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

Abstract

Ahmed S BaHammam,1 Salih A Aleissi,1 Samar Z Nashwan,1 Awad H Olaish,1 Aljohara S Almeneessier1,2 1The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ahmed S BaHammam, University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia, Tel [phone], Fax [phone], Email [email protected]: 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

Keywords

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