Impact of treating obesity hypoventilation syndrome on body mass index

R G S Andrade; J F Masa; J-C Borel; L F Drager; P R Genta; B Mokhlesi; G Lorenzi-Filho

doi:10.1016/j.pulmoe.2023.09.004

Impact of treating obesity hypoventilation syndrome on body mass index

Pulmonology. 2023 Nov 22:S2531-0437(23)00170-8. doi: 10.1016/j.pulmoe.2023.09.004. Online ahead of print.

Authors

R G S Andrade¹, J F Masa², J-C Borel³, L F Drager¹, P R Genta¹, B Mokhlesi⁴, G Lorenzi-Filho⁵

Affiliations

¹ Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil.
² 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.
³ HP2 Laboratory, Grenoble Alpes University, Grenoble, France.
⁴ Division of Pulmonary, Critical Care and Sleep Medicine, Rush University Medical Center, Chicago, IL, USA.
⁵ Sleep Laboratory from pneumology department of Heart Institute of University of São Paulo, São Paulo, Brazil. Electronic address: geraldo.lorenzi@incor.usp.br.

PMID: 37996386
DOI: 10.1016/j.pulmoe.2023.09.004

Abstract

Study objectives: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Obesity hypoventilation syndrome; Positive airway pressure; Weight.