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Updated: Feb 26, 2026

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肥満低換気症候群（OHS）における自動調整型対手動調整型非侵襲的換気の有効性：ランダム化比較試験

Maria Ángeles Sánchez-Quiroga¹, Iván Benítez^2,3, Babak Mokhlesi⁴

¹Virgen del Puerto Hospital, Plasencia, Cáceres, Spain; San Pedro de Alcántara Hospital, Cáceres, Spain.

American journal of respiratory and critical care medicine

|February 25, 2026

要旨

Rationale:

Obesity hypoventilation syndrome (OHS) is treated with non-invasive ventilation (NIV) that is titrated during polysomnography. Auto-adjusted NIV could obviate the need for polysomnographic titration, thereby reducing costs and delays in care. However, non-inferiority long-term clinical trials comparing auto-adjusted NIV with manually-adjusted NIV are lacking.

Objective:

To determine the comparative effectiveness of automatic vs manual NIV modality in OHS.

Methods:

In this multicenter, blinded, parallel group, non-inferiority and cost-effectiveness trial, we randomly assigned treatment-naïve ambulatory patients with OHS to auto-adjusted NIV (volume-targeted pressure support with auto-EPAP) or manually-adjusted NIV (bilevel PAP ST mode).

Measurements:

The primary outcome was change in daytime PaCO2 at 12 months, with the non-inferiority premise set at -2 mmHg. Secondary outcomes included symptoms, quality of life, and healthcare resource utilization. Intention-to-treat and per-protocol analyses were performed.

Main Results:

205 ambulatory patients with OHS were randomized, 107 to auto-adjusted NIV and 89 to manually-adjusted NIV. The mean [95% CI] improvement in PaCO2 was -9.2 [-9.7;-8.7] mmHg in the auto-adjusted group and -8.7 [-9.1;-8.3] mmHg in the manually-adjusted group, with mean adjusted difference of 0.15 mmHg between groups ([low confidence limit -1.4]; non-inferiority P = 0.01). Cost-effectiveness was favorable to auto-adjusted group with a saving of 15287€(95% CI: -2370; -6854) per patient. There were no significant differences in other secondary outcomes.

Conclusions:

In ambulatory patients with OHS, auto-adjusted NIV had a non-inferior long-term effectiveness compared to manually-adjusted NIV while being more cost-effective. Auto-adjusted NIV may be preferred in clinical practice given its lower complexity and cost.

キーワード:

自動調整型非侵襲的換気非侵襲的換気肥満低換気症候群睡眠時無呼吸

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