Review Article

Positive Pressure for Obesity Hypoventilation Syndrome

Table 1

Studies reporting clinical impact of positive pressure therapies on chronic hypercapnic respiratory failure.

Studyn/designMean BMI
kg/m2
Intervention(s)
(mean values in cmH2O)
Measurements whenGas exchangeSymptomsSleep

Mokhlesi et al. [36]75/Retro51CPAP = 14
Bilevel
PAP = 18/13*
Median = 84 d PCO2 54 to 49 mmHg;
α to adherence hours

Piper et al. [37]36/PR53CPAP = 14**  
Bilevel
PAP = 16/10*
3 months PCO2 5.8 v. 6.9 
mmHg
Sleepiness both groups; QOL > on bi-level PAPBilevel PAP better sleep quality

Hida et al. [38]26/PNR36CPAP3–6 months Sleepiness QOL

Banerjee et al. [39]23/PNR59CPAP = 14“later date” TST < 80 and 90% AHI, REM

Berger et al. [23]23/Retro56CPAP = 13
Bilevel PAP 18/8
Average of 14 months PCO2 55 to 45
 mmHg

Storre et al. [47]10/Prospective42Bilevel PAP 15/6
AVAPS 16/5
6 weeks PCO2 47 to 42 in AVAPS and 46 in Bi-level PAP Anxiety, social functioning Arousals, REM, RDI, AHI

Pérez De Llano et al. [40]54/Retro44Initial bilevel
PAP settings 10/6
Mean of 50 months PCO2 61 to 44 Dyspnea ESS 16 to 6

Masa et al. [43]22/Prospective41NIMV***4 months to a year PCO2 58 to 45 Headaches
Dyspnea
Edema
Sleepiness
Morning drowsiness

Pérez De Llano et al. [40]24/Prospective
44Bilevel PAP
titration
CPAP 10
24 hrs PCO2 58 to 44 in Bi-level PAP
PCO2 60 to 42 in CPAP
ESS

Priou et al. [44]130/Retro44Bilevel PAP
IPAP 14 to 28
EPAP 6 to 14
6 months PCO2 56 to 45 ESS 10 to 4
AHI 87 to 13

Murphy et al. [48]50/PR51Bilevel PAP 25/10
AVAPS:
volume = 657 mL
EPAP = 9
3 months PCO2 51 to 47 in Bi-level PAP
PCO2 53 to 48 in AVAPS
No between-group differences; intragroup comparisons not reported

Borel et al. [49]35/PR40Bilevel PAP
(versus counseling)
1 month PCO2 48 to 43
in Bi-level PAP
REM 17 to 26%
AHI 40 to 6
In bi-level PAP

Inspiratory pressure/expiratory pressure; **4 patients in CPAP group failed long term, requiring bilevel PAP, ***NIMV: volume cycled device or bilevel PAP device, PR: prospective randomized; PNR: prospective nonrandomized; Retro: retrospective; TST: total sleep time; QOL: quality of life; AHI: apnea-hypopnea index; REM: rapid eye movements; RDI: respiratory disturbance index; ESS: Epworth sleepiness score.