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Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Lund Univ, Dept Resp Med, SE-22100 Lund, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
2016 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 110, p. 73-78Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Background and objectives: Obesity hypoventilation syndrome (OHS) is often diagnosed late. The aim of this study was to analyse gender differences at initiation of long-term mechanical ventilation (LTMV) in patients with (OHS), to analyse gender differences in treatment effect and to study how the prescription of LTMV due to OHS has changed over time. Methods: Data on patients on LTMV due to OHS between 1996 and 2014 were obtained from Swedevox, a nationwide health quality registry of patients on LTMV in Sweden. Results: When starting LTMV, women were generally older (age 64.4 +/- 11.2 vs. 60.1 +/- 12.1 years, p < 0.001), more obese (BMI 43.0 +/- 8.2 vs. 41.5 +/- 7.9 kg/m(2), p < 0.001), more hypoxic (PaO2 7.6 +/- 1.5 vs. 7.9 +/- 1.6 kPa, p +/- 0.001), had more hypercapnia (PaCO2 7.2 +/- 1.3 vs. 6.9 +/- 1.3 kPa, p = 0.001), had higher base excess (6.9 +/- 4.1 vs. 5.8 +/- 4.7 kPa, p < 0.001) and more frequently started LTMV in a non-elective situation (43.2% vs. 37.5%, p = 0.026) than men. Improvement of arterial blood gas values or in age-adjusted mortality at one-year follow-up did not differ. During the study period, the age of patients at the initiation of LTMV rose by 3.4 years/decade (P = 0.001) in women and with 1.9 years/decade (P = 0.048) in men but there were no significant changes in BMI (P = 0.425). Conclusions: Diagnosis of OHS is more delayed in women and as a consequence the disease is more advanced when diagnosed. In spite of this, there is no gender difference in survival rate in patients with OHS treated with LTMV. More and older patients with OHS nowadays gain access to LTMV.

Place, publisher, year, edition, pages
2016. Vol. 110, p. 73-78
Keywords [en]
Body mass index, Gender differences, Long-term mechanical ventilation, Obesity hypoventilation syndrome
National Category
Respiratory Medicine and Allergy Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-274924DOI: 10.1016/j.rmed.2015.11.010ISI: 000367380700010PubMedID: 26680503OAI: oai:DiVA.org:uu-274924DiVA, id: diva2:898124
Funder
Swedish Association of Local Authorities and RegionsAvailable from: 2016-01-27 Created: 2016-01-26 Last updated: 2018-09-25Bibliographically approved
In thesis
1. Obesity, Sleep and Sleep-disordered Breathing
Open this publication in new window or tab >>Obesity, Sleep and Sleep-disordered Breathing
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sleep problems are associated with impaired quality of life and daytime sleepiness. Obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome (OHS), are associated with metabolic changes and an increased cardiovascular morbidity and mortality. The most preferred treatment of OSA and OHS is positive airway pressure (PAP) therapy. Diagnostic delay and non-adherence to PAP therapy are major clinical problems.

Aims and methods: Paper I: A longitudinal population-based cohort study aimed to investigate the role of obesity and weight gain in the development of sleep problems in 1,896 men and 5,116 women who responded to questionnaires at baseline and followed up after 10–13 years.

Paper II: A national registry-based cohort study aimed to analyse gender differences in patients with OHS starting long term mechanical ventilation (LTMV) and to study how the prescription of LTMV due to OHS has changed over time with data on 1,527 patients derived from the Swedish quality registry Swedevox between 1996 and 2014.

Paper III: A longitudinal observational cohort study aimed to investigate the impact of adherence to continuous positive airway pressure (CPAP) treatment on IGF-1 concentration in 69 patients with OSA followed up after 4.8 ± 2.5 months.

Paper IV: A national registry-based cohort study aimed to identify protective and risk factors against the discontinuation of CPAP treatment in patients with OSA and to estimate the mortality risk in those who were non-adherent to CPAP therapy on 16,425 patients derived from the Swedish quality registry Swedevox between July 2010 and March 2017.

Results and conclusions: Weight gain is a risk factor for developing several sleep problems and daytime sleepiness. Women with OHS are older with a more advanced clinical picture at initiation of LTMV and start LTMV more frequently in a non-elective situation than men. CPAP usage ≥ 4 h/night is associated with increased IGF-1 concentration in patients with OSA. Use of humidifier, increasing age, more severe OSA and BMI up to 35 are associated with greater adherence to CPAP treatment. Female gender and coexisting hypertension are risk factors for the discontinuation of CPAP. Failure to adhere to CPAP is associated with increased mortality.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 94
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1496
Keywords
Sleep, Obesity, Obstructive Sleep Apnea, Obesity Hypoventilation syndrome
National Category
Respiratory Medicine and Allergy
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-361345 (URN)978-91-513-0453-3 (ISBN)
Public defence
2018-11-09, Brömssalen, Gävle sjukhus, Lasarettsvägen 1, Gävle, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-10-17 Created: 2018-09-23 Last updated: 2018-10-17

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Palm, AndreasJanson, ChristerLindberg, Eva

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