A Randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome

Mark E. Howard*, Amanda J. Piper, Bronwyn Stevens, Anne E. Holland, Brendon J. Yee, Eli Dabscheck, Duncan Mortimer, Angela T. Burge, Daniel Flunt, Catherine Buchan, Linda Rautela, Nicole Sheers, David Hillman, David J. Berlowitz

*Corresponding author for this work

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background 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. Methods 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. Results Sixty participants were randomised; 57 completed follow-up and were included in analysis (mean age 53 years, body mass index 55 kg/m2, PaCO2 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 PaCO2 were similar after 3 months (5.3 hours/night Bi-level PAP, 5.0 hours/night CPAP, p=0.62; PaCO2 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 (PaCO2) was the only significant predictor of persistent ventilatory failure at 3 months (OR 2.3, p=0.03). Conclusions In newly diagnosed severe OHS, Bi-level PAP and CPAP resulted in similar improvements in ventilatory failure, HRQoL and adherence. Baseline PaCO2 predicted persistent ventilatory failure on treatment. Long-term studies are required to determine whether these treatments have different costeffectiveness or impact on mortality.

Original languageEnglish
Pages (from-to)437-444
Number of pages8
JournalThorax
Volume72
Issue number5
DOIs
Publication statusPublished - May 2017
Externally publishedYes

Fingerprint Dive into the research topics of 'A Randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome'. Together they form a unique fingerprint.

  • Cite this

    Howard, M. E., Piper, A. J., Stevens, B., Holland, A. E., Yee, B. J., Dabscheck, E., ... Berlowitz, D. J. (2017). A Randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome. Thorax, 72(5), 437-444. https://doi.org/10.1136/thoraxjnl-2016-208559