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Obesity hypoventilation syndrome treated with non‐invasive ventilation: Is a switch to CPAP therapy feasible?
Author(s) -
ArellanoMaric Maria P.,
Hamm Christine,
Duiverman Marieke L.,
Schwarz Sarah,
Callegari Jens,
Storre Jan H.,
Schmoor Claudia,
Spielmanns Marc,
Galetke Wolfgang,
Windisch Wolfram
Publication year - 2020
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13704
Subject(s) - medicine , obesity hypoventilation syndrome , continuous positive airway pressure , hypoventilation , copd , hypercapnia , polysomnography , positive airway pressure , anesthesia , restrictive lung disease , ventilation (architecture) , pulmonary function testing , obstructive sleep apnea , respiratory system , apnea , mechanical engineering , acidosis , engineering
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 (PaCO 2 ) 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.