Abstract：
BACKGROUND: Chronic effects of noninvasive ventilation on myocardial function in patients with obesity hypoventilation syndrome (OHS) are scarcely understood. The aim of the present study was to evaluate the long-term effects of volume-targeted bilevel positive airway pressure ventilation (BiPAP) on cardiac parameters and myocardial biomarkers in patients with OHS.
METHODS: Clinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored.
RESULTS: Thirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m2) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study.
CONCLUSIONS: The present findings of increased SV, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable OHS and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.
METHODS: Clinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored.
RESULTS: Thirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m2) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study.
CONCLUSIONS: The present findings of increased SV, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable OHS and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.
摘要：
背景：目前尚不清楚无创通气对肥胖低通气综合征（OHS）患者心肌功能的慢性影响。本研究的目的是评估容量靶向双水平气道正压通气（BiPAP）对OHS患者心脏参数和心肌生物标志物的长期影响。
方法：临床稳定的OHS患者被连续纳入三级中心，开始长期BiPAP治疗。在基线,所有参与者均接受了通宵心肺多测功.开始使用通过口鼻罩递送的体积靶向自发/定时模式的BiPAP治疗。在基线和使用BiPAP3和12个月后，通过阻抗心动图进行逐搏无创监测用于评估心功能。血清肌钙蛋白1,N末端B型利钠肽(NT-ProBNP),肿瘤坏死因子-α（TNF-α），监测白细胞介素-6（IL-6）。
结果：13名患者（10名男性；平均年龄，55.8±9.8岁；招募的平均体重指数为47.8±5.9kg/m2）。从基线到3，再到12个月的BiPAP使用，左心室每搏输出量(SV),喷射时间（LVET），和射血时间指数显著增加(P=0.030;P<0.001;P=0.003,分别),而心率和收缩时间的比率显着降低（分别为P=0.004；P=0.034）。血清NT-proBNP降低，观察到IL-6和TNF-α（分别为P=0.045；P=0.018；P=0.003）。在整个研究中没有检测到血清肌钙蛋白的显著变化。
结论：目前发现的SV增加，与LVET的延长有关，在使用BiPAP治疗超过1年的稳定OHS和慢性中度至重度日间高碳酸血症患者中,NT-proBNP的降低和循环炎症标志物的降低支持了这种治疗模式在此类患者中的作用.
方法：临床稳定的OHS患者被连续纳入三级中心，开始长期BiPAP治疗。在基线,所有参与者均接受了通宵心肺多测功.开始使用通过口鼻罩递送的体积靶向自发/定时模式的BiPAP治疗。在基线和使用BiPAP3和12个月后，通过阻抗心动图进行逐搏无创监测用于评估心功能。血清肌钙蛋白1,N末端B型利钠肽(NT-ProBNP),肿瘤坏死因子-α（TNF-α），监测白细胞介素-6（IL-6）。
结果：13名患者（10名男性；平均年龄，55.8±9.8岁；招募的平均体重指数为47.8±5.9kg/m2）。从基线到3，再到12个月的BiPAP使用，左心室每搏输出量(SV),喷射时间（LVET），和射血时间指数显著增加(P=0.030;P<0.001;P=0.003,分别),而心率和收缩时间的比率显着降低（分别为P=0.004；P=0.034）。血清NT-proBNP降低，观察到IL-6和TNF-α（分别为P=0.045；P=0.018；P=0.003）。在整个研究中没有检测到血清肌钙蛋白的显著变化。
结论：目前发现的SV增加，与LVET的延长有关，在使用BiPAP治疗超过1年的稳定OHS和慢性中度至重度日间高碳酸血症患者中,NT-proBNP的降低和循环炎症标志物的降低支持了这种治疗模式在此类患者中的作用.
