Continuous positive airway pressure in clinically stable patients with mild-to-moderate obesity hypoventilation syndrome and obstructive sleep apnoea
Por:
Salord, N, Mayos, M, Miralda, RM, Farre, A, Carreras, M, Sust, R, Masuet-Aumatell, C, Rodriguez, J, Perez, A
Publicada:
1 oct 2013
Resumen:
Background and objectiveThe use of continuous positive airway pressure (CPAP) treatment in patients with obesity hypoventilation syndrome (OHS) and obstructive sleep apnoea (OSA) was evaluated, and factors that might predict CPAP treatment failure were determined.
MethodsA sleep study was performed in 29 newly diagnosed, clinically stable OHS patients. CPAP treatment was commenced if the apnoea-hypopnoea index was >15. Lung function, night-time oximetry, blood adipokine and C-reactive protein levels were assessed prospectively on enrollment and after 3 months. Treatment failure at 3 months was defined as daytime arterial partial pressure of carbon dioxide (PaCO2) >45mmHg and/or oxygen saturation (SpO(2)) <90% for >30% of the night-time oximetry study.
ResultsAll patients had severe OSA (median apnoea-hypopnoea index=74.7 (62-100) with a nocturnal mean SpO(2) of 81.47), and all patients were treated with CPAP. The percentage of time spent below 90% saturation improved from 8.4% (0.0-39.0%) to 0.3% (0.4-4.0%). Awake PaCO2 decreased from 50 (47-53) mmHg to 43 (40-45) mmHg. Seven patients failed CPAP treatment after 3 months. PaCO2 at 1 month and mean night-time SpO(2) during the first night of optimal CPAP were associated with treatment failure at 3 months (odds ratio 1.4 (1.03-1.98); P=0.034 and 0.6 (0.34-0.93); P=0.027).
ConclusionsCPAP treatment improves night-time oxygenation and daytime hypoventilation in selected clinically stable OHS patients who also have OSA. Patients with worse night-time saturation while on CPAP and higher daytime PaCO2 at 1 month were more likely to fail CPAP treatment.
Filiaciones:
Salord, N:
Hosp Santa Creu & Sant Pau, Dept Resp Med, Barcelona 08025, Spain
Resp Dis Res Network CibeRes, Barcelona, Spain
Univ Autonoma Barcelona, Sch Med, Dept Internal Med, E-08193 Barcelona, Spain
Hosp Univ Bellvitge, Dept Resp Med, Lhospitalet De Llobregat, Spain
Mayos, M:
Hosp Santa Creu & Sant Pau, Dept Resp Med, Barcelona 08025, Spain
Resp Dis Res Network CibeRes, Barcelona, Spain
Univ Autonoma Barcelona, Sch Med, Dept Internal Med, E-08193 Barcelona, Spain
Miralda, RM:
Hosp Santa Creu & Sant Pau, Dept Resp Med, Barcelona 08025, Spain
Farre, A:
Hosp Santa Creu & Sant Pau, Dept Resp Med, Barcelona 08025, Spain
Carreras, M:
Hosp Santa Creu & Sant Pau, Dept Resp Med, Barcelona 08025, Spain
Sust, R:
Hosp Santa Creu & Sant Pau, Dept Biochem, Barcelona 08025, Spain
Masuet-Aumatell, C:
Hosp Univ Bellvitge, Dept Prevent Med, Lhospitalet De Llobregat, Spain
Rodriguez, J:
Hosp Santa Creu & Sant Pau, Dept Biochem, Barcelona 08025, Spain
Perez, A:
Hosp Santa Creu & Sant Pau, Dept Endocrinol & Nutr, Barcelona 08025, Spain
Reseach Network Diabet & Metab Dis CIBERDEM, Barcelona, Spain
Hosp Univ Bellvitge, Dept Resp Med, Lhospitalet De Llobregat, Spain
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