Castro-Añón Olalla, Pérez de Llano Luis A, De la Fuente Sánchez Sandra, Golpe Rafael, Méndez Marote Lidia, Castro-Castro Julián, González Quintela Arturo
Respiratory Division and Sleep Disorders Unit, Lucus Augusti University Hospital, Galician Health Service, Lugo, Spain.
Lucus Augusti University Hospital, Galician Health Service, Lugo, Spain.
PLoS One. 2015 Feb 11;10(2):e0117808. doi: 10.1371/journal.pone.0117808. eCollection 2015.
To study whether mortality and cardiovascular morbidity differ in non-invasive ventilation (NIV)-treated patients with severe obesity-hypoventilation syndrome (OHS) as compared with CPAP-treated patients with obstructive sleep apnea syndrome (OSAS), and to identify independent predictors of mortality in OHS.
Two retrospective cohorts of OHS and OSAS were matched 1:2 according to sex, age (± 10 year) and length of time since initiation of CPAP/NIV therapy (± 6 months).
Three hundred and thirty subjects (110 patients with OHS and 220 patients with OSAS) were studied. Mean follow-up time was 7 ± 4 years. The five year mortality rates were 15.5% in OHS cohort and 4.5% in OSAS cohort (p< 0.05). Patients with OHS had a 2-fold increase (OR 2; 95% CI: 1.11-3.60) in the risk of mortality and 1.86 fold (OR 1.86; 95% CI: 1.14-3.04) increased risk of having a cardiovascular event. Diabetes, baseline diurnal SaO2 < 83%, EPAP < 7 cmH2O after titration and adherence to NIV < 4 hours independently predicted mortality in OHS.
Mortality of severe OHS is high and substantially worse than that of OSAS. Severe OHS should be considered a systemic disease that encompasses respiratory, metabolic and cardiovascular components that require a multimodal therapeutic approach.
研究与持续气道正压通气（CPAP）治疗的阻塞性睡眠呼吸暂停综合征（OSAS）患者相比，无创通气（NIV）治疗的重度肥胖低通气综合征（OHS）患者的死亡率和心血管疾病发病率是否存在差异，并确定OHS患者死亡率的独立预测因素。
根据性别、年龄（±10岁）以及开始CPAP/NIV治疗后的时间长度（±6个月），将两个OHS和OSAS的回顾性队列按1:2进行匹配。
共研究了330名受试者（110名OHS患者和220名OSAS患者）。平均随访时间为7±4年。OHS队列的五年死亡率为15.5%，OSAS队列的五年死亡率为4.5%（p<0.05）。OHS患者的死亡风险增加了2倍（比值比[OR]2；95%置信区间[CI]：1.11-3.60），发生心血管事件的风险增加了1.86倍（OR 1.86；95%CI：1.14-3.04）。糖尿病、基线日间动脉血氧饱和度（SaO2）<83%、滴定后呼气末正压（EPAP）<7 cmH2O以及无创通气依从性<4小时是OHS患者死亡率的独立预测因素。
重度OHS的死亡率很高，且明显高于OSAS。重度OHS应被视为一种全身性疾病，涵盖呼吸、代谢和心血管等多个方面，需要采取多模式治疗方法。
