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Correspondence |

Obesity Hypoventilation SyndromeTreatment of Obesity Hypoventilation Syndrome: The Need For a Multifaceted Approach to Treatment FREE TO VIEW

Patrick B. Murphy, MBBS; Michael I. Polkey, PhD; Nicholas Hart, PhD
Author and Funding Information

From the Department of Asthma, Allergy and Respiratory Science (Drs Murphy and Hart), Division of Asthma, Allergy and Lung Biology, King’s College London; Lane Fox Unit (Dr Hart), Guy’s and St. Thomas’ NHS Foundation Trust; National Institute for Health Research Biomedical Research Unit at The Royal Brompton and Harefields NHS Foundation Trust (Dr Polkey); and National Institute for Health Research Comprehensive Biomedical Research Centre (Dr Hart).

Correspondence to: Patrick B. Murphy, Lane Fox Respiratory Unit, St. Thomas’ Hospital, Westminster Bridge Rd, London, SE1 7EH, England; e-mail: patrick.b.murphy@kcl.ac.uk


Funding/Support: The study group has received unrestricted educational grants from ResMed, Philips Respironics, Fisher & Paykel Healthcare, and B&D Electromedical LLP. The authors acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St. Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust and the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Murphy has received expenses for travel to conferences from Philips Respironics. Dr Hart has received fees for lecturing from Philips Respironics and Fisher & Paykel Healthcare. Dr Polkey has received fees for lecturing from Philips Respironics.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(2):540-541. doi:10.1378/chest.12-0626
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Published online

The article by Borel et al1 in CHEST (March 2012) is a timely addition to our understanding of obesity hypoventilation syndrome, an increasingly prevalent condition.2 The study confirms the data from uncontrolled studies and reaffirms the current clinical consensus by demonstrating the clinical improvements that occur when managing patients with obesity hypoventilation syndrome with noninvasive ventilation. The study control group involved lifestyle advice and was also associated with significant improvements in some clinical parameters. It should be noted that sleep-disordered breathing has been shown to improve with lifestyle modification and exercise training,3 and, thus, the control group was not a sham of active treatment but employed a different modality of treatment. This may explain, in part, the nonsignificant findings of the results.

Previous data4 and the current study have been unable to demonstrate a reduction in weight or improvement in physical activity with the treatment of sleep-disordered breathing. However, the heightened cardiovascular risk in this patient group and the benefits of even modest risk modification5 indicate this is a vital area of management. In recent work published by our own group,6 we showed that improvements in objectively assessed physical activity in this patient population occurred following treatment with noninvasive ventilation are correlated with reduction in weight. However, as with the current article, we were unable to demonstrate that anthropometric changes led to improvements in glycemic control or serum lipids. Evaluation of the addition of specific training and lifestyle modifications to conventional medical therapy are required to advance this challenging area of respiratory and sleep medicine.

Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Borel J-C, Tamisier R, Gonzalez-Bermejo J, et al. Noninvasive ventilation in mild obesity hypoventilation syndrome: a randomized controlled trial. Chest. 2012;141(3):692-702.
 
Janssens J-P, Derivaz S, Breitenstein E, et al. Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area. Chest. 2003;123(1):67-79.
 
Kline CE, Crowley EP, Ewing GB, et al. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep. 2011;34(12):1631-1640.
 
West SD, Kohler M, Nicoll DJ, Stradling JR. The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: A randomised controlled trial. Sleep Med. 2009;10(9):1056-1058.
 
Anderson JW, Kendall CW, Jenkins DJ. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr. 2003;22(5):331-339.
 
Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial [published online ahead of print March 1, 2012]. Thorax. doi:10.1136/thoraxjnl-2011-201081..
 

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References

Borel J-C, Tamisier R, Gonzalez-Bermejo J, et al. Noninvasive ventilation in mild obesity hypoventilation syndrome: a randomized controlled trial. Chest. 2012;141(3):692-702.
 
Janssens J-P, Derivaz S, Breitenstein E, et al. Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area. Chest. 2003;123(1):67-79.
 
Kline CE, Crowley EP, Ewing GB, et al. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep. 2011;34(12):1631-1640.
 
West SD, Kohler M, Nicoll DJ, Stradling JR. The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: A randomised controlled trial. Sleep Med. 2009;10(9):1056-1058.
 
Anderson JW, Kendall CW, Jenkins DJ. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr. 2003;22(5):331-339.
 
Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial [published online ahead of print March 1, 2012]. Thorax. doi:10.1136/thoraxjnl-2011-201081..
 
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