• Jaime Corral, Maria Victoria Mogollon, M-Ángeles Sánchez-Quiroga, Javier Gómez de Terreros, Auxiliadora Romero, Candela Caballero, Joaquin Teran-Santos, María L Alonso-Álvarez, Teresa Gómez-García, Mónica González, Soledad López-Martínez, Pilar de Lucas, José M Marin, Odile Romero, Trinidad Díaz-Cambriles, Eusebi Chiner, Carlos Egea, Roberto M Lang, Babak Mokhlesi, Juan F Masa, and Spanish Sleep Network.
• Pneumology Service, San Pedro de Alcantara Hospital, Cáceres, Spain.
• Thorax. 2018 Apr 1; 73 (4): 361-368.

RationaleDespite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysfunction, no randomised trials have assessed the impact of non-invasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography.ObjectivesWe performed a secondary analysis of the data from the largest multicentre randomised controlled trial of OHS (Pickwick project, n=221) to determine the comparative efficacy of 2 months of NIV (n=71), CPAP (n=80) and lifestyle modification (control group, n=70) on structural and functional echocardiographic changes.MethodsConventional transthoracic two-dimensional and Doppler echocardiograms were obtained at baseline and after 2 months. Echocardiographers at each site were blinded to the treatment arms. Statistical analysis was performed using intention-to-treat analysis.ResultsAt baseline, 55% of patients had pulmonary hypertension and 51% had evidence of left ventricular hypertrophy. Treatment with NIV, but not CPAP, lowered systolic pulmonary artery pressure (-3.4 mm Hg, 95% CI -5.3 to -1.5; adjusted P=0.025 vs control and P=0.033 vs CPAP). The degree of improvement in systolic pulmonary artery pressure was greater in patients treated with NIV who had pulmonary hypertension at baseline (-6.4 mm Hg, 95% CI -9 to -3.8). Only NIV therapy decreased left ventricular hypertrophy with a significant reduction in left ventricular mass index (-5.7 g/m2; 95% CI -11.0 to -4.4). After adjusted analysis, NIV was superior to control group in improving left ventricular mass index (P=0.015). Only treatment with NIV led to a significant improvement in 6 min walk distance (32 m; 95% CI 19 to 46).ConclusionIn patients with OHS, medium-term treatment with NIV is more effective than CPAP and lifestyle modification in improving pulmonary hypertension, left ventricular hypertrophy and functional outcomes. Long-term studies are needed to confirm these results.Trial Registration NumberPre-results, NCT01405976 (https://clinicaltrials.gov/).© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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