Factors Associated with the Efficiency of Home Non-Invasive Ventilation in Patients with Obesity-Hypoventilation Syndrome in Martinique

Moustapha Agossou; Ramona Barzu; Bérénice Awanou; Joelle Bellegarde-Joachim; Jean-Michel Arnal; Moustapha Dramé

doi:10.3390/jcm12103381

Factors Associated with the Efficiency of Home Non-Invasive Ventilation in Patients with Obesity-Hypoventilation Syndrome in Martinique

J Clin Med. 2023 May 10;12(10):3381. doi: 10.3390/jcm12103381.

Authors

Moustapha Agossou¹, Ramona Barzu¹, Bérénice Awanou¹, Joelle Bellegarde-Joachim², Jean-Michel Arnal³, Moustapha Dramé^{4

5}

Affiliations

¹ Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France.
² Réseau Respi-R, DAC Martinique, 97200 Fort-de-France, France.
³ Service de Réanimation Polyvalente, Hôpital Sainte Musse, 83100 Toulon, France.
⁴ Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France.
⁵ EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France.

Abstract

Obesity-hypoventilation syndrome (OHS) is a respiratory complication of obesity characterized by chronic hypercapnic respiratory failure. It is often associated with several comorbidities and is treated by positive airway pressure (PAP) therapy. This study aimed to identify factors associated with persistent hypercapnia in patients receiving home non-invasive ventilation (NIV). We performed a retrospective study including patients with documented OHS. In total, 143 patients were included (79.7% women, age 67 ± 15.5 years, body mass index 41.6 ± 8.3 kg/m²). After 4.6 ± 4.0 years of follow-up, 72 patients (50.3%) remained hypercapnic. In bivariable analysis, clinical data showed no difference in follow-up duration, number of comorbidities, comorbidities, or circumstance of discovery. Patients with persistent hypercapnia on NIV were generally older, with lower BMI and more comorbidities. (5.5 ± 1.8 versus 4.4 ± 2.1, p = 0.001), female sex (87.5% versus 71.8%), was treated by NIV (100% versus 90.1%, p < 0.01), had lower FVC (56.7 ± 17.2 versus 63.6 ± 18% of theoretical value, p = 0.04), lower TLC (69.1 ± 15.3 versus 74.5 ± 14.6% of theoretical value, p = 0.07), lower RV (88.4 ± 27.1 versus 102.5 ± 29.4% of theoretical value, p = 0.02), higher pCO2 at diagnosis (59.7 ± 11.7 versus 54.6 ± 10.1 mmHg, p = 0.01) and lower pH (7.38 ± 0.03 versus 7.40 ± 0.04, p = 0.007), higher pressure support (12.6 ± 2.6 versus 11.5 ± 2.4 cmH₂O, p = 0.04) and lower EPAP (8.2 ± 1.9 versus 9 ± 2.0 cmH₂O, p = 0.06). There was no difference in non-intentional leaks and daily use between patients between both groups. By multivariable analysis, sex, BMI, pCO2 at diagnosis, and TLC were independent risk factors for persistent hypercapnia on home NIV. In individuals with OHS, persistent hypercapnia on home NIV therapy is frequent. Sex, BMI, pCO2 at diagnosis, and TLC were all associated with an increased risk of persistent hypercapnia in persons treated with home NIV.

Keywords: comorbidity; home ventilation; non-invasive ventilation; obesity-hypoventilation syndrome; persistent hypercapnia.

Grants and funding

This research received no external funding.