Letter to the Editor
Mortality in Obesity-Hypoventilation Syndrome and Prognostic Risk Factors
Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico
E. Ojeda Castillejo
, P. de Lucas Ramos, P. Resano Barrios, S. López Martín, P. Rodríguez Rodríguez, L. Morán Caicedo, J.M. Bellón Cano, J.M. Rodríguez González-Moro
Corresponding author
Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Ojeda Castillejo, P. de Lucas Ramos, P. Resano Barrios, S. López Martín, P. Rodríguez Rodríguez, L. Morán Caicedo, J.M. Bellón Cano, J.M. Rodríguez González-Moro" "autores" => array:8 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Ojeda Castillejo" "email" => array:1 [ 0 => "e.ojeda.castillejo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "de Lucas Ramos" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Resano Barrios" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "López Martín" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Rodríguez Rodríguez" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Morán Caicedo" ] 6 => array:2 [ "nombre" => "J.M." "apellidos" => "Bellón Cano" ] 7 => array:2 [ "nombre" => "J.M." "apellidos" => "Rodríguez González-Moro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the letter sent to <span class="elsevierStyleSmallCaps">Archivos de Bronconeumología</span> regarding our article “Noninvasive Mechanical Ventilation in Patients With Obesity Hypoventilation Syndrome. Long-term Outcome and Prognostic Factors”.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> We would like to thank the authors and venture to respond.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We agree that the lack of comorbidity data is the greatest limitation of this study, particularly since the main aim was to define prognostic factors for predicting mortality. However, this aspect was not taken into account in the preliminary design of the database, and we rejected the idea of a retrospective search in the clinical records that would have reduced the quality of our data. While including comorbidities in the analysis would have been interesting, this omission does not affect the results, namely, that patients with sleep apnea and those with better ventilatory function at the start of the ventilation program have the best prognosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">With regard to the methodological concerns expressed by the authors of the letter, both initiation of ventilation and monitoring of ventilation mode comply with standard recommendations. Lowest pressure support (PS) was 10<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O, gradually increasing to 16, depending on arterial blood gases and tolerance. If 90% saturation could not be achieved with the initial PS, oxygen supplements were added until saturation was 90%, while FiO<span class="elsevierStyleInf">2</span> was subsequently modified according to arterial blood gas and saturation achieved with the effective or maximum PS. The statistical tests for comparison were selected on the basis of the sample size and normal distribution, and nonparametric tests were used, assuming penalties.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although all patients were included in the analysis of lung function and gas exchange outcomes until they left the ventilation program, the survival analysis was performed exclusively on patients who remained on ventilation until death (endpoint event). This means that patients who were withdrawn from the program due to poor compliance were not included in these analyses. As the authors of the letter rightly observe, and as confirmed in a recently study,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> compliance is key to the success of noninvasive ventilation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In our opinion, nighttime monitoring of patients is particularly important. While we agree that studies evaluating the benefits of polygraphy and/or polysomnography monitoring are needed, we are convinced that ventilator efficacy must be monitored in terms of PaCO<span class="elsevierStyleInf">2</span>, the value directly related with alveolar ventilation. Our belief, corroborated by other authors,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> is that this type of monitoring is essential. It is a routine practice in our clinic, and early morning arterial blood gases are measured in the patient on ventilation both at the start of the ventilation program and in all follow-up visits.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In brief, although the study is limited by the lack of data evaluating the impact of comorbidity, we believe that it is important to have been able to show in a long term study that the severity of ventilatory impairment is a factor for poor prognosis in patients with obesity-hypoventilation syndrome requiring noninvasive ventilation, while concomitant sleep apnea constitutes a protective factor. PaCO<span class="elsevierStyleInf">2</span> monitoring is essential for ensuring effective ventilatory support and obtaining good outcomes.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors state that they had no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ojeda Castillejo E, de Lucas Ramos P, Resano Barrios P, López Martín S, Rodríguez Rodríguez P, Morán Caicedo L, et al. Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico. Arch Bronconeumol. 2015;51:304-305.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilación mecánica no invasiva en pacientes con síndrome de obesidad-hipoventilación. Evolución a largo plazo y factores pronósticos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Ojeda Castillejo" 1 => "P. de Lucas Ramos" 2 => "S. López Martín" 3 => "P. Resano Barrio" 4 => "P. Rodríguez Rodríguez" 5 => "L. Morán Caicedo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2014.02.015" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2015" "volumen" => "51" "paginaInicial" => "61" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24703500" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Borel" 1 => "J.L. Pepin" 2 => "C. Pison" 3 => "A. Vesin" 4 => "J. González-Bermejo" 5 => "I. Court Fortune" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/resp.12327" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2014" "volumen" => "19" "paginaInicial" => "857" "paginaFinal" => "865" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24912564" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Best clinical practices for the sleep center adjustment of non invasive positive pressure ventilation NIPPV in stable chronic alveolar hypoventilation syndromes" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "NPPV Titration Task Force of the American Academy of Sleep Medicine" "etal" => true "autores" => array:6 [ 0 => "R.B. Berry" 1 => "A. Chediak" 2 => "L.K. Brown" 3 => "J. Finder" 4 => "D. Gozal" 5 => "C. Iber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Sleep Med" "fecha" => "2010" "volumen" => "6" "paginaInicial" => "491" "paginaFinal" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20957853" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000006/v1_201505280222/S1579212915000968/v1_201505280222/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000006/v1_201505280222/S1579212915000968/v1_201505280222/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000968?idApp=UINPBA00003Z" ]
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| 2017 May | 25 | 7 | 32 |
| 2017 April | 26 | 9 | 35 |
| 2017 March | 12 | 6 | 18 |
| 2017 February | 17 | 6 | 23 |
| 2017 January | 12 | 5 | 17 |
| 2016 December | 18 | 8 | 26 |
| 2016 November | 29 | 12 | 41 |
| 2016 October | 33 | 11 | 44 |
| 2016 September | 29 | 14 | 43 |
| 2016 August | 33 | 19 | 52 |
| 2016 July | 27 | 10 | 37 |
| 2016 March | 6 | 0 | 6 |
| 2015 December | 6 | 0 | 6 |
| 2015 October | 25 | 3 | 28 |
| 2015 September | 13 | 10 | 23 |
| 2015 August | 0 | 2 | 2 |
| 2015 July | 0 | 1 | 1 |
| 2015 June | 0 | 1 | 1 |
Show all
