The purpose was to study whether mortality and cardiovascular morbidity differ in non-invasive ventilation (NIV)-treated patients with severe obesity-hypoventilation syndrome ( OHS ) as compared with CPAP-treated patients with obstructive sleep apnea syndrome ( OSAS ), and to identify independent predictors of mortality in obesity-hypoventilation syndrome.
Two retrospective cohorts of obesity-hypoventilation syndrome and obstructive sleep apnea were matched 1:2 according to sex, age ( ±10 year ) and length of time since initiation of CPAP/NIV therapy ( ±6 months ).
Three hundred and thirty subjects ( 110 patients with obesity-hypoventilation syndrome and 220 patients with obstructive sleep apnea ) were studied.
Mean follow-up time was 7±4 years.
The five year mortality rates were 15.5% in OHS cohort and 4.5% in OSAS cohort ( p less than 0.05 ).
Patients with obesity-hypoventilation syndrome had a 2-fold increase ( odds ratio, OR=2; 95% CI: 1.11-3.60 ) in the risk of mortality and 1.86 fold ( OR=1.86; 95% CI: 1.14-3.04 ) increased risk of having a cardiovascular event.
Diabetes, baseline diurnal SaO2 less than 83%, EPAP less than 7 cmH2O after titration and adherence to NIV less than 4 hours independently predicted mortality in obesity-hypoventilation syndrome.
In conclusion, mortality of severe obesity-hypoventilation syndrome is high and substantially worse than that of obstructive sleep apnea.
Severe obesity-hypoventilation syndrome should be considered a systemic disease that encompasses respiratory, metabolic and cardiovascular components that require a multimodal therapeutic approach. ( Xagena )
Castro-Añón O et al, PLoS One 2015;10:e0117808