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Echocardiographic Changes with Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome. Long-Term Pickwick Randomized Controlled Clinical Trial

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 and CPAP led to similar degrees of improvement in pulmonary hypertension and left ventricular diastolic dysfunction.Clinical trial registered with www.clinicaltrials.gov (NCT01405976).

Otras publicaciones de la misma revista o congreso con autores/as de la Universidad de Cantabria

 Fuente: Am J Respir Crit Care Med . 2020 Mar 1;201(5):586-597

Editorial: American Thoracic Society

 Año de publicación: 2020

Nº de páginas: 12

Tipo de publicación: Artículo de Revista

 DOI: 10.1164/rccm.201906-1122OC

ISSN: 1073-449X,1535-4970

Url de la publicación: https://doi.org/10.1164/rccm.201906-1122oc

Autores/as

MASA, JUAN F.

MOKHLESI, BABAK

BENÍTEZ, IVÁN

MOGOLLÓN, MARÍA VICTORIA

GÓMEZ DE TERREROS, FRANCISCO JAVIER

SÁNCHEZ QUIROGA, MARIA ÁNGELES

ROMERO, AUXILIADORA

CABALLERO ERASO, CANDELA

ALONSO ÁLVAREZ, MARIA LUZ

ORDAX CARBAJO, ESTRELLA

GÓMEZ GARCÍA, TERESA

LÓPEZ MARTÍN, SOLEDAD

MARIN, JOSÉ M.

MARTÍ, SERGI

DÍAZ CAMBRILES, TRINIDAD

CHINER, EUSEBI

EGEA, CARLOS

BARCA, JAVIER

VÁZQUEZ POLO, FRANCISCO JOSÉ

NEGRÍN, MIGUEL A.

MARTEL ESCOBAR, MARÍA

BARBE, FERRÁN

CORRAL, JAIME

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