Non-invasive ventilation in obstructive sleep apnoea/obesity hypoventilation syndrome: Experience from an Indian tertiary care respiratory centre.
Obesity hypoventilation syndrome (OHS) includes morbid obesity (Body mass index>30 kilograms/m2), daytime hypercapnia (arterial carbon dioxide level >45 mm Hg) with features of sleep disordered breathing. Data are scarce in the management of acute-on-chronic hypercapnic failure with NIV, especially from developing countries like India. We set out to evaluate the demography of OHS patients presenting with acute on chronic hypercapnic failure and evaluate the effect of NIV in improvement of symptoms and correction of blood gas parameters.
This ambidirectional observational study included 30 patients who were confirmed cases of OHS and were admitted with hypercapnic respiratory failure and managed with NIV and discharged later on domiciliary NIV. The patients were evaluated for the complications of OHS and were followed up for improvement with domiciliary NIV.
Out of the 30 patients of OHS,16 (53%) were males while 14 (47%) were females. 17 patients (56.7%) had type II diabetes mellitus, while 25 (83%) patients were known cases of primary hypertension. The mean age was 61 years (SD-11.15), and the mean Body Mass Index (BMI) was 36.2 kilograms/meter2 (SD-6.19). On admission, the mean pH was 7.35 (SD-0.10), mean pCO2 was 55.33 mmHg (SD-17.56), and mean HCO3 was 31.31 (SD-5.23), suggestive of acute on chronic hypoventilation. 10 out of 30 patients were hypoxic at presentation, out of which 5 required (Non-Rebreathing Mask (NRBM on admission. All these patients were managed with NIV, and they showed significant clinical improvement in the form of improved sensorium, decreased oxygen requirement, and improved exercise tolerance. The mean improvement in pH after one week was 7.41, and the mean level of pCO2 was 48.10 mmHg after 1 week of NIV. Significant improvements were observed in arterial blood gases (pCO2 reduced from 55.33 ± 6.1 mmHg to 48.22; P<0.001) and Epworth Sleepiness Scale (ESS) scores. The decrease in pCO2 was statistically significant. These patients were discharged on domiciliary NIV and were followed up on an OPD basis.
All patients with OHS who presented with acute on chronic hypercapnic failure responded well to NIV therapy with significant improvement in exercise tolerance, weight loss, decreased symptom burden, and blood gase parameters. These findings reinforce the role of structured NIV therapy in OHS management.
This ambidirectional observational study included 30 patients who were confirmed cases of OHS and were admitted with hypercapnic respiratory failure and managed with NIV and discharged later on domiciliary NIV. The patients were evaluated for the complications of OHS and were followed up for improvement with domiciliary NIV.
Out of the 30 patients of OHS,16 (53%) were males while 14 (47%) were females. 17 patients (56.7%) had type II diabetes mellitus, while 25 (83%) patients were known cases of primary hypertension. The mean age was 61 years (SD-11.15), and the mean Body Mass Index (BMI) was 36.2 kilograms/meter2 (SD-6.19). On admission, the mean pH was 7.35 (SD-0.10), mean pCO2 was 55.33 mmHg (SD-17.56), and mean HCO3 was 31.31 (SD-5.23), suggestive of acute on chronic hypoventilation. 10 out of 30 patients were hypoxic at presentation, out of which 5 required (Non-Rebreathing Mask (NRBM on admission. All these patients were managed with NIV, and they showed significant clinical improvement in the form of improved sensorium, decreased oxygen requirement, and improved exercise tolerance. The mean improvement in pH after one week was 7.41, and the mean level of pCO2 was 48.10 mmHg after 1 week of NIV. Significant improvements were observed in arterial blood gases (pCO2 reduced from 55.33 ± 6.1 mmHg to 48.22; P<0.001) and Epworth Sleepiness Scale (ESS) scores. The decrease in pCO2 was statistically significant. These patients were discharged on domiciliary NIV and were followed up on an OPD basis.
All patients with OHS who presented with acute on chronic hypercapnic failure responded well to NIV therapy with significant improvement in exercise tolerance, weight loss, decreased symptom burden, and blood gase parameters. These findings reinforce the role of structured NIV therapy in OHS management.
Authors
Marwah Marwah, Choudhary Choudhary, Kumar Kumar, Srishti Srishti, Shrinath Shrinath, Sharma Sharma
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