Biomarker changes during long-term noninvasive ventilation in obesity hypoventilation syndrome: a prospective observational study

Abstract Purpose Obesity hypoventilation syndrome (OHS) is a severe form of sleep-disordered breathing and a major contributor to chronic respiratory failure, yet optimal treatment strategies and reliable biomarkers for monitoring therapeutic efficacy remain undefined. This prospective observational study aimed to evaluate biomarker changes during the first six months of home mechanical ventilation in OHS patients and explore potential patterns. Methods We assessed hematological, nutritional, muscle, cardiovascular, inflammatory, and fatigue-related biomarkers in OHS patients starting goal-directed noninvasive ventilation aimed to achieve normocapnia at baseline, then 1, 3, and 6 months after initiation of treatment. Predictors of five-year survival were assessed. Subgroup analyses were performed based on initiation type and apnea–hypopnea index. Results We observed significant improvement in clinical parameters and red cell distribution width, ferritin, total protein, albumin, creatinine, creatine-kinase, total calcium, interleukin-6, and apolipoprotein A1 values during the first 6 months of treatment. Patients with low AHI and those acutely initiated exhibited persistently elevated activin A levels at six months, suggesting incomplete biological recovery and persisting inflammatory-metabolic alterations. Albumin and PaCO 2 normalization at six months were associated with survival in exploratory analysis. Conclusion Initiation of home mechanical ventilation is associated with versatile biomarker changes in OHS patients. Persistent differences in certain biomarkers could help identify underlying heterogeneity. Further studies are needed to validate these findings and explore the role of biomarker profiling in OHS management.