Mid- and Long-term Efficacy of Non-invasive Ventilation in Obesity Hypoventilation Syndrome: The Pickwick's Study

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• 作者：Mar&iacute ; a J. Ló ; pez-Jimé ; nez^a ; Juan F. Masa^a ; ^r ; ^{fmasa@separ.es" class="auth_mail" title="E-mail the corresponding author} ; Jaime Corral^a ; ^r ; Joaqu&iacute ; n Terá ; n^b ; ^r ; Estrella Ordaz^b ; ^r ; Maria F. Troncoso^c ; ^r ; Nicolá ; s Gonzá ; lez-Mangado^c ; ^r ; Mó ; nica Gonzá ; lez^d ; Soledad Lopez-Mart&iacute ; nez^e ; Pilar De Lucas^e ; José ; M. Mar&iacute ; n^f ; ^r ; Sergi Mart&iacute ; ^g ; ^r ; Trinidad D&iacute ; az-Cambriles^h ; ^r ; Josefa D&iacute ; az-de-Atauri^h ; ^r ; Eusebi Chinerⁱ ; Felipe Aizpuru^j ; ^r ; Carlos Egea^k ; ^r ; Auxiliadora Romero^l ; José ; M. Ben&iacute ; tez^m ; Jesú ; s Sá ; nchez-Gó ; mez^m ; Rafael Golpeⁿ ; Ana Santiago-Recuerda^o ; Silvia Gó ; mez^p ; ^r ; Ferrá ; n Barbe^p ; ^r ; Mó ; nica Bengoa^q ; Cooperative Group^&loz ;
• 关键词：Obesity-hypoventilation syndrome ; Noninvasive mechanical ventilation ; Continuous positive airway pressure ; Sleep apnea syndrome
• 刊名：Archivos de Bronconeumología (English Edition)
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：52
• 期：3
• 页码：158-165
• 全文大小：361 K

文摘

The Pickwick project is a prospective, randomized and controlled study, which addresses the issue of obesity hypoventilation syndrome (OHS), a growing problem in developed countries. OHS patients were divided according to apnea–hypopnea index (AHI) ≥30 and <30 determined by polysomnography. The group with AHI≥30 was randomized to intervention with lifestyle changes, noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP); the group with AHI <30 received NIV or lifestyle changes.

The aim of the study was to evaluate the efficacy of NIV treatment, CPAP and lifestyle changes (control) in the medium and long-term management of patients with OHS. The primary variables were PaCO₂ and days of hospitalization, and operating variables were the percentage of dropouts for medical reasons and mortality.

Secondary medium-term objectives were: (1) to evaluate clinical–functional effectiveness on quality of life, echocardiographic and polysomnographic variables; (2) to investigate the importance of apneic events and leptin in the pathogenesis of daytime alveolar hypoventilation and change according to the different treatments; (3) to investigate whether metabolic, biochemical and vascular endothelial dysfunction disorders depend on the presence of apneas and hypopneas and (4) changes in inflammatory markers and endothelial damage according to treatment.

Secondary long-term objectives are to evaluate: (1) clinical and functional effectiveness and quality of life with NIV and CPAP; (2) changes in leptin, inflammatory markers and endothelial damage according to treatment; (3) changes in pulmonary hypertension and other echocardiographic variables, as well as blood pressure and incidence of cardiovascular events, and (4) dropout rate and mortality.