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Long-term effectiveness of CPAP in patients with severe obesity-hypoventilation syndrome

  • Sleep Breathing Physiology and Disorders • Short Communication
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Abstract

Purpose

The optimal mode of long-term positive airway pressure (PAP) treatment for obesity-hypoventilation syndrome (OHS) is not clear. The objectives of this study were to analyze whether or not patients with severe OHS treated with continuous positive airway pressure (CPAP) remained controlled with this therapy over the long term and to investigate which variables were associated with CPAP failure and the need to switch to non-invasive ventilation (NIV).

Methods

In a retrospective single-center study, patients admitted to the hospital because of severe OHS between 1996 and 2015 were analyzed. A multiple regression analysis was performed in order to determine which variables were associated with either CPAP success or failure to maintain long-term control.

Results

Of 126 consecutive patients, 115 accepted long-term PAP treatment. CPAP or NIV treatment was prescribed according to a protocol that included overnight polysomnographic PAP titration. Follow-up time was 8.0 ± 4.8 years. At the end of this period, 29% of CPAP-treated patients had been re-assigned to NIV because of recurrence of global respiratory failure. High levels of obesity, weight gain, lower FEV1/FVC values and the need for nocturnal supplementary oxygen independently predicted CPAP failure.

Conclusion

CPAP therapy for severe OHS in patients who have these risk factors should be closely monitored in the long-term for possible treatment failure.

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Abbreviations

AHI:

Apnea-hypopnea index

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

CT90%:

Percentages of time spent at saturations below 90%

FEV1%:

Percent-predicted forced expiratory volume in 1 s

FVC%:

Percent-predicted forced vital capacity

NIV:

Non-invasive ventilation

OHS:

Obesity hypoventilation syndrome

OSA:

Obstructive sleep apnea

PaO2 :

Arterial oxygen partial pressure

PaCO2 :

Arterial carbon dioxide partial pressure.

PAP:

Positive airway pressure

PEP:

Positive expiratory pressure

PIP:

Positive inspiratory pressure

ROC:

Receiver operating characteristic.

SaO2 :

Arterial oxygen saturation

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Authors and Affiliations

  1. Pneumology Service, Lucus Augusti University Hospital, C/Dr Ulises Romero 1, 27003, EOXI Lugo, Cervo y Monforte, Spain

    Luis Pérez de Llano, Olalla Castro-Añón, Laura Castro-Cabana, Lidia Méndez Marote & Rafael Golpe

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  1. Luis Pérez de Llano
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  2. Olalla Castro-Añón
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  3. Laura Castro-Cabana
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  4. Lidia Méndez Marote
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  5. Rafael Golpe
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Contributions

LPLL, OCA, and RG conceived the presented idea. LPLL and RG took the lead in writing the manuscript with support from OCA. Data acquisition: LCC, OCA, LMM. Data analysis: RG. All authors discussed the project, in person, and contributed to the final manuscript.

Corresponding author

Correspondence to Rafael Golpe.

Ethics declarations

Competing interests

Luis Perez de Llano declares to have received grants and/or fees for consultancy or speeches from Novartis, Astra-Zeneca, GSK, Teva, Boehringer-Ingelheim, Chiesi, Sanofi, Menarini, Mundipharma, and Esteve. Rafael Golpe declares that he has received speaking or advisory fees, or economic aid to attend congresses from Astra-Zeneca, GSK, Novartis, Chiesi, Mundipharma, Menarini, TEVA, Grifols, Ferrer, Boehringer-Ingelheim, Rovi, and Gebro. The rest of the authors declare that they have no conflict of interests.

Ethics approval and consent to participate

The study was approved by the Galician Ethics Committee (Reg. No. 2017/079).

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de Llano, L.P., Castro-Añón, O., Castro-Cabana, L. et al. Long-term effectiveness of CPAP in patients with severe obesity-hypoventilation syndrome. Sleep Breath 25, 947–950 (2021). https://doi.org/10.1007/s11325-020-02177-z

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  • DOI: https://doi.org/10.1007/s11325-020-02177-z

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