Juan F Masa1,2,3, Babak Mokhlesi4, Iván Benítez2,5, Maria Victoria Mogollon1, Francisco Javier Gomez de Terreros1,2,3, Maria Ángeles Sánchez-Quiroga2,3,6, Auxiliadora Romero2,7, Candela Caballero-Eraso2,7, Maria Luz Alonso-Álvarez2,8, Estrella Ordax-Carbajo2,8, Teresa Gomez-Garcia2,9, Mónica González10, Soledad López-Martín11, José M Marin2,12, Sergi Martí2,13, Trinidad Díaz-Cambriles2,14, Eusebi Chiner15, Carlos Egea2,16, Javier Barca3,17, Francisco-José Vázquez-Polo18, Miguel A Negrín18, María Martel-Escobar18, Ferran Barbe2,5, Jaime Corral1,2,3. 1. Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain. 2. CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. 3. Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, Spain. 4. Medicine/Pulmonary and Critical Care, University of Chicago, Chicago, Illinois. 5. Institut de Recerca Biomédica de Lleida (IRBLLEIDA), Lleida, Spain. 6. Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain. 7. Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain. 8. Respiratory Department, University Hospital, Burgos, Spain. 9. Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain. 10. Respiratory Department, Valdecilla Hospital, Santander, Spain. 11. Respiratory Department, Gregorio Marañon Hospital, Madrid, Spain. 12. Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain. 13. Respiratory Department, Valld'Hebron Hospital, Barcelona, Spain. 14. Respiratory Department, Doce de Octubre Hospital, Madrid, Spain. 15. Respiratory Department, San Juan Hospital, Alicante, Spain. 16. Respiratory Department, Alava University Hospital IRB, Vitoria, Spain. 17. Nursing Department, Extremadura University, Cáceres, Spain; and. 18. Department of Quantitative Methods, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
Abstract
Rationale: Obesity hypoventilation syndrome (OHS) has been associated with cardiac dysfunction. However, randomized trials assessing the impact of long-term noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) on cardiac structure and function assessed by echocardiography are lacking. Objectives: In a prespecified secondary analysis of the largest multicenter randomized controlled trial of OHS (Pickwick Project; N = 221 patients with OHS and coexistent severe obstructive sleep apnea), we compared the effectiveness of three years of NIV and CPAP on structural and functional echocardiographic changes. Methods: At baseline and annually during three sequential years, patients underwent transthoracic two-dimensional and Doppler echocardiography. Echocardiographers at each site were blinded to the treatment allocation. Statistical analysis was performed using a linear mixed-effects model with a treatment group and repeated measures interaction to determine the differential effect between CPAP and NIV.Measurements and Main Results: A total of 196 patients were analyzed: 102 were treated with CPAP and 94 were treated with NIV. Systolic pulmonary artery pressure decreased from 40.5 ± 1.47 mm Hg at baseline to 35.3 ± 1.33 mm Hg at three years with CPAP, and from 41.5 ± 1.56 mm Hg to 35.5 ± 1.42 with NIV (P < 0.0001 for longitudinal intragroup changes for both treatment arms). However, there were no significant differences between groups. NIV and CPAP therapies similarly improved left ventricular diastolic dysfunction and reduced left atrial diameter. Both NIV and CPAP improved respiratory function and dyspnea.Conclusions: In patients with OHS who have concomitant severe obstructive sleep apnea, long-term treatment with NIV andCPAP led to similar degrees of improvement in pulmonary hypertension and left ventricular diastolic dysfunction.Clinical trial registered with www.clinicaltrials.gov (NCT01405976).
RCT Entities:
Rationale: Obesity hypoventilation syndrome (OHS) has been associated with cardiac dysfunction. However, randomized trials assessing the impact of long-term noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) on cardiac structure and function assessed by echocardiography are lacking. Objectives: In a prespecified secondary analysis of the largest multicenter randomized controlled trial of OHS (Pickwick Project; N = 221 patients with OHS and coexistent severe obstructive sleep apnea), we compared the effectiveness of three years of NIV and CPAP on structural and functional echocardiographic changes. Methods: At baseline and annually during three sequential years, patients underwent transthoracic two-dimensional and Doppler echocardiography. Echocardiographers at each site were blinded to the treatment allocation. Statistical analysis was performed using a linear mixed-effects model with a treatment group and repeated measures interaction to determine the differential effect between CPAP and NIV.Measurements and Main Results: A total of 196 patients were analyzed: 102 were treated with CPAP and 94 were treated with NIV. Systolic pulmonary artery pressure decreased from 40.5 ± 1.47 mm Hg at baseline to 35.3 ± 1.33 mm Hg at three years with CPAP, and from 41.5 ± 1.56 mm Hg to 35.5 ± 1.42 with NIV (P < 0.0001 for longitudinal intragroup changes for both treatment arms). However, there were no significant differences between groups. NIV and CPAP therapies similarly improved left ventricular diastolic dysfunction and reduced left atrial diameter. Both NIV and CPAP improved respiratory function and dyspnea.Conclusions: In patients with OHS who have concomitant severe obstructive sleep apnea, long-term treatment with NIV and CPAP led to similar degrees of improvement in pulmonary hypertension and left ventricular diastolic dysfunction.Clinical trial registered with www.clinicaltrials.gov (NCT01405976).
Authors: Juan F Masa; Iván D Benítez; Shahrokh Javaheri; Maria Victoria Mogollon; Maria Á Sánchez-Quiroga; Francisco J Gomez de Terreros; Jaime Corral; Rocio Gallego; Auxiliadora Romero; Candela Caballero-Eraso; Estrella Ordax-Carbajo; María F Troncoso; Mónica González; Soledad López-Martín; José M Marin; Sergi Martí; Trinidad Díaz-Cambriles; Eusebi Chiner; Carlos Egea; Javier Barca; Ferrán Barbé; Babak Mokhlesi Journal: J Clin Sleep Med Date: 2022-04-01 Impact factor: 4.062
Authors: David Berger; Olivier Wigger; Stefano de Marchi; Martin R Grübler; Andreas Bloch; Reto Kurmann; Odile Stalder; Kaspar Felix Bachmann; Stefan Bloechlinger Journal: Clin Res Cardiol Date: 2022-04-06 Impact factor: 6.138