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Impaired Objective Daytime Vigilance in Obesity-Hypoventilation Syndrome^*

Impact of Noninvasive Ventilation

^* From the Sleep Laboratory and Exploration fonctionelle cardio-respiratoire (Dr. Chouri-Pontarollo), and the HP2 laboratory (Drs. Tamisier, Wuyam, Levy, and Pépin, and Mr. Borel), Institut National de la Santé et de la Recherche Médicale ERI 0017, University Hospital, Grenoble, France.

Correspondence to: Jean-Louis Pépin, MD, PhD, Laboratoire du sommeil, EFCR, CHU de Grenoble, BP217X, 38043 Grenoble cedex 09, France; e-mail: JPepin{at}chu-grenoble.fr

Abstract

Background: Obesity-hypoventilation syndrome (OHS) is efficiently treated by noninvasive ventilation (NIV). Sleep respiratory disturbances, reduced ventilatory drive, and excessive daytime sleepiness (EDS) are commonly reported, but their relationships remain unclear.

Objectives: To characterize sleep breathing disorders encountered in patients with OHS, to compare low and normal CO₂ responders in terms of sleep abnormalities, subjective and objective measures of EDS, and to measure the changes induced by NIV on these parameters.

Methods: At baseline and after 5 nights of NIV, 15 consecutive patients (mean [± SD] age, 55 ± 9 years; mean body mass index, 38.7 ± 6.1 kg/m²; PaCO₂, 47.3 ± 2.3 mm Hg) prospectively underwent polysomnography, CO₂ ventilatory response testing, Epworth sleepiness scale scoring, and the Oxford Sleep Resistance (OSLER) test, which is an objective vigilance test.

Results: OHS patients exhibited obstructive sleep apnea syndrome (mean apnea-hypopnea index, 62 ± 32 events per hour) and rapid eye movement (REM) sleep hypoventilation (mean REM sleep time, 35 ± 33%). Baseline CO₂ sensitivity was significantly related to the proportion of hypoventilation during REM sleep (r = 0.54; p = 0.037). Six patients showed abnormal sleep latencies during the OSLER test (71% of the low CO₂ responders vs 14% of the normal CO₂ responders). Low CO₂ responders exhibited significantly shorter sleep latencies during the OSLER test (23 ± 14 vs 37 ± 8 min, respectively; p = 0.05). Using NIV, diurnal blood gas levels were improved and REM sleep hypoventilation were suppressed. Objective sleepiness was improved in low CO₂ responders (p = 0.04).

Conclusion: In OHS patients, the lower the daytime CO₂ response, the higher the proportion of REM sleep hypoventilation and daytime sleepiness. Short-term therapy with NIV improves all of these parameters.

Key Words: noninvasive ventilation • obesity hypoventilation syndrome • ventilatory response • vigilance test

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