Echocardiographic changes with non-invasive ventilation and CPAP in obesity hypoventilation syndrome. Issue 4 (16th November 2017)

• Record Type: Journal Article
• Authors: Corral, Jaime; Mogollon, Maria Victoria; Sánchez-Quiroga, M-Ángeles; Gómez de Terreros, Javier; Romero, Auxiliadora; Caballero, Candela; Teran-Santos, Joaquin; Alonso-Álvarez, María L; Gómez-García, Teresa; González, Mónica; López-Martínez, Soledad; de Lucas, Pilar; Marin, José M; Romero, Odile; Díaz-Cambriles, Trinidad; Chiner, Eusebi; Egea, Carlos; Lang, Roberto M; Mokhlesi, Babak; Masa, Juan F
• Is Part Of: Thorax. Volume 73:Issue 4(2018)
• Page Start: 361
• Page End: 368
• Publication Date: 2017-11-16
• Subjects: sleep apnoea -- non invasive ventilation; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2017-210642
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Rationale: 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. Objectives: 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. Methods: 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. Results: 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/m 2 ; 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). Conclusion: 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. Trial registration number: Pre-results, NCT01405976 (https://clinicaltrials.gov/ ).