Health Trajectories Around Non-Invasive Ventilation Initiation For Obesity Hypoventilation Syndrome.

Rationale: Positive airway pressure therapy modalities in obesity hypoventilation syndrome (OHS) are still debated.

Objective(s): To describe health trajectories before and after starting non-invasive ventilation (NIV) and compare post-NIV outcomes between groups with different pre-NIV trajectories.

Methods: Data came from the French national health insurance reimbursement database for individuals with OHS and ≥1 NIV prescription between 1 January 2015 and 31 December 2019. Health trajectory clusters were determined using mixture models being graphically represented by time sequence analysis.

Results: Data from 8,842 individuals were analyzed (59.7% had coexisting obstructive sleep apnea, 64% had ≥1 comorbidity). Median follow-up was 3.1 years. Cluster 1 (n=5,853; 66.2%) started NIV while stable after pulmonary function testing (PFT), arterial blood gases (ABG) and sleep studies; 23.7% underwent bariatric surgery around NIV initiation. One-year therapy termination and mortality rates were 51.8% and 5.5%, respectively. Cluster 2 (n=757; 8.6%) started NIV during or immediately after ≥1 acute intensive care unit hospitalization in the previous year; one-year NIV termination and mortality rates were 34.3% and 9.1%, respectively. Cluster 3 (n=526; 5.9%) had NIV initiation after a sleep study, PFTs/ABG and 3 months of continuous positive airway pressure (CPAP); one-year therapy termination and mortality rates were 23.0% and 2.1%, respectively. In Cluster 4 (n=1,706; 19.3%), long-term CPAP preceded the switch to NIV after reassessment in ambulatory care; one-year therapy termination and mortality rates were 18.4% and 4.5%, respectively.

Conclusions: These novel data highlight marked heterogeneity in OHS and use of PAP therapies, which significantly impacts outcomes. Primary source of funding: ResMed.