AVAPS-AE vs. ST mode: A randomised controlled trial in patients with obesity hypoventilation syndrome

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Introduction: Obesity Hypoventilation Syndrome (OHS) is usually treated by noninvasive ventilation (NIV) using ST mode. The aim of our study was to assess if AVAPS-AE mode improves PaCO2 control and sleep quality after 2 months following NIV initiation as compared to ST mode. Methods: Prospective multicentric randomised controlled trial including patient with OHS, with daytime hypercapnia (PaCO2≥6kPa), with a BMI ≥30kg/m2 and naive from home NIV. Patients were allocated to receive NIV in AVAPS-AE or ST mode. Results: Sixty patients were included in final analysis. Baseline characteristics were similar between both groups except for baseline bicarbonate level (p:0.038) (Table 1). Mean NIV use was 6.2hours per night in both groups (p:0.93). Improvement in PaCO2 was similar between both groups with a mean reduction of -0.87 kPa [95%CI -1.14 to -0.50) in the AVAPS-AE group vs. -0.87kPa [95%CI -1.12 to -0.46] in the ST group (p:0.984). Similar reduction was achieved with the Epworth Sleepiness Scale: -3.5; [95%CI -5.5 to -1.4] vs. -3.6 [95%CI -6.0 to -1.1], (p:0.938) and the Pittsburgh Sleep Quality Index: -1.2 [95%CI -3.1 to 0.7] vs. -2.7 [95%CI -5.2 – 0.28], (p:0.332). Conclusion: Our results show that AVAPS-AE and ST modes achieved similar control of daytime PaCO2 with similar subjective sleep quality. These findings need to be confirmed with objective sleep quality assessments.