Long‐term outcome with focus on pulmonary hypertension in Obesity Hypoventilation Syndrome

Introduction Pulmonary Hypertension (PH) is a frequent comorbidity in Obesity Hypoventilation Syndrome (OHS). Objective We investigated long‐term outcome of OHS with a particular emphasis on PH. Methods In a prospective design, 64 patients with OHS and established noninvasive positive pressure venti...

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Bibliographic Details
Published in:The clinical respiratory journal 2020-10, Vol.14 (10), p.940-947
Main Authors: Budweiser, Stephan, Tratz, Florian, Gfüllner, Florian, Pfeifer, Michael
Format: Article
Language:English
Subjects:
chronic hypoventilation
chronic respiratory failure
Hypoventilation
Long‐term survival
Mortality
prognostic factors
Pulmonary hypertension
Regression analysis
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Summary:Introduction Pulmonary Hypertension (PH) is a frequent comorbidity in Obesity Hypoventilation Syndrome (OHS). Objective We investigated long‐term outcome of OHS with a particular emphasis on PH. Methods In a prospective design, 64 patients with OHS and established noninvasive positive pressure ventilation (NPPV), were assessed by serum biomarkers, right heart catheterization, blood gases analysis, lung function, Epworth‐Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), World Health Organization‐functional class (WHO‐FC) and health‐related quality of life (HRQL) via the Severe Respiratory Insufficiency (SRI) questionnaire. After a planned follow‐up of 5 years patients were reassessed regarding vital status, WHO‐FC, ESS, SRI, PSQI, body mass index (BMI) and NPPV use. Prognostic markers were explored using univariate and multivariate Cox regression analyses. Results At the 5‐year follow‐up, BMI tended to decrease (P = 0.05), while WHO‐FC, ESS and PSQI remained unchanged. HRQL deteriorated in terms of SRI summary score and most subdomains (P  1256 pg/mL (HR = 5.162, 95%‐CI = 1.136‐23.467, P = 0.018), diffusion capacity for carbon monoxide (DLCO, %pred) (HR = 0.341, 95%‐CI = 0.114‐1.019, P = 0.043) and higher oxygen use during daytime (HR = 5.236, 95%‐CI = 1.489‐18.406, P = 0.004) predicted mortality. No independent factor predicting mortality was detected in multivariate analysis. Conclusion Despite a high long‐term NPPV use HRQL worsened. Age, oxygen use at baseline, DLCO (%pred) and NT‐proBNP, as a surrogate parameter for PH, were related to long‐term survival.
ISSN:1752-6981
1752-699X
DOI:10.1111/crj.13225