Results of CPAP Titration and Short-Term Adherence Rates in Patients with Obesity Hypoventilation Syndrome and Mild/Moderate Obstructive Sleep Apnea

• Published in: Nature and science of sleep Vol. 14; pp. 1137 - 1148
• Main Authors: BaHammam, Ahmed S, Aleissi, Salih A, Nashwan, Samar Z, Olaish, Awad H, Almeneessier, Aljohara S
• Format: Journal Article
• Language: English
• Published: Dove Medical Press Limited 30.06.2022; Dove; Dove Medical Press
• Subjects: Analysis; bi-level positive airway pressure; Care and treatment; compliance; Continuous positive airway pressure; cpap; desaturation; Health aspects; Obesity hypoventilation syndrome; obstructive sleep apnea; Original Research; Patient compliance; titration; Saudi Arabia
• ISSN: 1179-1608; 1179-1608
• DOI: 10.2147/NSS.S369316

Purpose: No study has assessed the titration success of CPAP therapy in patients with obesity hypoventilation syndrome (OHS) and an apnea-hypopnea index (AHI) <30 event/h. This study aimed to assess the titration success of CPAP therapy under polysomnography and subsequent short-term adherence (1 month) in patients with OHS and an AHI <30 event/h. Methods: Consecutive OHS patients with an AHI <30 events/h between 2010 and 2019 were included (n=54). All OHS patients were first started on CPAP during the therapeutic sleep-study. If the therapeutic-study showed that the SpO2 remained < 90% for 20% of the total sleep time, a second therapeutic study was arranged with bi-level PAP (BPAP). Thirty patients agreed to participate in the 1-month follow-up adherence study. We applied the American-Thoracic-Society criteria for PAP adherence. Results: The mean age was 54.8[+ or -]14.6 years, and the mean BMI was 45.9[+ or -]12.2 kg/[m.sup.2]. Successful titration on CPAP was attained in 36 (66.7%) patients, and 18 (33.3%) required BPAP. Patients who failed the CPAP trial had a significantly higher PaCO2 and bicarbonate, a more restrictive respiratory pattern on spirometry, and a significantly higher time with SpO2<90% (mins) during sleep. The only independent correlate of CPAP-titration success on the multivariable regression analysis was the desaturation index (OR: 1.33 [1.033-1.712]). More than 80% of the participants were using CPAP therapy after one-month with no differences in adherence between the CPAP and BPAP groups. Conclusions: The current results suggest that CPAP therapy could be an acceptable alternative therapy to BPAP in patients with OHS without severe OSA. Keywords: CPAP, bi-level positive airway pressure, compliance, obstructive sleep apnea, desaturation, titration