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• W2619218557 abstract "To the EditorWe appreciate the interest of Dr Murphy and colleagues in our article in CHEST1Borel J-C Tamisier R Gonzalez-Bermejo J et al.Noninvasive ventilation in mild obesity hypoventilation syndrome: a randomized controlled trial.Chest. 2012; 141: 692-702Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar on a randomized control study investigating the efficacy of noninvasive ventilation (NIV) on respiratory, sleep, cardiovascular, metabolic, and inflammatory outcomes in obesity hypoventilation syndrome (OHS). We acknowledge that our control group was not submitted to sham-NIV, but had only lifestyle counseling. Indeed, any participation in a clinical research study is likely to improve a patient's lifestyle. Therefore, patients in both groups may have changed their lifestyle (eg, increased their physical activity). In any case, this cannot mask a specific effect of NIV on cardiovascular and metabolic parameters.Our study demonstrated that short-term NIV dramatically improves sleep and blood gases but does not alter inflammatory, metabolic, or cardiovascular markers. This suggests a need to address these comorbidities by offering combined treatment modalities. Programs aimed at reducing the detrimental consequences of obesity systematically target an increase in physical activity and a reduction in sedentary behaviors. In their recent work in patients with OHS, Murphy and colleagues2Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial [published online ahead of print March 1, 2012]. Thorax doi:10.1136/thoraxjnl-2011-201081.Google Scholar reported objective improvement in physical activity after 3 months of nocturnal NIV. This elegant study, including patients both in a stable state and in post-acute respiratory failure, compared two ventilatory modes with a randomized control design. Therefore, all patients were exposed to NIV treatment. Thus, it is disputable whether weight loss and physical activity improvements were related to NIV per se or to lifestyle changes associated with inclusion in a clinical research protocol. Moreover, patients placed on NIV during post-acute respiratory failure were likely to have low physical activity at baseline, whereas a dramatic improvement in activity was expected after 3 months of recovery.Actually, obesity itself promotes limited physical activity and sedentary behavior partly because of exercise-related dyspnea. NIV during exercise training in rehabilitation programs might enhance exercise capacity by reducing the respiratory load in subjects who are morbidly obese.3Dreher M Kabitz HJ Burgardt V Walterspacher S Windisch W Proportional assist ventilation improves exercise capacity in patients with obesity.Respiration. 2010; 80: 106-111Crossref PubMed Scopus (30) Google Scholar Additionally, we have demonstrated that the training of respiratory muscles in subjects who are obese improves dyspnea and exercise capacity.4Villiot-Danger JC Villiot-Danger E Borel JC Pépin JL Wuyam B Vergès JS Respiratory muscle endurance training in obese patients.Int J Obes (Lond). 2011; 35: 692-699Crossref PubMed Scopus (44) Google Scholar We are currently evaluating these tools in rehabilitation programs aimed at reducing cardiometabolic risks in obese subjects,5National Institutes of Health Clinical Center. Obese patients with obstructive sleep apnea syndrome (OSAS) and exercise training (OBEX1). NCT01155271. ClinicalTrials.gov. Bethesda, MD: National Institutes of Health; 2010. http://clinicaltrials.gov/ct2/show/NCT01155271. Updated March 13, 2012.Google Scholar in addition to nocturnal NIV. NIV initiation could, thus, be the appropriate starting time for such integrated programs, although the best modalities to improve motivation and adherence have yet to be determined.6Jordan KE Ali M Shneerson JM Attitudes of patients towards a hospital-based rehabilitation service for obesity hypoventilation syndrome.Thorax. 2009; 64: 1007Crossref PubMed Scopus (14) Google Scholar Future studies should not only evaluate the efficacy of combining nocturnal NIV and rehabilitation programs, but also determine the rate of drop-outs and the cost-effectiveness of such combined strategies in OHS treatment. To the EditorWe appreciate the interest of Dr Murphy and colleagues in our article in CHEST1Borel J-C Tamisier R Gonzalez-Bermejo J et al.Noninvasive ventilation in mild obesity hypoventilation syndrome: a randomized controlled trial.Chest. 2012; 141: 692-702Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar on a randomized control study investigating the efficacy of noninvasive ventilation (NIV) on respiratory, sleep, cardiovascular, metabolic, and inflammatory outcomes in obesity hypoventilation syndrome (OHS). We acknowledge that our control group was not submitted to sham-NIV, but had only lifestyle counseling. Indeed, any participation in a clinical research study is likely to improve a patient's lifestyle. Therefore, patients in both groups may have changed their lifestyle (eg, increased their physical activity). In any case, this cannot mask a specific effect of NIV on cardiovascular and metabolic parameters.Our study demonstrated that short-term NIV dramatically improves sleep and blood gases but does not alter inflammatory, metabolic, or cardiovascular markers. This suggests a need to address these comorbidities by offering combined treatment modalities. Programs aimed at reducing the detrimental consequences of obesity systematically target an increase in physical activity and a reduction in sedentary behaviors. In their recent work in patients with OHS, Murphy and colleagues2Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial [published online ahead of print March 1, 2012]. Thorax doi:10.1136/thoraxjnl-2011-201081.Google Scholar reported objective improvement in physical activity after 3 months of nocturnal NIV. This elegant study, including patients both in a stable state and in post-acute respiratory failure, compared two ventilatory modes with a randomized control design. Therefore, all patients were exposed to NIV treatment. Thus, it is disputable whether weight loss and physical activity improvements were related to NIV per se or to lifestyle changes associated with inclusion in a clinical research protocol. Moreover, patients placed on NIV during post-acute respiratory failure were likely to have low physical activity at baseline, whereas a dramatic improvement in activity was expected after 3 months of recovery.Actually, obesity itself promotes limited physical activity and sedentary behavior partly because of exercise-related dyspnea. NIV during exercise training in rehabilitation programs might enhance exercise capacity by reducing the respiratory load in subjects who are morbidly obese.3Dreher M Kabitz HJ Burgardt V Walterspacher S Windisch W Proportional assist ventilation improves exercise capacity in patients with obesity.Respiration. 2010; 80: 106-111Crossref PubMed Scopus (30) Google Scholar Additionally, we have demonstrated that the training of respiratory muscles in subjects who are obese improves dyspnea and exercise capacity.4Villiot-Danger JC Villiot-Danger E Borel JC Pépin JL Wuyam B Vergès JS Respiratory muscle endurance training in obese patients.Int J Obes (Lond). 2011; 35: 692-699Crossref PubMed Scopus (44) Google Scholar We are currently evaluating these tools in rehabilitation programs aimed at reducing cardiometabolic risks in obese subjects,5National Institutes of Health Clinical Center. Obese patients with obstructive sleep apnea syndrome (OSAS) and exercise training (OBEX1). NCT01155271. ClinicalTrials.gov. Bethesda, MD: National Institutes of Health; 2010. http://clinicaltrials.gov/ct2/show/NCT01155271. Updated March 13, 2012.Google Scholar in addition to nocturnal NIV. NIV initiation could, thus, be the appropriate starting time for such integrated programs, although the best modalities to improve motivation and adherence have yet to be determined.6Jordan KE Ali M Shneerson JM Attitudes of patients towards a hospital-based rehabilitation service for obesity hypoventilation syndrome.Thorax. 2009; 64: 1007Crossref PubMed Scopus (14) Google Scholar Future studies should not only evaluate the efficacy of combining nocturnal NIV and rehabilitation programs, but also determine the rate of drop-outs and the cost-effectiveness of such combined strategies in OHS treatment. We appreciate the interest of Dr Murphy and colleagues in our article in CHEST1Borel J-C Tamisier R Gonzalez-Bermejo J et al.Noninvasive ventilation in mild obesity hypoventilation syndrome: a randomized controlled trial.Chest. 2012; 141: 692-702Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar on a randomized control study investigating the efficacy of noninvasive ventilation (NIV) on respiratory, sleep, cardiovascular, metabolic, and inflammatory outcomes in obesity hypoventilation syndrome (OHS). We acknowledge that our control group was not submitted to sham-NIV, but had only lifestyle counseling. Indeed, any participation in a clinical research study is likely to improve a patient's lifestyle. Therefore, patients in both groups may have changed their lifestyle (eg, increased their physical activity). In any case, this cannot mask a specific effect of NIV on cardiovascular and metabolic parameters. Our study demonstrated that short-term NIV dramatically improves sleep and blood gases but does not alter inflammatory, metabolic, or cardiovascular markers. This suggests a need to address these comorbidities by offering combined treatment modalities. Programs aimed at reducing the detrimental consequences of obesity systematically target an increase in physical activity and a reduction in sedentary behaviors. In their recent work in patients with OHS, Murphy and colleagues2Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial [published online ahead of print March 1, 2012]. Thorax doi:10.1136/thoraxjnl-2011-201081.Google Scholar reported objective improvement in physical activity after 3 months of nocturnal NIV. This elegant study, including patients both in a stable state and in post-acute respiratory failure, compared two ventilatory modes with a randomized control design. Therefore, all patients were exposed to NIV treatment. Thus, it is disputable whether weight loss and physical activity improvements were related to NIV per se or to lifestyle changes associated with inclusion in a clinical research protocol. Moreover, patients placed on NIV during post-acute respiratory failure were likely to have low physical activity at baseline, whereas a dramatic improvement in activity was expected after 3 months of recovery. Actually, obesity itself promotes limited physical activity and sedentary behavior partly because of exercise-related dyspnea. NIV during exercise training in rehabilitation programs might enhance exercise capacity by reducing the respiratory load in subjects who are morbidly obese.3Dreher M Kabitz HJ Burgardt V Walterspacher S Windisch W Proportional assist ventilation improves exercise capacity in patients with obesity.Respiration. 2010; 80: 106-111Crossref PubMed Scopus (30) Google Scholar Additionally, we have demonstrated that the training of respiratory muscles in subjects who are obese improves dyspnea and exercise capacity.4Villiot-Danger JC Villiot-Danger E Borel JC Pépin JL Wuyam B Vergès JS Respiratory muscle endurance training in obese patients.Int J Obes (Lond). 2011; 35: 692-699Crossref PubMed Scopus (44) Google Scholar We are currently evaluating these tools in rehabilitation programs aimed at reducing cardiometabolic risks in obese subjects,5National Institutes of Health Clinical Center. Obese patients with obstructive sleep apnea syndrome (OSAS) and exercise training (OBEX1). NCT01155271. ClinicalTrials.gov. Bethesda, MD: National Institutes of Health; 2010. http://clinicaltrials.gov/ct2/show/NCT01155271. Updated March 13, 2012.Google Scholar in addition to nocturnal NIV. NIV initiation could, thus, be the appropriate starting time for such integrated programs, although the best modalities to improve motivation and adherence have yet to be determined.6Jordan KE Ali M Shneerson JM Attitudes of patients towards a hospital-based rehabilitation service for obesity hypoventilation syndrome.Thorax. 2009; 64: 1007Crossref PubMed Scopus (14) Google Scholar Future studies should not only evaluate the efficacy of combining nocturnal NIV and rehabilitation programs, but also determine the rate of drop-outs and the cost-effectiveness of such combined strategies in OHS treatment. Obesity Hypoventilation Syndrome: The Need For a Multifaceted Approach to TreatmentCHESTVol. 142Issue 2PreviewThe article by Borel et al1 in CHEST (March 2012) is a timely addition to our understanding of obesity hypoventilation syndrome, an increasingly prevalent condition.2 The study confirms the data from uncontrolled studies and reaffirms the current clinical consensus by demonstrating the clinical improvements that occur when managing patients with obesity hypoventilation syndrome with noninvasive ventilation. The study control group involved lifestyle advice and was also associated with significant improvements in some clinical parameters. Full-Text PDF" @default.
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• W2619218557 title "Obesity Hypoventilation Syndrome: Response" @default.
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