RT Journal Article
T1 Echocardiographic changes with non-invasive ventilation and CPAP in obesity hypoventilation syndrome.
A1 Corral, Jaime
A1 Mogollon, Maria Victoria
A1 Sánchez-Quiroga, M-Ángeles
A1 Gómez de Terreros, Javier
A1 Romero, Auxiliadora
A1 Caballero, Candela
A1 Teran-Santos, Joaquin
A1 Alonso-Álvarez, María L
A1 Gómez-García, Teresa
A1 González, Mónica
A1 López-Martínez, Soledad
A1 de Lucas, Pilar
A1 Marin, José M
A1 Romero, Odile
A1 Díaz-Cambriles, Trinidad
A1 Chiner, Eusebi
A1 Egea, Carlos
A1 Lang, Roberto M
A1 Mokhlesi, Babak
A1 Masa, Juan F
A1 Spanish Sleep Network, 
K1 non invasive ventilation
K1 sleep apnoea
AB Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysfunction, no randomised trials have assessed the impact of non-invasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography. We performed a secondary analysis of the data from the largest multicentre randomised controlled trial of OHS (Pickwick project, n=221) to determine the comparative efficacy of 2 months of NIV (n=71), CPAP (n=80) and lifestyle modification (control group, n=70) on structural and functional echocardiographic changes. Conventional transthoracic two-dimensional and Doppler echocardiograms were obtained at baseline and after 2 months. Echocardiographers at each site were blinded to the treatment arms. Statistical analysis was performed using intention-to-treat analysis. At baseline, 55% of patients had pulmonary hypertension and 51% had evidence of left ventricular hypertrophy. Treatment with NIV, but not CPAP, lowered systolic pulmonary artery pressure (-3.4 mm Hg, 95% CI -5.3 to -1.5; adjusted P=0.025 vs control and P=0.033 vs CPAP). The degree of improvement in systolic pulmonary artery pressure was greater in patients treated with NIV who had pulmonary hypertension at baseline (-6.4 mm Hg, 95% CI -9 to -3.8). Only NIV therapy decreased left ventricular hypertrophy with a significant reduction in left ventricular mass index (-5.7 g/m2; 95% CI -11.0 to -4.4). After adjusted analysis, NIV was superior to control group in improving left ventricular mass index (P=0.015). Only treatment with NIV led to a significant improvement in 6 min walk distance (32 m; 95% CI 19 to 46). In patients with OHS, medium-term treatment with NIV is more effective than CPAP and lifestyle modification in improving pulmonary hypertension, left ventricular hypertrophy and functional outcomes. Long-term studies are needed to confirm these results. Pre-results, NCT01405976 (https://clinicaltrials.gov/).
YR 2017
FD 2017-11-16
LK http://hdl.handle.net/10668/11809
UL http://hdl.handle.net/10668/11809
LA en
DS RISalud
RD Apr 7, 2025