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The Obesity Hypoventilation Syndrome Can Be Treated With Noninvasive Mechanical Ventilation^*

^* From the Pulmonary Division (Drs. Masa, Riesco, Hernández, Sánchez de Cos, and Disdier), "San Pedro de Alcántara" Hospital, Cáceres, Spain; and St. Elizabeth’s Medical Center (Dr. Celli), Boston, MA.

Correspondence to: Juan F. Masa, MD, C/Rafael Alberti 12, 10001 Cáceres, Spain; e-mail: fmasa{at}separ.es

Study objectives: To assess the effectiveness of nasal noninvasive mechanical ventilation (NIMV) in patients with obesity hypoventilation syndrome (OHS).

Design: Clinical assay that compares two groups of patients with hypercapnic respiratory failure, one group with OHS and the other group with kyphoscoliosis, in their basal situation and after 4 months of treatment with nocturnal NIMV. Thirty-six patients (22 patients with OHS and 14 patients with kyphoscoliosis) completed the study protocol.

Results: The frequency of symptoms, such as morning headache, morning drowsiness, dyspnea, and leg edema, improved in a statistically significant way in both groups of patients. The sleepiness improved only in the group with OHS. The comparison of frequency of symptoms between both groups of patients after NIMV treatment did not present statistically significant differences. In the resting situation and without nasal ventilation in place, the PO₂ (mean ± SD) changed from 51 ± 10 to 64 ± 11 mm Hg (p < 0.001) and PCO₂ from 58 ± 10 to 45 ± 5 mm Hg (p < 0.001) when the patients with OHS were treated with NIMV. In the group of patients with kyphoscoliosis, likewise without nasal ventilation in place, PO₂ changed from 53 ± 6 to 65 ± 5 mm Hg (p < 0.001) and PCO₂ from 59 ± 11 to 45 ± 4 mm Hg (p < 0.001) with NIMV treatment. When we compared PO₂ and PCO₂ in both groups of patients at the beginning and at the end of NIMV treatment, we did not find statistically significant differences between OHS and kyphoscoliosis.

Conclusions: NIMV improves the clinical symptoms and the respiratory failure of patients with OHS to a similar degree to that reported for diseases in which its use is completely established, such as kyphoscoliosis. Therefore, NIMV could be an alternative to the treatment of patients with OHS.

Key Words: home mechanical ventilation • hypercapnic respiratory failure • kyphoscoliosis • noninvasive mechanical ventilation • obesity • obesity hypoventilation syndrome

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