Qualify of life and palliation predict survival in patients with chronic alveolar hypoventilation and nocturnal ventilatory support
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- Olofson, J., Dellborg, C., Sullivan, M. et al. Qual Life Res (2009) 18: 273. doi:10.1007/s11136-009-9445-7
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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.
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.
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.
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).
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.
KeywordsNeuromuscular disorders Restrictive chest wall disorders Non-invasive positive pressure ventilation
Amyotrofic lateral sclerosis
Chronic alveolar hypoventilation
Continuous positive airway pressure
Hospital anxiety and depression scale
Health-related quality of life
The mood adjective check list
Non-invasive positive pressure ventilation
Arterial carbon dioxide tension
Arterial oxygen tension
Quality of life
Sickness impact profile
Percutaneous oxygen saturation
- Tb sequel