa, Juan F.; Mokhlesi, Babak

doi:10.1513/annalsats.201907-528oc

Cited by 28 publications

(12 citation statements)

References 37 publications

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“…Inasmuch as NIV seems superior to CPAP for daytime hypercapnia, emerging evidence in literature from recent guidelines and studies (Afshar et al., 2019; Gomez de Terreros et al., 2019; Masa et al., 2019; Mokhlesi et al., 2019) favours CPAP as a cost‐effective initial PAP intervention, citing that the apparent superiority of NIV over CPAP stems from a few RCTs showing superiority based only on physiological outcomes over a short or medium term (3 months) with a relative paucity of data (Masa et al., 2019) on outcomes related to healthcare utilisation. Even so, evidence from at least one RCT (Howard et al., 2017) shows that the only significant predictor of persistent ventilatory failure in patients with OHS after 3 months of follow‐up was the degree of PaCO 2 at baseline, with an eightfold increased risk for those with a PaCO 2 of >62 mmHg, suggesting that the presence of daytime hypercapnia in patients with OHS does indeed confer a substantially higher clinical risk than eucapnic obstructive sleep apnea (OSA).…”

Section: Discussionmentioning

confidence: 99%

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

Iftikhar

Greer

Wigger

et al. 2020

Journal of Sleep Research

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Obesity hypoventilation syndrome (OHS) is defined as obesity, sleep-disordered breathing, and hypercapnic respiratory failure in the absence of another cause of hypoventilation (Iftikhar & Roland, 2018). There is an increasing prevalence of OHS in parallel with the worldwide increase in obesity (Ng et al., 2014) and it is also the most common indication for home non-invasive ventilation (NIV) in many countries (Garner et al., 2013). Because systemic inflammation, endothelial dysfunction, and insulin resistance are more pronounced in people with OHS compared with eucapnic obesity, OHS is associated with several different cardiovascular and metabolic abnormalities, as well as complications such as pulmonary hypertension, cor pulmonale and unstable respiratory failure

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Section: Discussionmentioning

confidence: 99%

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

Iftikhar

Greer

Wigger

et al. 2020

Journal of Sleep Research

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“…OSA phenotype, CPAP therapy is considered the first-line therapy [15]. CPAP relieves OSA and ameliorates hypoventilation over an average of 3-month period [16].…”

Section: Central Sleep Apnea Due To High-altitude Periodic Breathingmentioning

confidence: 99%

Sleep-Related Breathing Disorders: When CPAP Is Not Enough

Selim

Ramar

2021

Neurotherapeutics

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Three decades ago, continuous positive airway pressure (CPAP) was introduced to treat obstructive sleep apnea (OSA). Shortly after, bilevel positive airway pressure devices (BPAP) that independently adjusted inspiratory and expiratory positive airway pressure were developed to treat complex sleep-related breathing disorders unresponsive to CPAP. Based on the bilevel positive airway pressure platform (hardware) governed by propriety algorithms (software), advanced modes of noninvasive ventilation (NIV) were developed to address complex cardiorespiratory pathophysiology beyond OSA. This review summarizes key aspects of different bilevel PAP therapies (BPAP with/without backup rate, adaptive servoventilation, and volume-assured pressure support) to treat common sleep-related hypoventilation disorders, treatment-emergent central sleep apnea, and central sleep apnea syndromes.

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“…20 The year 2020 has seen the publication of several of the systematic reviews that underpinned their recommendations, including into the role of PAP therapy. 21 Only three short-term (1-2 months) RCTs had compared PAP to supportive care, although there are multiple non-randomized comparative studies. PAP therapy was associated with increased resolution of OHS and reduction in mortality, gas exchange, emergency presentations and quality of life measures.…”

Section: Prevalence Of Osa Key Pointsmentioning

confidence: 99%

Contemporary Concise Review 2020: Sleep

Ainge‐Allen

Yee

2021

Respirology

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Obstructive sleep apnoea (OSA) now affects one-seventh of the world's population.• Treatment of even mild OSA can improve daytime sleepiness and quality of life.• Recent modifications to uvulopalatopharyngoplasty may make it a more widely applicable treatment option in selected patients with OSA. • Diet and exercise have effects on sleep apnoea severity independent of weight loss.• Insomnia has become increasingly common during the coronavirus disease 2019 (COVID-19) pandemic.

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The Role of Positive Airway Pressure Therapy in Adults with Obesity Hypoventilation Syndrome. A Systematic Review and Meta-Analysis

Cited by 28 publications

References 37 publications

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

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

Sleep-Related Breathing Disorders: When CPAP Is Not Enough

Contemporary Concise Review 2020: Sleep

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