Chest
Volume 138, Issue 1, July 2010, Pages 84-90
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ORIGINAL RESEARCH
SLEEP MEDICINE
Long-Term Outcome of Noninvasive Positive Pressure Ventilation for Obesity Hypoventilation Syndrome

https://doi.org/10.1378/chest.09-2472Get rights and content

Background

Few data are available on the long-term outcome of noninvasive positive pressure ventilation (NPPV) for obesity hypoventilation syndrome (OHS). This study was designed to determine long-term survival, treatment adherence, and prognostic factors in patients with OHS in whom NPPV was initiated in an acute setting vs under stable clinical conditions.

Methods

One hundred thirty consecutive patients with OHS (56 women) who started NPPV between January 1995 and December 2006 either under stable conditions (stable group, n = 92) or during ICU management of acute hypercapnic exacerbation (acute group, n = 38) were retrospectively analyzed.

Results

Arterial blood gases and the Epworth sleepiness scale were both significantly improved after 6 months of NPPV. With a mean follow-up of 4.1 ± 2.9 years, 24 (18.5%) patients died and 24 (18.5%) discontinued NPPV. On Kaplan-Meier analysis, 1-, 2-, 3-, and 5-year survival probabilities were 97.5%, 93%, 88.3%, and 77.3%, respectively. Mortality was lower than that described in a previous series of patients with untreated OHS. Supplemental oxygen therapy was the only independent predictor of mortality. The probability of continuing NPPV was 80% at 3 years with a high rate of daily use (> 7 h). Female sex was predictive of lower long-term adherence to NPPV. The acute and stable groups did not differ in terms of arterial blood gases and Epworth sleepiness scale at 6 months, long-term survival, and treatment adherence.

Conclusions

The results of this study support long-term NPPV as an effective and well-tolerated treatment of OHS whether initiated in the acute or chronic setting.

Section snippets

Population

All patients with OHS consecutively discharged with NPPV from the Department of Respiratory Medicine of Angers University Hospital between January 1995 and December 2006 were included in the study. OHS was diagnosed according to the current definition by BMI ≥ 30 kg/m2 and daytime hypercapnia (Paco2 > 45 mm Hg) in the absence of any other cause of hypoventilation on the basis of clinical examination, chest radiograph, and pulmonary function tests (eg, COPD [FEV1 to vital capacity ratio < 70%]).1

Study Population and NPPV Technique

A total of 130 patients (56 women and 74 men) with OHS discharged with NPPV between January 1995 and December 2006 were included. NPPV had been initiated under stable clinical conditions for 92 (71%) patients and during ICU management of an acute exacerbation for 38 (29%) patients, six of whom required invasive mechanical ventilation prior to NPPV. The mean NPPV prescription rate for OHS was 5.8 patients per year from 1995 to 1999 and 14.4 patients per year from 2000 to 2006. The increased NPPV

Discussion

This study evaluated the long-term outcome of NPPV in a large sample of patients with OHS with a follow-up of up to 10 years. As previously described,7 a marked increase in NPPV prescriptions for OHS was observed during the study period that may reflect growth of the obesity epidemic but also a better knowledge by primary care and chest physicians of the consequences of obesity on respiratory function and the beneficial effects of NPPV in this population. Except for a lower baseline ESS,

Acknowledgments

Author contributions: Dr Priou: contributed to conception and design; acquisition, analysis and interpretation of data; and drafting the submitted article; and provided final approval of the version to be published.

Dr Hamel: contributed to analysis and interpretation of data; critical revision of the submitted article for important intellectual content; and provided final approval of the version to be published.

Dr Person: contributed to conception, design, and interpretation of data; critical

References (28)

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