Results of CPAP Titration and Short-Term Adherence Rates in Patients with Obesity Hypoventilation Syndrome and Mild/Moderate Obstructive Sleep Apnea

Abstract

Purpose

No study has assessed the titration success of CPAP therapy in patients with obesity hypoventilation syndrome (OHS) and an apnea-hypopnea index (AHI) <30 event/h. This study aimed to assess the titration success of CPAP therapy under polysomnography and subsequent short-term adherence (1 month) in patients with OHS and an AHI <30 event/h.

Methods

Consecutive OHS patients with an AHI <30 events/h between 2010 and 2019 were included (n=54). All OHS patients were first started on CPAP during the therapeutic sleep-study. If the therapeutic-study showed that the SpO2 remained < 90% for 20% of the total sleep time, a second therapeutic study was arranged with bi-level PAP (BPAP). Thirty patients agreed to participate in the 1-month follow-up adherence study. We applied the American-Thoracic-Society criteria for PAP adherence.

Results

The mean age was 54.8±14.6 years, and the mean BMI was 45.9±12.2 kg/m². Successful titration on CPAP was attained in 36 (66.7%) patients, and 18 (33.3%) required BPAP. Patients who failed the CPAP trial had a significantly higher PaCO2 and bicarbonate, a more restrictive respiratory pattern on spirometry, and a significantly higher time with SpO2<90% (mins) during sleep. The only independent correlate of CPAP-titration success on the multivariable regression analysis was the desaturation index (OR: 1.33 [1.033–1.712]). More than 80% of the participants were using CPAP therapy after one-month with no differences in adherence between the CPAP and BPAP groups.

Conclusions

The current results suggest that CPAP therapy could be an acceptable alternative therapy to BPAP in patients with OHS without severe OSA.

Keywords:

• CPAP
• bi-level positive airway pressure
• compliance
• obstructive sleep apnea
• desaturation
• titration

Data Availability

Data are available upon request. However, releasing data needs IRB approval.

Ethics Statement

The study protocol was approved by the Ethics Committee of the College of Medicine, King Saud University, and Medical City. All participants provided written informed consent. This study was performed according to the Declaration of Helsinki.

Acknowledgment

This study was supported by a research grant from the “Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in Saudi Arabia (08-MED511-02)”.

At this time, we keep in mind the coauthor Awad H. Olaish who passed before the publication of this work; we all miss you.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors report no conflicts of interest in this work.