Qualify of life and palliation predict survival in patients with chronic alveolar hypoventilation and nocturnal ventilatory support.
OBJECTIVE
Non-invasive positive pressure ventilation (NPPV) improves health-related quality of life (HRQL) in patients with chronic alveolar hypoventilation (CAH). We studied the prognostic impact of HRQL on survival in relation to clinical factors.


METHODS
Forty-four patients with CAH due to post-polio (12), scoliosis (11), post-tb (17) or other diagnoses (4) who received nocturnal NPPV were prospectively studied during 6-10 years.


METHODS
Blood gases and HRQL were analysed at baseline and after 9 months and after 8 years. HRQL was evaluated with measures of functioning (SIP), emotional well-being (HADS and MACL), and global QL.


RESULTS
Blood gases and HRQL measures improved during NPPV. The overall 5-year survival rate was 73%. In multivariate survival analysis, a diagnosis of post-polio and low baseline SIP physical index scores, indicating low levels of physical dysfunction, predicted longer survival (P = 0.02, respectively). Similarly, palliation of physical dysfunction and preserved or improved global QL by 9 months were associated with longer overall survival (P = 0.009 and P = 0.001, respectively; multivariate Cox regression).


CONCLUSIONS
Seventy-three percent of patients treated for CAH with NPPV survived more than 5 years. Diagnosis and self-rated physical functioning at pre-treatment were related to survival, as were major improvements in physical functioning and global QL during NPPV.
Olofson
Jan
J
Department of Respiratory Medicine and Allergology, Institute of Medicine, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, 413 45, Sweden. jan.olofson@lungall.gu.se
Dellborg
Catharina
C
Sullivan
Marianne
M
Midgren
Bengt
B
Caro
Oscar
O
Bergman
Bengt
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases; D011175:Positive-Pressure Respiration; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D055815:Young Adult