Impaired objective daytime vigilance in obesity-hypoventilation syndrome: impact of noninvasive ventilation.
BACKGROUND
Obesity-hypoventilation syndrome (OHS) is efficiently treated by noninvasive ventilation (NIV). Sleep respiratory disturbances, reduced ventilatory drive, and excessive daytime sleepiness (EDS) are commonly reported, but their relationships remain unclear.


OBJECTIVE
To characterize sleep breathing disorders encountered in patients with OHS, to compare low and normal CO(2) responders in terms of sleep abnormalities, subjective and objective measures of EDS, and to measure the changes induced by NIV on these parameters.


METHODS
At baseline and after 5 nights of NIV, 15 consecutive patients (mean [+/- SD] age, 55 +/- 9 years; mean body mass index, 38.7 +/- 6.1 kg/m(2); Paco(2), 47.3 +/- 2.3 mm Hg) prospectively underwent polysomnography, CO(2) ventilatory response testing, Epworth sleepiness scale scoring, and the Oxford Sleep Resistance (OSLER) test, which is an objective vigilance test.


RESULTS
OHS patients exhibited obstructive sleep apnea syndrome (mean apnea-hypopnea index, 62 +/- 32 events per hour) and rapid eye movement (REM) sleep hypoventilation (mean REM sleep time, 35 +/- 33%). Baseline CO(2) sensitivity was significantly related to the proportion of hypoventilation during REM sleep (r = 0.54; p = 0.037). Six patients showed abnormal sleep latencies during the OSLER test (71% of the low CO(2) responders vs 14% of the normal CO(2) responders). Low CO(2) responders exhibited significantly shorter sleep latencies during the OSLER test (23 +/- 14 vs 37 +/- 8 min, respectively; p = 0.05). Using NIV, diurnal blood gas levels were improved and REM sleep hypoventilation were suppressed. Objective sleepiness was improved in low CO(2) responders (p = 0.04).


CONCLUSIONS
In OHS patients, the lower the daytime CO(2) response, the higher the proportion of REM sleep hypoventilation and daytime sleepiness. Short-term therapy with NIV improves all of these parameters.
Chouri-Pontarollo
Nathalie
N
Sleep Laboratory and Exploration fonctionelle cardio-respiratoire, Institut National de la Santé et de la Recherche Médicale ERI 0017, University Hospital, Grenoble, France.
Borel
Jean-Christian
JC
Tamisier
Renaud
R
Wuyam
Bernard
B
Levy
Patrick
P
Pépin
Jean-Louis
JL
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000503:physiopathology* / Q000628:therapy*; D017286:Polysomnography; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D014851:Wakefulness