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Title: Echocardiographic changes with positive airway pressure therapy in obesity hypoventilation syndrome long-term pickwick randomized controlled clinical trial
Authors: Masa, Juan F.
Mokhlesi, Babak
Benítez, Iván
Mogollon, Maria Victoria
De Terreros, Francisco Javier Gomez
Sánchez-Quiroga, Maria Ángeles
Romero, Auxiliadora
Caballero-Eraso, Candela
Alonso-Álvarez, Maria Luz
Ordax-Carbajo, Estrella
Gomez-Garcia, Teresa
González, Mónica
López-Martín, Soledad
Marin, José M.
Martí, Sergi
Díaz-Cambriles, Trinidad
Chiner, Eusebi
Egea, Carlos
Barca, Javier
Vázquez-Polo, Francisco J. 
Negrín Hernández, Miguel Ángel 
Martel Escobar, María Carmen 
Barbe, Ferran
Corral, Jaime
UNESCO Clasification: 32 Ciencias médicas
Keywords: Sleep apnea
Pulmonary hypertension
Diastolic dysfunction
Noninvasive ventilation, et al
Issue Date: 2020
Journal: American Journal of Respiratory and Critical Care Medicine 
Abstract: 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 withNIV andCPAPled to similar degrees of improvement in pulmonary hypertension and left ventricular diastolic dysfunction.
ISSN: 1073-449X
DOI: 10.1164/rccm.201906-1122OC
Source: American Journal of Respiratory and Critical Care Medicine [ISSN 1073-449X], v. 201 (5), p. 586-597
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