Georges Thomas, Jaffré Sandrine, Morin Jean, Delbove Agathe, Guyomarch Béatrice, Alami Hakim, Bretonnière Cédric, Blanc François-Xavier
Respiratory Medicine Department, CHD Vendée, La Roche sur Yon, France.
Nantes Université, Nantes University Hospital, Service de Pneumologie, L'institut du thorax, Nantes, France.
Respir Care. 2023 Dec 28;69(1):68-75. doi: 10.4187/respcare.10816.
Increasing numbers of patients have obesity-hypoventilation syndrome (OHS) because of the increasing prevalence of obesity. The accuracy of transcutaneous [Formula: see text] ([Formula: see text]) has recently been validated. However, no study evaluated systematically measuring nocturnal [Formula: see text] in the follow-up of patients with OHS and home mechanical ventilation to detect residual nocturnal hypoventilation. We aimed to evaluate the contribution of nocturnal [Formula: see text] to assess nocturnal hypoventilation compared with current routine examinations, that is, daytime arterial blood gases and nocturnal pulse oximetry.
A prospective monocentric pilot study was conducted from August 2018 to November 2019. Patients with stable OHS and who were treated with home noninvasive ventilation for at least 6 months were eligible to participate. After oral consent, we performed both diurnal arterial blood gases and combined home oximetry and capnography. The primary end point was the presence of residual nocturnal hypoventilation, defined as [Formula: see text] > 45 mm Hg or bicarbonate ≥ 27 mmol/L, [Formula: see text] < 90% for ≥ 10% of the night, or [Formula: see text]> 49 mm Hg for ≥ 10% of the night.
A total of 32 subjects were included. Twenty-nine subjects with nocturnal [Formula: see text] were analyzed. Eighteen of the 29 subjects showed residual nocturnal hypoventilation. The association of diurnal arterial blood gases and nocturnal pulse oximetry revealed nocturnal hypoventilation in only 9 subjects. Among the 19 subjects with both normal blood gases and normal nocturnal pulse oximetry, 11 had nocturnal hypoventilation detected with transcutaneous capnography. Only one subject presented with hypoventilation symptoms (asthenia).
The assessment of [Formula: see text] in comparison with nocturnal pulse oximetry and arterial blood gases provides important information for the diagnosis of residual nocturnal hypoventilation in the subjects with OHS who were ventilated at home.
由于肥胖患病率不断上升，肥胖低通气综合征（OHS）患者数量日益增加。经皮二氧化碳分压（PtcCO₂）的准确性最近已得到验证。然而，尚无研究系统评估在OHS患者及家庭机械通气随访中测量夜间PtcCO₂以检测夜间残余低通气情况。我们旨在评估与当前常规检查（即日间动脉血气和夜间脉搏血氧饱和度测定）相比，夜间PtcCO₂对评估夜间低通气的作用。
2018年8月至2019年11月进行了一项前瞻性单中心试点研究。稳定的OHS患者且接受家庭无创通气至少6个月者有资格参与。经口头同意后，我们进行了日间动脉血气分析以及家庭血氧饱和度和二氧化碳监测。主要终点是存在夜间残余低通气，定义为PtcCO₂>45 mmHg或碳酸氢根≥27 mmol/L，夜间≥10%时间内血氧饱和度<90%，或夜间≥10%时间内PtcCO₂>49 mmHg。
共纳入32名受试者。对29名有夜间PtcCO₂数据的受试者进行了分析。29名受试者中有18名出现夜间残余低通气。日间动脉血气和夜间脉搏血氧饱和度测定联合分析仅发现9名受试者存在夜间低通气。在19名血气和夜间脉搏血氧饱和度均正常的受试者中，11名通过经皮二氧化碳监测检测到夜间低通气。只有一名受试者出现低通气症状（乏力）。
与夜间脉搏血氧饱和度测定和动脉血气相比，PtcCO₂评估为在家中接受通气的OHS受试者夜间残余低通气的诊断提供了重要信息。
