Effectiveness of CPAP vs. Noninvasive Ventilation Based on Disease Severity in Obesity Hypoventilation Syndrome and Concomitant Severe Obstructive Sleep Apnea

Juan F Masa; Iván D Benítez; Maria Á Sánchez-Quiroga; Francisco J Gomez de Terreros; Jaime Corral; Auxiliadora Romero; Candela Caballero-Eraso; Estrella Ordax-Carbajo; Maria F Troncoso; Mónica González; Soledad López-Martín; José M Marin; Sergi Martí; Trinidad Díaz-Cambriles; Eusebi Chiner; Carlos Egea; Javier Barca; Francisco J Vázquez-Polo; Miguel A Negrín; María Martel-Escobar; Ferrán Barbé; Babak Mokhlesi; Spanish Sleep Network; Authors from Spanish Sleep Network

doi:10.1016/j.arbres.2021.05.019

Effectiveness of CPAP vs. Noninvasive Ventilation Based on Disease Severity in Obesity Hypoventilation Syndrome and Concomitant Severe Obstructive Sleep Apnea

Arch Bronconeumol. 2022 Mar;58(3):228-236. doi: 10.1016/j.arbres.2021.05.019. Epub 2021 Jun 4.

[Article in English, Spanish]

Authors

Juan F Masa¹, Iván D Benítez², Maria Á Sánchez-Quiroga³, Francisco J Gomez de Terreros⁴, Jaime Corral⁴, Auxiliadora Romero⁵, Candela Caballero-Eraso⁵, Estrella Ordax-Carbajo⁶, Maria F Troncoso⁷, Mónica González⁸, Soledad López-Martín⁹, José M Marin¹⁰, Sergi Martí¹¹, Trinidad Díaz-Cambriles¹², Eusebi Chiner¹³, Carlos Egea¹⁴, Javier Barca¹⁵, Francisco J Vázquez-Polo¹⁶, Miguel A Negrín¹⁶, María Martel-Escobar¹⁶, Ferrán Barbé², Babak Mokhlesi¹⁷; Spanish Sleep Network; Authors from Spanish Sleep Network

Affiliations

¹ Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain. Electronic address: masa@separ.es.
² Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
³ Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain.
⁴ Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain.
⁵ Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
⁶ Respiratory Department, University Hospital, Burgos, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
⁷ Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
⁸ Respiratory Department, Valdecilla Hospital, Santander, Spain.
⁹ Respiratory Department, Gregorio Marañón Hospital, Madrid, Spain.
¹⁰ Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
¹¹ Respiratory Department, Vall d'Hebron Hospital, Barcelona, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
¹² Respiratory Department, Doce de Octubre Hospital, Madrid, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
¹³ Respiratory Department, San Juan Hospital, Alicante, Spain.
¹⁴ Respiratory Department, Alava University Hospital IRB, Vitoria, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
¹⁵ Nursing Department, Extremadura University, Cáceres, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain.
¹⁶ Department of Quantitative Methods, Las Palmas de Gran Canaria University Canary Islands, Spain.
¹⁷ Medicine/Pulmonary and Critical Care, University of Chicago, IL, USA.

PMID: 35312607
DOI: 10.1016/j.arbres.2021.05.019

Abstract

Rationale: Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea (OSA) is treated with CPAP or noninvasive ventilation (NIV) during sleep. NIV is costlier, but may be advantageous because it provides ventilatory support. However, there are no long-term trials comparing these treatment modalities based on OHS severity.

Objective: To determine if CPAP have similar effectiveness when compared to NIV according to OHS severity subgroups.

Methods: Post hoc analysis of the Pickwick randomized clinical trial in which 215 ambulatory patients with untreated OHS and concomitant severe OSA, defined as apnoea-hypopnea index (AHI)≥30events/h, were allocated to NIV or CPAP. In the present analysis, the Pickwick cohort was divided in severity subgroups based on the degree of baseline daytime hypercapnia (PaCO₂ of 45-49.9 or ≥50mmHg). Repeated measures of PaCO₂ and PaO₂ during the subsequent 3 years were compared between CPAP and NIV in the two severity subgroups. Statistical analysis was performed using linear mixed-effects model.

Results: 204 patients, 97 in the NIV group and 107 in the CPAP group were analyzed. The longitudinal improvements of PaCO₂ and PaO₂ were similar between CPAP and NIV based on the PaCO₂ severity subgroups.

Conclusion: In ambulatory patients with OHS and concomitant severe OSA who were treated with NIV or CPAP, long-term NIV therapy was similar to CPAP in improving awake hypercapnia, regardless of the severity of baseline hypercapnia. Therefore, in this patient population, the decision to prescribe CPAP or NIV cannot be solely based on the presenting level of PaCO₂.

Keywords: Apnea del sueño; Continuous positive airway pressure (CPAP); Noninvasive ventilation; Obesity hypoventilation syndrome; Positive airway pressure (PAP); Presión positiva continua en las vías respiratorias (CPAP); Presión positiva en las vías respiratorias (PAP); Sleep apnea; Sleep disorders; Síndrome de hipoventilación-obesidad; Trastornos del sueño; Ventilación no invasiva.