The Association Between Adherence to Positive Airway Pressure Therapy and Long-Term Outcomes in Patients With Obesity Hypoventilation Syndrome: A Prospective Observational Study.

Autor: Bouloukaki I; Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece., Mermigkis C; Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece., Michelakis S; Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece., Moniaki V; Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece., Mauroudi E; Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece., Tzanakis N; Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece., Schiza SE; Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece.
Jazyk: angličtina
Zdroj: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine [J Clin Sleep Med] 2018 Sep 15; Vol. 14 (9), pp. 1539-1550. Date of Electronic Publication: 2018 Sep 15.
DOI: 10.5664/jcsm.7332
Abstrakt: Study Objectives: To assess the role of different levels of adherence and long-term effects of positive airway pressure (PAP) therapy on gas exchange, sleepiness, quality of life, depressive symptoms, and all-cause mortality in patients with obesity hypoventilation syndrome (OHS).
Methods: A total of 252 patients with newly diagnosed OHS were followed up for a minimum of 2 years after PAP initiation. PAP adherence (h/night) was monitored. Arterial blood gas samples were taken with patients being alert for more than 4 hours after morning awakening. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (Short Form 36 [SF-36]) and patient's depressive symptoms (Beck Depression Inventory [BDI]) were assessed before and at the end of the follow-up period, along with all-cause mortality.
Results: At the end of the follow-up period (median duration [25th-75th percentile], 30 [24-52] months), PaO 2 increased from baseline (72.7 ± 10.3 versus 63.2 ± 10.6, P < .001) and both PaCO 2 and HCO 3 - decreased (43.0 [39.2-45.0] versus 50.0 [46.7-55.4] and 27.5 ± 3.2 versus 31.4 ± 4.2, respectively, P < .001). In addition, PAP therapy significantly improved ESS (7 [4-9] versus 14 [11-16], P < .001), BDI (8.8 ± 4.9 versus 15.5 ± 7.3, P < .001) and SF-36 (82 [78-87] versus 74 [67-79], P < .001) scores. Over the follow-up period 11 patients died. Patients who used PAP for > 6 h/night had significant improvements ( P < .05) in blood gases and SF-36 scores than less adherent patients.
Conclusions: Increased hours of use and long-term therapy with PAP are effective in the treatment of patients with OHS. Clinicians should encourage adherence to PAP therapy in order to provide a significant improvement in clinical status and gas exchange in these patients.
Commentary: A commenary on this article appears in this issue on page 1455.
Clinical Trial Registration: Title: PAP Therapy in Patients With Obesity Hypoventilation Syndrome, Registry: ClinicalTrials.gov, Identifier: NCT03449641, URL: https://clinicaltrials.gov/ct2/show/NCT03449641.
(© 2018 American Academy of Sleep Medicine.)
Databáze: MEDLINE
Externí odkaz: