Noninvasive mechanical ventilation in patients with obesity hypoventilation syndrome. Long-term outcome and prognostic factors.
BACKGROUND
Obesity is associated with 2 closely related respiratory diseases: obesity hypoventilation syndrome (OHS) and obstructive sleep apnea-hypopnea syndrome (OSAHS). It has been shown that noninvasive ventilation during sleep produces clinical and functional improvement in these patients. The long-term survival rate with this treatment, and the difference in clinical progress in OHS patients with and without OSAHS are analyzed.


METHODS
Longitudinal, observational study with a cohort of patients diagnosed with OHS, included in a home ventilation program over a period of 12 years, divided into 2 groups: pure OHS and OSAHS-associated OHS. Bi-level positive airway pressure ventilation was administered. During the follow-up period, symptoms, exacerbations and hospitalizations, blood gas tests and pulmonary function tests, and survival rates were monitored and compared.


RESULTS
Eighty-three patients were eligible for analysis, 60 women (72.3%) and 23 men (27.7%), with a mean survival time of 8.47 years. Fifty patients (60.2%) were included in the group without OSAHS (OHS) and 33 (39.8%) in the OSAHS-associated OHS group (OHS-OSAHS). PaCO₂ in the OHS group was significantly higher than in the OHS-OSAHS group (P<.01). OHS patients also had a higher hospitalization rate (P<.05). There was a significant improvement in both groups in FEV₁ and FVC, and no differences between groups in PaCO₂ and PaO₂ values. There were no differences in mortality between the 2 groups, but low FVC values were predictive of mortality.


CONCLUSIONS
The use of mechanical ventilation in patients with OHS, with or without OSAHS, is an effective treatment for the correction of blood gases and functional alterations and can achieve prolonged survival rates.
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: e.ojeda.castillejo@gmail.com.
Elena
E
Ojeda Castillejo
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Pilar
P
de Lucas Ramos
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Soledad
S
López Martin
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Pilar
P
Resano Barrios
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Paula
P
Rodríguez Rodríguez
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Liliana
L
Morán Caicedo
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
José María
JM
Bellón Cano
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
José Miguel
JM
Rodriguez Gonzalez-Moro
D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D045422:Continuous Positive Airway Pressure; D005260:Female; D005541:Forced Expiratory Volume; D006699:Home Care Services; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010349:Patient Compliance; D017286:Polysomnography; D011379:Prognosis; D011446:Prospective Studies; D014797:Vital Capacity
D002245:Carbon Dioxide; D010100:Oxygen
Non-invasive mechanical ventilation; Obesity hypoventilation syndrome; Sleep apnea syndrome; Síndrome de apnea del sueño; Síndrome de obesidad-hipoventilación; Ventilación mecánica no invasiva