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Qualify of life and palliation predict survival in patients with chronic alveolar hypoventilation and nocturnal ventilatory support

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Abstract

Objectives

Non-invasive positive pressure ventilation (NPPV) improves health-related quality of life (HRQL) in patients with chronic alveolar hypoventilation (CAH). We studied the prognostic impact of HRQL on survival in relation to clinical factors.

Patients

Forty-four patients with CAH due to post-polio (12), scoliosis (11), post-tb (17) or other diagnoses (4) who received nocturnal NPPV were prospectively studied during 6–10 years.

Measurements

Blood gases and HRQL were analysed at baseline and after 9 months and after 8 years. HRQL was evaluated with measures of functioning (SIP), emotional well-being (HADS and MACL), and global QL.

Results

Blood gases and HRQL measures improved during NPPV. The overall 5-year survival rate was 73%. In multivariate survival analysis, a diagnosis of post-polio and low baseline SIP physical index scores, indicating low levels of physical dysfunction, predicted longer survival (P = 0.02, respectively). Similarly, palliation of physical dysfunction and preserved or improved global QL by 9 months were associated with longer overall survival (P = 0.009 and P = 0.001, respectively; multivariate Cox regression).

Conclusion

Seventy-three percent of patients treated for CAH with NPPV survived more than 5 years. Diagnosis and self-rated physical functioning at pre-treatment were related to survival, as were major improvements in physical functioning and global QL during NPPV.

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Abbreviations

ALS:

Amyotrofic lateral sclerosis

CAH:

Chronic alveolar hypoventilation

CPAP:

Continuous positive airway pressure

HADS:

Hospital anxiety and depression scale

HRQL:

Health-related quality of life

kPa:

kilo Pascal

MACL:

The mood adjective check list

NPPV:

Non-invasive positive pressure ventilation

PaCO2 :

Arterial carbon dioxide tension

PaO2 :

Arterial oxygen tension

QL:

Quality of life

SIP:

Sickness impact profile

SpO2 :

Percutaneous oxygen saturation

Tb sequel:

Tuberculosis sequel

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Acknowledgments

The authors would like to thank Prof Sven Larsson, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, for valuable advice. The study was made possible by grants from the Swedish Heart- and Lung Association. Funding sources: the Swedish Heart- and Lung Association, Göteborg University (LUA/ALF). Conflict of interest statement: there exist no actual or potential conflicts of interest between any of the authors and organisations with financial interest in the subject matter

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Authors and Affiliations

  1. Department of Respiratory Medicine and Allergology, Institute of Medicine, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, 413 45, Sweden

    Jan Olofson, Catharina Dellborg & Bengt Bergman

  2. Health Care Research Unit, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

    Marianne Sullivan

  3. Department of Respiratory Medicine, University Hospital of Lund, Lund, Sweden

    Bengt Midgren

  4. Department of Respiratory Medicine, Orebro Univeristy Hospital, Orebro, Sweden

    Oscar Caro

Authors
  1. Jan Olofson
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  2. Catharina Dellborg
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  3. Marianne Sullivan
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  4. Bengt Midgren
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  5. Oscar Caro
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  6. Bengt Bergman
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Correspondence to Jan Olofson.

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Olofson, J., Dellborg, C., Sullivan, M. et al. Qualify of life and palliation predict survival in patients with chronic alveolar hypoventilation and nocturnal ventilatory support. Qual Life Res 18, 273–280 (2009). https://doi.org/10.1007/s11136-009-9445-7

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  • DOI: https://doi.org/10.1007/s11136-009-9445-7

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