Average volume-assured pressure support in obesity hypoventilation: A randomized crossover trial.
BACKGROUND
Average volume-assured pressure support (AVAPS) has been introduced as a new additional mode for a bilevel pressure ventilation (BPV) device (BiPAP; Respironics; Murrysville, PA), but studies on the physiologic and clinical effects have not yet been performed. There is a particular need to better define the most efficient ventilatory treatment modality for patients with obesity hypoventilation syndrome (OHS).


METHODS
In OHS patients who did not respond to therapy with continuous positive airway pressure, the effects of BPV with the spontaneous/timed (S/T) ventilation mode with and without AVAPS over 6 weeks on ventilation pattern, gas exchange, sleep quality, and health-related quality of life (HRQL) assessed by the severe respiratory insufficiency questionnaire (SRI) were prospectively investigated in a randomized crossover trial.


RESULTS
Ten patients (mean [+/- SD] age, 53.5 +/- 11.7 years; mean body mass index, 41.6 +/- 12.1 kg/m2; mean FEV1/FVC ratio, 79.4 +/- 6.5%; mean transcutaneous P(CO2) [PtcCO2], 58 +/- 12 mm Hg) were studied. PtcCO2 nonsignificantly decreased during nocturnal BPV-S/T by -5.6 +/- 11.8 mm Hg (95% confidence interval [CI], -14.7 to 3.4 mm Hg; p = 0.188), but significantly decreased during BPV-S/T-AVAPS by -12.6 +/- 12.2 mm Hg (95% CI, -22.0 to -3.2 mm Hg; p = 0.015). Pneumotachographic measurements revealed a higher individual variance of peak inspiratory pressure (p < 0.001) and a trend for lower leak volumes but also for higher tidal volumes during BPV-S/T-AVAPS. The SRI summary scale score improved from 63 +/- 15 to 78 +/- 14 during BPV-S/T (p = 0.004) and to 76 +/- 16 during BPV-S/T-AVAPS (p = 0.014). Sleep quality and oxygen saturation also comparably improved following BPV-S/T and BPV-S/T-AVAPS.


CONCLUSIONS
BPV-S/T substantially improved oxygenation, sleep quality, and HRQL in patients with OHS. AVAPS provided additional benefits on ventilation quality, thus resulting in a more efficient decrease of PtcCO2. However, this did not provide further clinical benefits regarding sleep quality and HRQL.
Storre
Jan Hendrik
JH
Department of Pneumology, University Hospital Freiburg, Killianstrasse 5, D-79106 Freiburg, Germany.
Seuthe
Benjamin
B
Fiechter
René
R
Milioglou
Stavroula
S
Dreher
Michael
M
Sorichter
Stephan
S
Windisch
Wolfram
W
D000328:Adult; D001784:Blood Gas Analysis; D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods*; D018592:Cross-Over Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000503:physiopathology* / Q000628:therapy*; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy; D012890:Sleep / Q000502:physiology; D011795:Surveys and Questionnaires; D013990:Tidal Volume / Q000502:physiology; D014797:Vital Capacity / Q000502:physiology