Obesity Hypoventilation Syndrome Research Articles

Gender differences in obstructive sleep apnea syndrome: a pilot study.

OSAS is a syndrome that often presents clinically differently between men and women. The aim of this study was to assess the clinical presentation, nocturnal home sleep cardiorespiratory monitoring and therapeutic adherence to CPAP in both sexes to identify the most frequent patterns. Data from the first visit, the nocturnal home sleep cardiorespiratory monitoring and follow-up visit of 74 OSA patients were collected. Exclusion criteria included other respiratory and/or neuromuscular diseases (including Obesity hypoventilation syndrome) and other non-respiratory sleep disorders. Men were older and had a higher supine AHI and ODI compared to women. In addition, BMI and age correlated positively with AHI in males. Women had a higher hypopneas frequency and better therapeutic adherence to CPAP. Men were associated with a higher AHI when sleeping in the supine position and this may be useful to look for new therapeutic options in combination with or as an alternative to CPAP. BMI correlated positively with AHI in men and this should be considered to stimulate weight loss as the main treatment to reduce the number of apneas/hypopneas, as men also had less therapeutic adherence to CPAP in our study. Females presented a significantly higher frequency of hypopneas than men, as well as a lower number of desaturation events per hour (ODI): these differences in the nocturnal home sleep cardiorespiratory monitoring could reflect different pathophysiological mechanisms of OSAS onset between the two sexes, which should be investigated in future scientific studies.

A-51 | In-Hospital Outcomes of Acute Myocardial Infarction in Patients with Obesity Hypoventilation Syndrome: A Retrospective Cohort Study

A-51 | In-Hospital Outcomes of Acute Myocardial Infarction in Patients with Obesity Hypoventilation Syndrome: A Retrospective Cohort Study

Pulmonary Hypertension Associated with Chronic Lung Disease

Abstract: Patients with Chronic Lung Disease (CLD) are frequently burdened by pulmonary hypertension (PH), which is associated with reduced functional capacity, poor quality of life, increased oxygen requirements, and increased morbidity and mortality. The development of PH associated with chronic lung disease (PH-CLD) is complex and multifactorial and varies between different types of CLD. In this review, we provide an update on PH-CLD, with a particular focus on Interstitial Lung Disease (ILD), chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and obesity hypoventilation syndrome (OHS). We discussed epidemiology, histopathology, pathophysiology, diagnostic evaluation, and treatment approaches. There are limited data on the use of pulmonary arterial hypertension-specific treatments in PH-CLD, so it has been proposed to phenotype patients based on their degree of pulmonary vascular disease to guide individualized care. The heterogeneity within PH-CLD highlights the importance of identifying novel molecular pathways unique to each subgroup to ultimately achieve precision medicine.

Treatment and long-term follow-up of obesity hypoventilation syndrome

Bevezetés: Az obesitas-hypoventilatiós szindróma (OHS) a tartós otthoni noninvazív légzéstámogatás leggyakoribb indikációja világszerte. Magyarországon ma még kevés adat áll rendelkezésre előfordulásáról és kimeneteléről, bár a tartós otthoni lélegeztetés finanszírozási és terápiás lehetőségei közel egy évtizede elérhetők. Célkitűzés: Vizsgálatunk célja az volt, hogy a Semmelweis Egyetem Otthoni Lélegeztetési Programjában gondozott OHS-páciensek rövid és hosszú távú klinikai mutatóit elemezzük, különös tekintettel a betegek hosszú távú túlélésére. Módszer: Prospektív vizsgálatunk során azokat az OHS-pácienseket követtük nyomon, akik esetében a tartós légzéstámogatás 2018. 01. 01. és 2023. 01. 30. között indult. Eredmények: A vizsgálatba 63 OHS-beteget vontunk be. A hosszú távú légzéstámogatás 25 (40%) esetben elektíven, 38 (60%) esetben pedig akut légzési elégtelenség kezelését követően került beállításra. 6 hónap lélegeztetésterápiát követően a betegek 96,83%-a (61 páciens) jó együttműködést mutatott a terápiával. A kontrollvizsgálat adatai alapján a betegek átlagosan napi 7,49 (± 2,92) órát használták a noninvazív lélegeztetőgépet, és 54 páciens (86%) esetében elérhető volt a normocapnia. A 63 beteg teljes gondozási ideje a megfigyelési időszak (67 hónap) alatt átlagosan 32,51 (± 18,45) hónap volt, és 6 hónaptól 66 hónapig terjedt. Számításunk alapján a vizsgálatban részt vevők 5 éves kumulatív túlélése 86% volt. Következtetés: Az OHS-betegek a protokoll szerinti, célorientált tartós légzéstámogatás mellett igen jó klinikai eredményekre és a nemzetközi irodalmi adatokhoz képest is kiemelkedő túlélésre számíthatnak. Orv Hetil. 2024; 165(10): 385–392.

Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation?

Background and objectiveNon-invasive ventilation (NIV) improves survival of patients with chronic respiratory failure (CRF). Most often, pressure settings are made to normalize arterial blood gases. However, this objective is not always achieved due to intolerance to increased pressure or poor compliance. Few studies have assessed the effect of persistent hypercapnia on ventilated patients’ survival. Data from the Pays de la Loire Respiratory Health Research Institute cohort were analyzed to answer this question. Study design and methodsNIV-treated adults enrolled between 2009 and 2019 were divided into 5 subgroups: obesity-hypoventilation syndrome (OHS), COPD, obese COPD, neuromuscular disease (NMD) and chest wall disease (CWD). PaCO2 correction was defined as the achievement of a PaCO2 < 6 kPa or a 20% decrease in baseline PaCO₂ in COPD patients. The endpoint was all-cause mortality. Follow-up was censored in case of NIV discontinuation. ResultsData from 431 patients were analyzed. Median survival was 103 months and 148 patients died. Overall, PaCO2 correction was achieved in 74% of patients. Bivariate analysis did not show any survival difference between patients who achievedPaCO₂ correction and those who remained hypercapnic: overall population: p = 0.74; COPD: p = 0.97; obese COPD: p = 0.28; OHS: p = 0.93; NMD: p = 0.84; CWD: p = 0.28. ConclusionModerate residual hypercapnia under NIV does not negatively impact survival in CRF patients. In individuals with poor tolerance of pressure increases, residual hypercapnia can therefore be tolerated under long-term NIV. Larger studies, especially with a higher number of patients with residual PaCO2 > 7 kPa, are needed to confirm these results.

Obesity hypoventilation syndrome prevalence and its impact in sleep oxygen saturation in 3 cities located at different altitudes

Obesity hypoventilation syndrome prevalence and its impact in sleep oxygen saturation in 3 cities located at different altitudes

Revisiting the Role of Serotonin in Sleep-Disordered Breathing.

Serotonin or 5-hydroxytryptamine (5-HT) is a ubiquitous neuro-modulator-transmitter that acts in the central nervous system, playing a major role in the control of breathing and other physiological functions. The midbrain, pons, and medulla regions contain several serotonergic nuclei with distinct physiological roles, including regulating the hypercapnic ventilatory response, upper airway patency, and sleep-wake states. Obesity is a major risk factor in the development of sleep-disordered breathing (SDB), such as obstructive sleep apnea (OSA), recurrent closure of the upper airway during sleep, and obesity hypoventilation syndrome (OHS), a condition characterized by daytime hypercapnia and hypoventilation during sleep. Approximately 936 million adults have OSA, and 32 million have OHS worldwide. 5-HT acts on 5-HT receptor subtypes that modulate neural control of breathing and upper airway patency. This article reviews the role of 5-HT in SDB and the current advances in 5-HT-targeted treatments for SDB.

A comparison of two obesity-related hypoventilation disorders: Impact on sleep, quality of life and neurocognitive outcomes and the effects of positive airway pressuretherapy.

Symptom impact and neurocognitive function have not been previously compared between patients with obesity-associated hypoventilation disorders (obesity hypoventilation syndrome [OHS]) and hypoventilation in the setting of obesity and obstructive airways disease (OHAD). The aim of this study is to compare baseline sleep-related symptoms, health-related quality of life, and neurocognitive function between OHS and OHAD and the impact of PAP therapy on these outcomes. Epworth Sleepiness Scale (ESS), Pittsburgh Sleepiness Quality Index (PSQI), SF36, and various neurocognitive tests, in addition to anthropometric, polysomnography, lung function, and blood gas data from participants with OHS and participants with OHAD, were included in the analysis. These data were originally collected in their respective randomized clinical trials, comparing the efficacy of different PAP modes (bilevel PAP vs. CPAP) in resolving hypercapnia. Between groups (OHS vs OHAD), pre- and post-treatment (with 3 months of positive airway pressure) comparisons were made using linear mixed modeling. 45 OHS participants (mean age 51 years old, 33% female, BMI 52kg/m2, FER 0.81, PaCO2 54 mmHg, AHI 87/h) and 32 OHAD participants (mean age 61years old, 31% female, BMI 43kg/m2, FER 0.60, PaCO2 54 mmHg, AHI 59/h) were included in the analysis. Both OHS and OHAD had similar baseline ESS (14(5.6) vs. 12(5.4)), Global PSQI (10(3.2) vs. 11(4.8)), SF36 and neurocognitive test performances (other than OHAD had lower digit symbol substitution test performance). Treatment with PAP therapy resulted in similar ESS, Global PSQI, and SF36 improvements in both groups. Neurocognitive performance did not significantly improve after PAP therapy in either group. The symptom impact between two separate hypoventilation disorders (OHS and OHAD), in terms of sleepiness, sleep quality, quality of life, and cognitive function, were similar. OHS and OHAD had similar treatment responses in these parameters after 3 months of PAP therapy.Nocturnal ventilatory support in OHS.

Mask Continuous Positive Airway Pressure Increases Diaphragm Thickening Fraction in Healthy Subjects

Introduction: The most widespread treatment for obstructive sleep apnoea and obesity hypoventilation syndrome is continuous positive airway pressure (CPAP). The addition of inspiratory support is a potential alternative. This is a physiological study to determine the effect of CPAP and inspiratory support pressure on respiratory effort measured by diaphragm thickening fraction (DTF) in healthy volunteers. Methods: DTF was measured in spontaneously breathing, healthy volunteers during 4 phases: (I) without connection to a ventilator, (II) on a ventilator without any applied pressures, (III) with a CPAP of 5 cmH₂O, and (IV) with an additional inspiratory support pressure of 5 cmH₂O. Results: Twenty-nine individuals agreed to participate. DTF was similar during the first two phases (32 ± 13% and 35 ± 22%). A considerable increase in DTF to 51 ± 21% was noted in phase III. The introduction of inspiratory support pressure during phase IV led to a reduction in DTF back to 36 ± 23% (p < 0.001). Tidal volume and minute ventilation were both slightly higher in phase IV compared to phase III. Conclusion: CPAP without inspiratory support pressure increases respiratory effort measured by DTF in healthy subjects. Further research is required to investigate this phenomenon in a clinical setting.

ДИХАЛЬНІ РОЗЛАДИ ПІД ЧАС СНУ У ДОРОСЛИХ: ТЕМИ ПОТОЧНИХ НАУКОВИХ ДОСЛІДЖЕНЬ ТА ОСНОВНІ ОНОВЛЕННЯ ПРАКТИЧНИХ РЕКОМЕНДАЦІЙ

Respiratory disorders during sleep are an urgent and multifaceted problem of clinical medicine, in which the insufficient practical implementation of medical care for patients does not correspond to fundamental scientific achievements. The aim of this review was to assess the significant updates of practical recommendations for the diagnosis and treatment of sleep-disordered breathing in adults. The global lack of practical success in the treatment of patients with sleep-related breathing disorders supports the high relevance of the problem and prompts new research in pathology (biomarkers, structural disorders, risk factors, etc.) and modification of devices for diagnosis and therapy. Today, the classification of sleep-related breathing disorders has been updated. The functional criteria of polysomnography in determining ventilation disorders have been clarified. Diagnostic criteria for disorders associated with obstructive and central sleep apnea have undergone minor changes. Updated practice guidelines for obstructive sleep apnea include failure of CPAP therapy, revised indications for positional therapy, and upper airway or bariatric surgery. Updates in the treatment of central sleep apnea relate to the functional state of the heart and the type of respiratory disorder. In heart failure with a reduced ejection fraction adaptive servo-ventilation is contraindicated, in hypercapnia and/or hypoventilation during the rapid phase of sleep non-invasive lung ventilation is required. Current updates recommend positive airway pressure therapy (CPAP-therapy for concomitant severe obstructive sleep apnea) in stable outpatients with obesity-hypoventilation syndrome, and noninvasive ventilation in hospitalized patients with respiratory failure. General approaches to treatment remain constant: ventilatory disorders require appropriate mechanical correction. Key words: sleep-related breathing disorders, obstructive sleep apnea, central sleep apnea.

Sleep-disordered Breathing and Inpatient Outcomes in Nonsurgical Patients: Analysis of the Nationwide Inpatient Cohort.

Rationale: Sleep-disordered breathing (SDB) is associated with increased complications and length of stay (LOS) after surgery. SDB-related adverse consequences for nonsurgical admissions are not well defined. Objectives: Evaluate associations between SDB and subtypes and LOS, cost, and mortality in nonsurgical patients. Methods: This retrospective cohort analysis used adult nonsurgical admissions from the 2017 National Inpatient Sample of the Healthcare Costs and Utilization Project. SDB associations with LOS (primary outcome), costs, and mortality were evaluated via logistic regression. Covariates included age, sex, Elixhauser Comorbidity Index, socioeconomic status, hospital type, and insurance type. Results: The cohort included 6,046,544 hospitalizations. Compared with those without SDB, patients with SDB were older (63.6 ± 13.5 vs. 57.4 ± 20.7 yr), higher proportion male (55.8% vs. 40.9%), and more likely to be White (75.7% vs. 66.5%). SDB was associated with increased odds of increased LOS and hospitalization costs (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.16-1.17 and OR, 1.67; 95% CI, 1.66-1.67 in adjusted analyses, respectively) but lower mortality (OR, 0.79; 95% CI, 0.77-0.81). The results for obstructive sleep apnea (OSA) echoed those for SDB. Obesity hypoventilation syndrome had substantially increased LOS (OR, 3.05; 95% CI, 2.98-3.13), mortality (1.76; 95% CI, 1.66-1.86), and costs (OR, 2.67; 95% CI, 2.60-2.73) even after adjustment. Conclusions: Obesity hypoventilation syndrome is associated with higher LOS, mortality, and costs during hospitalization, whereas OSA, despite higher LOS and costs, is associated with decreased mortality. Investigation is warranted on whether paradoxically higher costs but lower mortality in OSA may be indicative of less vigilance in hospitalized patients with undiagnosed SDB.

Using intra-breath oscillometry in obesity hypoventilation syndrome to detect tidal expiratory flow limitation: a potential marker to optimize CPAP therapy

BackgroundContinuous positive airway pressure (CPAP) therapy has profound effects in obesity hypoventilation syndrome (OHS). Current therapy initiation focuses on upper airway patency rather than the assessment of altered respiratory mechanics due to increased extrapulmonary mechanical load.MethodsWe aimed to examine the viability of intra-breath oscillometry in optimizing CPAP therapy for OHS. We performed intra-breath oscillometry at 10 Hz in the sitting and supine positions, followed by measurements at increasing CPAP levels (none-5-10-15-20 cmH2O) in awake OHS patients. We plotted intra-breath resistance and reactance (Xrs) values against flow (V’) and volume (V) to identify tidal expiratory flow limitation (tEFL).ResultsThirty-five patients (65.7% male) completed the study. We found a characteristic looping of the Xrs vs V’ plot in all patients in the supine position revealing tEFL: Xrs fell with decreasing flow at end-expiration. Intra-breath variables representing expiratory decrease of Xrs became more negative in the supine position [end-expiratory Xrs (mean ± SD): -1.9 ± 1.8 cmH2O·s·L− 1 sitting vs. -4.2 ± 2.2 cmH2O·s·L− 1 supine; difference between end-expiratory and end-inspiratory Xrs: -1.3 ± 1.7 cmH2O·s·L− 1 sitting vs. -3.6 ± 2.0 cmH2O·s·L− 1 supine, p < 0.001]. Increasing CPAP altered expiratory Xrs values and loop areas, suggesting diminished tEFL (p < 0.001). ‘Optimal CPAP’ value (able to cease tEFL) was 14.8 ± 4.1 cmH2O in our cohort, close to the long-term support average of 13.01(± 2.97) cmH2O but not correlated. We found no correlation between forced spirometry values, patient characteristics, apnea-hypopnea index and intra-breath oscillometry variables.ConclusionstEFL, worsened by the supine position, can be diminished by stepwise CPAP application in most patients. Intra-breath oscillometry is a viable method to detect tEFL during CPAP initiation in OHS patients and tEFL is a possible target for optimizing therapy in OHS patients.

A Narrative Review of the Clinical Trials in Sleep-Related Breathing Disorders from 2022 to Present.

Sleep-related breathing disorders (SRBD) comprise obstructive sleep apnea (OSA), central sleep apnea (CSA), obesity-hypoventilation syndrome (OHS), as well as isolated sleep-related hypoxemia (ISRH), according to the recent International Classification of Sleep Disorders 3. During the last decades, there have been cumulative research reports indicating an association between the SRBD and increased cardiometabolic illness and death, as well as decreased quality of life. Notwithstanding, the results have been inconclusive, and the evidence level was not high regarding the effect of treatment for the SRBD on adverse outcomes. In the current work, we aim to give a comprehensive review of the clinical trials published from January 2022 to August 31, 2023. We highlight the heterogeneity of cardiometabolic disorders among adults with SRBD and particularly emphasize OSA management, drug therapy for OSA, positive airway pressure (PAP) therapy and cardiovascular outcomes, other effects of PAP in pregnancy and neurocognitive function, as well as the effects of surgical treatment and oral appliances. We also underline future directions in OSA management, telemonitoring, and druginduced sleep endoscopy in managing the SRBD, especially OSA. We ascertain that more studies are needed within the CSA, OHS, and ISRH research fields.

Outcomes of patients with elevated pulmonary artery systolic pressure on echocardiography due to chronic lung diseases

BackgroundPulmonary hypertension is associated with increased mortality, and lung diseases are the second most common cause of pulmonary hypertension. We aimed to evaluate the prognostic value of echocardiography in low-middle income countries where right heart catheterization is difficult to perform. MethodsThis retrospective chart review study included adult patients hospitalized from June 2012 to May 2021, with a pulmonary artery systolic pressure (PASP) of ≥35 mmHg on echocardiography. The control arm consisted of patients with similar lung diseases who did not have an elevated PASP. ResultsThe study and control arm consisted of 128 patients each, with both groups having similar lung diseases. Obesity hypoventilation syndrome was the most common etiology of elevated PASP (28.1 %), followed by pulmonary embolism (20.3 %). The overall 1-year mortality of the study cohort, after diagnosis of elevated PASP, was 20.3 %. The control cohort with normal PASP had a 1-year mortality of 4.7 %. In the study cohort, patients with bronchiectasis had the highest cause-specific 1-year mortality (45.5 %). In the normal PASP cohort, the highest cause-specific 1-year mortality was observed in patients with interstitial lung disease (13.0 %). One-year hospital readmission was observed in 46.9 % and 33.6 % of patients in the study and control arms, respectively. On multivariate analysis, increased odds of 1-year mortality were observed in patients with elevated PASP, patients with 1-year hospital readmission, and in patients with interstitial lung disease or bronchiectasis. ConclusionElevated PASP on echocardiography may be a prognostic factor for mortality in patients with chronic lung diseases.

Messung des Atemzugvolumens bei Patienten mit Obesitas-Hypoventilations-Syndrom und Opiumabhängigkeit

Abstract Background Both obesity hypoventilation syndrome (OHS) and opium dependence can negatively affect nocturnal respiratory functionality. However, the effects of a combination of the two are relatively unknown. In this study, the tidal volume (VT) of OHS patients with and without opium dependence was estimated by measuring changes in the circumference of the thorax and the abdomen during sleep. Materials and methods This case–control study was performed in Iran, Isfahan. Initially, 20 healthy subjects calibrated the Pneumobelts (Löwenstein Medical Technology GmbH, Hamburg, Germany) by wearing the device and also breathing in and out of a Spirobag. From this, it was possible to estimate the coefficient factors for determining VT based on thoracic and abdominal measures. Subsequently, the study included 55 patients with OHS, who were divided into two groups: opium dependent and non-users. They were then admitted to the sleep lab for a single night of polysomnography (PSG). VT was estimated and then compared between groups. Results In total, there were 24 patients in the opium group and 31 in the non-user control group. All PSG variables were analyzed with independent-sample t-tests and an analysis of covariance was used to adjust for potential confounding variables. The following confounding variables were adjusted: sex, smoking, body mass index, and hypertension. VT values were not significantly different between groups (opium: 772 ± 125.4; non-user: 774 ± 95). Average oxygen saturation values were significantly lower in opium-dependent patients (opium: 86.1 ± 5.5; non-user: 89.1 ± 4.1). All other variables from PSG including chest and abdominal circumference were not significantly different between groups. Conclusion OHS patients with opium dependency showed similar VT levels when compared to non-users with OHS. Due to the rarity of the sample, it was difficult to gather exactly matched pairs. Therefore, it is possible that with a more closely related sample, we might be able to see a difference in VT between groups.

Impact of treating obesity hypoventilation syndrome on body mass index.

To evaluate the impact of positive airway pressure (PAP) therapy on body mass index (BMI) in patients with obesity hypoventilation syndrome (OHS) associated with obstructive sleep apnea (OSA). A systematic review using the following terms: "obesity hypoventilation syndrome" AND "treatment" AND "randomized" using Cochrane Central Register of Controlled Trials, Medline and Web of Science was performed from the first data available until February 10, 2023. The inclusion criteria were: (1) original article; (2) adult OHS with concomitant OSA (apnea-hypopnea index or AHI ≥5 events/h); (3) randomized trial with PAP arm and standard care (control); (4) BMI evaluation at baseline and after the first months. We performed an individual participant data meta-analysis of randomized controlled trials. Our initial search retrieved 32 articles and 3 randomized studies fulfilled study criteria and were included in the final analysis, leading to a total of 342 participants. Patients were predominantly females (62%) and had OHS associated with at least mild OSA. As compared to baseline, a decrease in BMI was observed at study endpoint but this difference was not different intergroups (-0.50 ± 1.49 and -0.50 ±1.83, in control and PAP groups respectively (p=0.939)). Weight change was not associate with PAP adherence, OSA severity or use of supplemental oxygen. In contrast to treatment of eucapnic OSA with PAP that is associated with weight gain, treatment of OSA+OHS patients with or without PAP is associated with weight loss. Future studies are necessary to elucidate the mechanism by which weight loss occurs.

Overview on Pediatric Obesity Hypoventilation Syndrome

The relationship between obesity and the onset of persistent daytime alveolar hypoventilation is known as obesity hypoventilation syndrome. This illness results from a complicated interaction between sleep-disordered breathing, reduced respiratory drive, and obesity-related respiratory impairment, and is associated with considerable morbidity and mortality. Extreme obesity has become far more common in the United States and other nations during the past three decades. The prevalence of OHS will inevitably rise considering the global obesity pandemic. When compared to people with sleep apnea, patients with OHS have a poorer quality of life, incur higher medical costs, and are more likely to develop pulmonary hypertension and die young. Even though this illness is associated with severe morbidity and mortality, it is commonly overlooked, and treatment is typically postponed. Clinicians need to keep a high index of suspicion since this syndrome carries a heavy burden of morbidity and mortality, which is reduced by early diagnosis and treatment. The definition and clinical presentation of OHS, a brief overview of its prevalence, a review of current understanding of pathophysiology, and discussion of recent developments in therapeutics will all be included in this review.

P065 A Comparison of Two Obesity Related Hypoventilation Disorders – Impact on Sleep, Quality of Life and Neurocognitive Outcomes and the Effects of PAP Therapy

Abstract Introduction Symptom burden and neurocognitive function have not been previous compared between patients with obesity-associated hypoventilation disorders (obesity hypoventilation syndrome, OHS), and hypoventilation in the setting of obesity and obstructive airways disease (OHAD). The aim of this study is to compare baseline sleep-related symptoms, health-related quality of life and neurocognitive function between OHS and OHAD and the impact of PAP therapy on these outcomes. Methods ESS, PSQI, SF36, and various neurocognitive tests, in addition to anthropometric, polysomnography, lung function and blood gas data from 45 patients with OHS and 32 patients with OHAD, were included in the analysis. Between groups (OHS vs OHAD), pre- and post-treatment (with 3 months of positive airway pressure) comparisons were made using linear mixed modelling. Results Both OHS and OHAD had similar baseline ESS (14(5.6) vs. 12(5.4)), Global PSQI (10(3.2) vs 11(4.8)), SF36 and neurocognitive test performances (other than OHAD had lower digit symbol substitution test performance). Treatment with PAP therapy resulted in similar improvements in ESS, Global PSQI, and SF36 in both groups. Neurocognitive performance did not significantly improve after PAP therapy in either group. Discussion The symptom burden between two separate hypoventilation disorders (OHS and OHAD), in terms of sleepiness, sleep quality, quality of life and cognitive function, were similar. OHS and OHAD had similar treatment responses in these parameters after 3 months of PAP therapy.

Contribution of Transcutaneous PCO2 in Obesity Hypoventilation Syndrome.

More and more patients have obesity-hypoventilation syndrome (OHS) because of the increasing prevalence of obesity. The accuracy of transcutaneous PCO2 (PtcCO2 ) has recently been validated. However, no study evaluated the interest of measuring systematically nocturnal PtcCO2 in the follow-up of patients with OHS and home mechanical ventilation to detect residual nocturnal hypoventilation. We aimed to evaluate the contribution of nocturnal PtcCO2 to assess nocturnal hypoventilation compared with current routine examinations, that is, daytime arterial blood gases and nocturnal pulse oximetry. A prospective monocentric pilot study was conducted from August 2018 to November 2019. Patients with stable OHS and who were treated with home noninvasive ventilation for at least 6 months were eligible to participate. After oral consent, we performed both diurnal arterial blood gases and combined home oximetry and capnography. The primary end point was the presence of residual nocturnal hypoventilation, defined as PaCO2 > 45 mm Hg or bicarbonate ≥ 27 mmol/L, SpO2 < 90% for ≥ 10% of the night, or PtcCO2 > 49 mm Hg for ≥ 10% of the night. A total of 32 subjects were included. Twenty-nine subjects with nocturnal PtcCO2 were analyzed. Eighteen of the 29 subjects showed residual nocturnal hypoventilation. The association of diurnal arterial blood gases and nocturnal pulse oximetry revealed nocturnal hypoventilation in only 9 subjects. Among the 19 subjects with both normal blood gases and normal nocturnal pulse oximetry, 11 had nocturnal hypoventilation with transcutaneous capnography. Only one subject presented with hypoventilation symptoms (asthenia). The assessment of PtcCO2 in comparison with nocturnal pulse oximetry and arterial blood gases provides important information for the diagnosis of residual nocturnal hypoventilation in the subjects with OHS who were ventilated at home.

Impact of Previous Continuous Positive Airway Pressure Use on Noninvasive Ventilation Adherence and Quality in Obesity Hypoventilation Syndrome: A Pragmatic Single-Center Cross-Sectional Study in Martinique.

There is a strong relationship between obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). When OHS is combined with severe OSA, treatment consists of continuous positive airway pressure (CPAP), followed by noninvasive ventilation (NIV) in the case of CPAP failure. Currently, the impact of a previous use of CPAP on the quality of NIV is unknown. We conducted a cross-sectional study with OHS patients, to assess the quality of NIV according to previous CPAP use. We included 75 patients with OHS on NIV (65 women, 87%). Among these, 40 patients (53.3%) who had had prior CPAP (CPAP+ group) were compared to the remaining 35 patients (46.7%) (CPAP- group). Key characteristics were comparable between the CPAP+ and the CPAP- groups: age at diagnosis of OHS was 67 ± 3 vs. 66 ± 4 years (p = 0.8), age at inclusion was 73 ± 15 vs. 69 ± 15 years (p = 0.29), number of comorbidities was 3.7 ± 1.2 vs. 3.3 ± 1.5, the Charlson index was 5.1 ± 2 vs. 4.6 ± 1.8, and BMI was 41.6 ± 7.6 kg/m2 vs. 41.2 ± 8.2, respectively, all p > 0.05. Follow-up length was greater in CPAP+ vs. CPAP- patients (5.6 ± 4.2 vs. 2.9 ± 2.9 years, p = 0.001). The quality of NIV based on daily adherence, pressure support, apnea-hypopnea index (AHI) and leaks was similar in both groups. Reduced adherence (less than 4 h daily) was found in 10 CPAP+ patients (25%) versus 7 CPAP- patients (20%), p = 0.80. NIV efficacy was also similar. This study found no difference in the quality of NIV or in adherence between patients who had had prior CPAP and those who had not. Previous CPAP does not appear to improve the quality of NIV.