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

• Published in: BMC pulmonary medicine Vol. 17; no. 1; p. 50
• Main Authors: Orfanos, Sarah, Jaffuel, Dany, Perrin, Christophe, Molinari, Nicolas, Chanez, Pascal, Palot, Alain
• Format: Journal Article
• Language: English
• Published: England BioMed Central 14.03.2017
• Subjects: Aged; Aged, 80 and over; Alveoli; Apnea; Continuous Positive Airway Pressure; Diurnal; Female; France; Gas exchange; Gases; Human health and pathology; Humans; Hypoventilation; Life Sciences; Lung diseases; Male; Mechanical ventilation; Medicine; Middle Aged; Nocturnal; Noninvasive Ventilation; Obesity; Obesity Hypoventilation Syndrome - blood; Obesity Hypoventilation Syndrome - therapy; Obstructive lung disease; Oximetry; Oxygen therapy; Patient Compliance; Patients; Pilot Projects; Polysomnography; Pressure; Prospective Studies; Public health; Pulmonology; Pulmonology and respiratory tract; Quality of Life; Questionnaires; Respiratory Function Tests; Respiratory tract; Sleep; Sleep apnea; Sleep disorders; Software; Task forces; Thorax; Treatment Failure; Ventilators; Bilevel positive airway pressure; Continuous positive airway pressure; Obesity hypoventilation syndrome; Obstructive sleep apnea; Non invasive ventilation
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-017-0391-9

Obesity 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. In 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. 22/30 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. This 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. ISRCTN13981084 . Registered: 27 February 2017 (retrospectively registered).