Institute for Breathing and Sleep, Heidelberg, Australia.
Austin Health, Heidelberg, Australia.
Thorax. 2017 May;72(5):437-444. doi: 10.1136/thoraxjnl-2016-208559. Epub 2016 Nov 15.
Obesity hypoventilation syndrome (OHS) is the most common indication for home ventilation, although the optimal therapy remains unclear, particularly for severe disease. We compared Bi-level and continuous positive airways pressure (Bi-level positive airway pressure (PAP); CPAP) for treatment of severe OHS.
We conducted a multicentre, parallel, double-blind trial for initial treatment of OHS, with participants randomised to nocturnal Bi-level PAP or CPAP for 3 months. The primary outcome was frequency of treatment failure (hospital admission, persistent ventilatory failure or non-adherence); secondary outcomes included health-related quality of life (HRQoL) and sleepiness.
Sixty participants were randomised; 57 completed follow-up and were included in analysis (mean age 53 years, body mass index 55 kg/m, PaCO 60 mm Hg). There was no difference in treatment failure between groups (Bi-level PAP, 14.8% vs CPAP, 13.3%, p=0.87). Treatment adherence and wake PaCO were similar after 3 months (5.3 hours/night Bi-level PAP, 5.0 hours/night CPAP, p=0.62; PaCO 44.2 and 45.9 mm Hg, respectively, p=0.60). Between-group differences in improvement in sleepiness (Epworth Sleepiness Scale 0.3 (95% CI -2.8, 3.4), p=0.86) and HRQoL (Short Form (SF)36-SF6d 0.025 (95% CI -0.039, 0.088), p=0.45) were not significant. Baseline severity of ventilatory failure (PaCO) was the only significant predictor of persistent ventilatory failure at 3 months (OR 2.3, p=0.03).
In newly diagnosed severe OHS, Bi-level PAP and CPAP resulted in similar improvements in ventilatory failure, HRQoL and adherence. Baseline PaCO predicted persistent ventilatory failure on treatment. Long-term studies are required to determine whether these treatments have different cost-effectiveness or impact on mortality.
ACTRN12611000874910, results.
肥胖低通气综合征（OHS）是家庭通气的最常见指征，尽管最佳治疗方法仍不清楚，尤其是对于严重疾病。我们比较了双水平和持续气道正压通气（Bi-level 正压通气（PAP）；CPAP）治疗严重 OHS。
我们进行了一项多中心、平行、双盲试验，用于初始 OHS 治疗，参与者随机分配接受夜间 Bi-level PAP 或 CPAP 治疗 3 个月。主要结局是治疗失败的频率（住院、持续通气衰竭或不依从）；次要结局包括健康相关生活质量（HRQoL）和嗜睡。
60 名参与者被随机分配；57 名完成随访并纳入分析（平均年龄 53 岁，体重指数 55kg/m，PaCO 60mmHg）。两组治疗失败无差异（Bi-level PAP，14.8% vs CPAP，13.3%，p=0.87）。3 个月后，治疗依从性和觉醒时 PaCO 相似（Bi-level PAP 夜间 5.3 小时/夜，CPAP 夜间 5.0 小时/夜，p=0.62；分别为 PaCO 44.2 和 45.9mmHg，p=0.60）。两组之间嗜睡（Epworth 嗜睡量表 0.3（95%CI-2.8，3.4），p=0.86）和 HRQoL（SF-36-SF6d 0.025（95%CI-0.039，0.088），p=0.45）的改善差异无统计学意义。通气衰竭（PaCO）的基线严重程度是 3 个月时持续通气衰竭的唯一显著预测因素（OR 2.3，p=0.03）。
在新诊断的严重 OHS 中，Bi-level PAP 和 CPAP 治疗可导致通气衰竭、HRQoL 和依从性相似的改善。基线 PaCO 预测治疗后的持续通气衰竭。需要进行长期研究以确定这些治疗方法在成本效益或死亡率方面是否存在差异。
ACTRN12611000874910，结果。
