Average Volume-Assured Pressure Support in Obesity Hypoventilation

Background Average volume-assured pressure support (AVAPS) has been introduced as a new additional mode for a bilevel pressure ventilation (BPV) device (BiPAP; Respironics; Murrysville, PA), but studies on the physiologic and clinical effects have not yet been performed. There is a particular need to better define the most efficient ventilatory treatment modality for patients with obesity hypoventilation syndrome (OHS). Methods In OHS patients who did not respond to therapy with continuous positive airway pressure, the effects of BPV with the spontaneous/timed (S/T) ventilation mode with and without AVAPS over 6 weeks on ventilation pattern, gas exchange, sleep quality, and health-related quality of life (HRQL) assessed by the severe respiratory insufficiency questionnaire (SRI) were prospectively investigated in a randomized crossover trial. Results Ten patients (mean [± SD] age, 53.5 ± 11.7 years; mean body mass index, 41.6 ± 12.1 kg/m 2 ; mean FEV 1 /FVC ratio, 79.4 ± 6.5%; mean transcutaneous P co 2 [Ptc co 2 ], 58 ± 12 mm Hg) were studied. Ptc co 2 nonsignificantly decreased during nocturnal BPV-S/T by −5.6 ± 11.8 mm Hg (95% confidence interval [CI], −14.7 to 3.4 mm Hg; p = 0.188), but significantly decreased during BPV-S/T-AVAPS by −12.6 ± 12.2 mm Hg (95% CI, −22.0 to −3.2 mm Hg; p = 0.015). Pneumotachographic measurements revealed a higher individual variance of peak inspiratory pressure (p Conclusion BPV-S/T substantially improved oxygenation, sleep quality, and HRQL in patients with OHS. AVAPS provided additional benefits on ventilation quality, thus resulting in a more efficient decrease of Ptc co 2 . However, this did not provide further clinical benefits regarding sleep quality and HRQL.