Haemodynamic effects of non-invasive ventilation in patients with obesity-hypoventilation syndrome
Article first published online: 25 OCT 2012
© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology
Volume 17, Issue 8, pages 1269–1274, November 2012
How to Cite
CASTRO-AÑÓN, O., GOLPE, R., PÉREZ-DE-LLANO, L. A., LÓPEZ GONZÁLEZ, M. J., ESCALONA VELASQUEZ, E. J., PÉREZ FERNÁNDEZ, R., TESTA FERNÁNDEZ, A. and GONZÁLEZ QUINTELA, A. (2012), Haemodynamic effects of non-invasive ventilation in patients with obesity-hypoventilation syndrome. Respirology, 17: 1269–1274. doi: 10.1111/j.1440-1843.2012.02252.x
- Issue published online: 25 OCT 2012
- Article first published online: 25 OCT 2012
- Accepted manuscript online: 17 AUG 2012 04:37AM EST
- Received 6 March 2012; invited to revise 16 April 2012; revised 22 May 2012; accepted 18 June 2012 (Associate Editor: Amanda Piper).
- continuous positive airway pressure;
- non-invasive mechanical ventilation;
- obesity hypoventilation syndrome;
- Pickwickian syndrome;
- sleep apnoea
Background and objective: Although it has been reported that pulmonary hypertension is more frequent in patients with obesity-hypoventilation syndrome than in patients with ‘pure’ obstructive sleep apnoea syndrome, little is known about the haemodynamic repercussions of this entity. The aim was to describe the haemodynamic status, as assessed by echocardiography and 6-min walk test (6MWT), of patients with a newly diagnosed, most severe form of obesity-hypoventilation syndrome, and to evaluate the impact of non-invasive ventilation in these patients.
Methods: A prospective, descriptive, and single-centre follow-up study was conducted. At baseline, patients underwent echocardiography, spirometry, static lung volume measurement, 6MWT, overnight pulse-oximetry and polygraphic recording. Changes in echocardiography and 6MWT were assessed after 6 months of non-invasive ventilation. Right ventricular overload was defined on the basis of right ventricular dilatation, hypokinesis, paradoxical septal motion and/or pulmonary hypertension.
Results: Thirty patients (20 women; mean age 69 ± 11) were tested. The percentage of patients with right ventricular overload did not change significantly after non-invasive ventilation (43.3–41.6%; P = 0.24). In patients with right ventricular overload at diagnosis, pulmonary artery systolic pressure decreased significantly at six months (58 ± 11 to 44 ± 12 mm Hg; P = 0.014), and mean distance on 6MWT increased from 350 ± 110 to 426 ± 78 m (P = 0.006), without significant changes in body mass index.
Conclusions: Right ventricular overload is a frequent finding in patients with the most severe form of obesity-hypoventilation syndrome. Treatment with non-invasive ventilation is associated with a decrease in pulmonary artery systolic pressure at six months and an increase in the distance covered during the 6MWT.