LAUSR

OHS is one of the most frequent indications for long-term NIV worldwide. Nevertheless, CPAP therapy has proven to be a suitable therapy for a significant percentage of these patients. The device election has relevant implications, taking into consideration the lower cost of a CPAP and its easiness of use. It is hypothesized that stable OHS patients receiving NIV therapy for ≥3 months can be switched to CPAP therapy, irrespective of the reasons that supported the NIV initiation. Methods: An open label multicentric interventional trial was performed. OHS patients under successful NIV therapy for ≥3 months underwent an APAP night, if the parameters were acceptable they were switched to CPAP for 4-6 weeks. Blood gases, polysomnography, lung function and questionnaires (quality of life, sleepiness, patient9s preference) were measured. Results: 42 stable OHS patients receiving home NIV for 34(IQR 13.7-57.4) months were recruited. Severe obstructive sleep apnea was present in 100% of them, COPD GOLD I/II was present in 52,3%. Importantly, 38% of them were started on NIV because of initial CPAP failure and 31% because of acute hypercapnic respiratory failure. Regarding the primary outcome, 30/42 patients (71%,95% CI 55-84%) maintained daytime PaCO2 levels ≤45mmHg after the home CPAP period. There was no impairment in quality of life, sleep parameters and lung function. Interestingly, 24(57%) of patients preferred CPAP therapy despite the high pressure levels (mean 13,8±1,8mbar). Compliance (% of use >4 h/d) under CPAP was significantly higher than under NIV, 95% and 87% respectively. Conclusions: It is feasible to switch stable OHS patients from NIV to CPAP. CPAP may lead to more patient´s compliance.