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Aljohara S Almeneessier,1,2 Salih Aleissi,1 Awad H Olaish,1 Ahmed S BaHammam1 1The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ahmed S BaHammamMedicine, University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Box 225503, Riyadh 11324, Saudi ArabiaTel +966-11-467-9495Fax +966-11-467-9179Email ashammam2@gmail.comPurpose: Long-term studies assessing positive airway pressure (PAP) therapy adherence in patients with obesity hypoventilation (OHS) are limited. The aim of this study was to assess PAP therapy adherence in Arab (Saudi) patients with OHS and an apnea-hypopnea index (AHI) > 30/h.Methods: A prospective cohort study of consecutive adult patients diagnosed with OHS between March 2010 and September 2019 was conducted. During the therapeutic sleep study, all OHS patients were started on continuous PAP (CPAP). Patients who failed to maintain oxygen saturation ≥ 88% despite the elimination of obstructive respiratory events were shifted to bi-level PAP (BPAP). Objective assessment of adherence was performed at 1, 6, and 12 months after initiating PAP therapy. We adopted the American-Thoracic-Society criteria for PAP adherence.Results: The study included 101 patients (women = 65 patients) with OHS, an AHI ≥ 30/h, and a mean age of 54.9 ± 12.7 years. Successful titration on CPAP was achieved in 64.4% of the patients and BPAP was required for 35.6% of the patients who failed CPAP titration. At the end of the study, 43.6% of the patients used PAP therapy in an acceptable manner. Adherence after 1 and 6 months was the only independent predictors of adherence at 12 months.Conclusion: PAP adherence among Saudi patients with OHS and severe obstructive sleep apnea was relatively low. Almost two-thirds of patients tolerated CPAP titration with the elimination of respiratory events and desaturation. Early adherence to PAP therapy was the only predictor of PAP therapy adherence at the end of the study.Keywords: CPAP, bi-level positive airway pressure, compliance, obstructive sleep apnea, desaturation, titration

Ahmed S BaHammam,1,2 Salih Aleissi,1 Awad H Olaish,1 Aljohara S Almeneessier,1,3 Anwar A Jammah4 1University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia; 3Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 4Endocrinology Unit, Thyroid Diseases Section, Department of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ahmed S BaHammamUniversity Sleep Disorders Center, College of Medicine, King Saud University, Box 225503, Riyadh 11324, Saudi ArabiaTel +966-11-467-9495Fax +966-11-467-9179Emails ashammam2@gmail.comAljohara S AlmeneessierFamily and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaTel +966-11-467-9495Fax +966-11-467-9179Email aljoharas@yahoo.comPurpose: Data on hypothyroidism in patients with obesity hypoventilation syndrome (OHS) are scarce. This study assessed the prevalence of hypothyroidism among a large group of patients with OHS.Patients and Methods: This was a prospective observational study of 308 consecutive patients with OHS seen between January 2002 and December 2018. Serum thyroid-stimulating hormone (TSH) and free-thyroxine (FT4) levels were measured in all patients. The OHS patients were compared with 445 patients with obstructive sleep apnoea (OSA) matched for age, sex, and body mass index (BMI).Results: The OHS patients had a mean age of 55.1 ± 13.8 years and a BMI of 43.9 ± 14.8 kg/m2; apnoea hypopnea index was ≥ 30 events/hr in 222 (72%). Clinical hypothyroidism was diagnosed in 58 (18.8%) of the OHS patients; only two cases (0.6%) were diagnosed in the sleep disorders clinic (newly diagnosed cases). Subclinical hypothyroidism was diagnosed in 19 (6.2%) of the OHS patients based on elevated TSH and normal FT4 levels; all cases were newly diagnosed. A logistic regression model identified female sex as the only predictor of clinical hypothyroidism in OHS patients (odds ratio: 2.801 [1.386– 5.662], p = 0.004). There was no significant difference in clinical hypothyroidism prevalence between the OHS and OSA patients; however, subclinical hypothyroidism was more common in OHS than in OSA patients (6.2% vs 2.9%, respectively, p = 0.03).Conclusion: Clinical hypothyroidism was prevalent among patients with OHS; however, newly diagnosed cases of clinical hypothyroidism were relatively low. Female sex was the only predictor of clinical hypothyroidism.Keywords: menopause, obstructive sleep apnoea, subclinical hypothyroidism, TSH, thyroxine

Almeneessier AS, Alballa NS, Alsalman BH, Aleissi S, OlaishAH, BaHammam AS. Nat Sci Sleep. 2019;11:231– 239. The authors have advised affiliation 1 on page 231 is incorrect.The correct affiliation should read “ 1Department ofMedicine, College of Medicine, the University SleepDisorders Center, King Saud University, Riyadh, SaudiArabia”. The authors apologize for this error. Read the original article