Echocardiographic Changes with Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome Long-Term Pickwick Randomized Controlled Clinical Trial
Por:
Masa, J, Mokhlesi, B, Benitez, I, Mogollon, M, de Terreros, F, Sanchez-Quiroga, M, Romero, A, Caballero-Eraso, C, Alonso-Alvarez, M, Ordax-Carbajo, E, Gomez-Garcia, T, Gonzalez, M, Lopez-Martin, S, Marin, J, Marti, S, Diaz-Cambriles, T, Chiner, E, Egea, C, Barca, J, Vazquez-Polo, F, Negrin, M, Martel-Escobar, M, Barbe, F, Corral, J and Spanish Sleep Network
Publicada:
1 mar 2020
Resumen:
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.
Filiaciones:
Masa, J:
San Pedro Alcantara Hosp, Resp Dept, Caceres, Spain
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Inst Univ Invest Biosanitaria Extremadura INUBE, Badajoz, Spain
Mokhlesi, B:
Univ Chicago, Med Pulm & Crit Care, Chicago, IL 60637 USA
Benitez, I:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Inst Recerca Biomed LLeida IRBLLEIDA, Lleida, Spain
Mogollon, M:
San Pedro Alcantara Hosp, Resp Dept, Caceres, Spain
de Terreros, F:
San Pedro Alcantara Hosp, Resp Dept, Caceres, Spain
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Inst Univ Invest Biosanitaria Extremadura INUBE, Badajoz, Spain
Sanchez-Quiroga, M:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Inst Univ Invest Biosanitaria Extremadura INUBE, Badajoz, Spain
Virgen del Puerto Hosp, Resp Dept, Plasencia, Caceres, Spain
Romero, A:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Univ Seville, Hosp Univ Virgen del Rocio, Unidad Medicoquirurg Enfermedades Resp, Inst Biomed Sevilla IBiS, Seville, Spain
Caballero-Eraso, C:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Univ Seville, Hosp Univ Virgen del Rocio, Unidad Medicoquirurg Enfermedades Resp, Inst Biomed Sevilla IBiS, Seville, Spain
Alonso-Alvarez, M:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Univ Hosp, Resp Dept, Burgos, Spain
Ordax-Carbajo, E:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Univ Hosp, Resp Dept, Burgos, Spain
Gomez-Garcia, T:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
IIS Fdn Jimenez Diaz, Resp Dept, Madrid, Spain
Gonzalez, M:
Valdecilla Hosp, Resp Dept, Santander, Spain
Lopez-Martin, S:
Gregorio Maranon Hosp, Resp Dept, Madrid, Spain
Marin, J:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Miguel Servet Hosp, Resp Dept, Zaragoza, Spain
Marti, S:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
ValldHebron Hosp, Resp Dept, Barcelona, Spain
Diaz-Cambriles, T:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Doce Octubre Hosp, Resp Dept, Madrid, Spain
:
San Juan Hosp, Resp Dept, Alicante, Spain
Egea, C:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Alava Univ Hosp IRB, Resp Dept, Vitoria, Spain
Barca, J:
Inst Univ Invest Biosanitaria Extremadura INUBE, Badajoz, Spain
Extremadura Univ, Nursing Dept, Caceres, Spain
Vazquez-Polo, F:
Univ Las Palmas Gran Canaria, Dept Quantitat Methods, Las Palmas Gran Canaria, Spain
Negrin, M:
Univ Las Palmas Gran Canaria, Dept Quantitat Methods, Las Palmas Gran Canaria, Spain
Martel-Escobar, M:
Univ Las Palmas Gran Canaria, Dept Quantitat Methods, Las Palmas Gran Canaria, Spain
Barbe, F:
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Inst Recerca Biomed LLeida IRBLLEIDA, Lleida, Spain
Corral, J:
San Pedro Alcantara Hosp, Resp Dept, Caceres, Spain
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Inst Univ Invest Biosanitaria Extremadura INUBE, Badajoz, Spain
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