{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T21:13:51Z","timestamp":1770153231150,"version":"3.49.0"},"reference-count":37,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T00:00:00Z","timestamp":1762041600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T00:00:00Z","timestamp":1762041600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>Fixed CPAP (fCPAP) is the preferred first\u2010line ventilatory therapy in patients with obesity hypoventilation syndrome with severe obstructive sleep apnoea (OHS\u2009+\u2009sOSA). Auto\u2010titrating CPAP (APAP) is not recommended but has not been systematically evaluated in this population. Our pilot study aimed to provide feasibility data for a larger comparative effectiveness trial to determine whether APAP is non\u2010inferior to fCPAP for improving hypercapnic respiratory failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants with OHS\u2009+\u2009sOSA were randomised to either APAP or fCPAP for 3\u2009months. The primary outcome was the change in PaCO\n                      <jats:sub>2<\/jats:sub>\n                      . Secondary outcomes included changes in quality of life and cardiovascular biomarkers. A sample size of 82 was needed to demonstrate non\u2010inferiority of APAP compared to fCPAP (assuming a non\u2010inferiority margin of \u22122.5\u2009mmHg). To assess feasibility we aimed to recruit up to 44 participants in this pilot trial.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010eight of 84 screened participants were randomised (Mean\u2009\u00b1\u2009SD: Age 55\u2009\u00b1\u200912.5\u2009years, BMI 54\u2009\u00b1\u20099.9\u2009kg\u2009m\n                      <jats:sup>\u22122<\/jats:sup>\n                      , PaCO\n                      <jats:sub>2<\/jats:sub>\n                      49\u2009\u00b1\u20092.6\u2009mmHg, AHI 88\u2009\u00b1\u200931 events\/h) to APAP (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915) or fCPAP (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913). Mean adherence exceeded 4\u2009h in both groups; however 25% of randomised participants did not complete the trial. Both treatments reduced PaCO\n                      <jats:sub>2<\/jats:sub>\n                      (fCPAP: \u22125.7\u2009\u00b1\u20091.6\u2009mmHg, APAP: \u22124.1\u2009\u00b1\u20092.8\u2009mmHg). Test of non\u2010inferiority for APAP versus fCPAP was inconclusive (mean \u0394PaCO\n                      <jats:sub>2<\/jats:sub>\n                      difference\u2009=\u2009\u22121.7\u2009mmHg (95% CI \u22125.0 to 1.6\u2009mmHg)). Adherence and sleep quality improvements favoured fCPAP, while other outcomes were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The pilot study highlighted important challenges with recruitment and retention. While the study is not powered to confirm the non\u2010inferiority of APAP, some outcomes appeared to favour fCPAP and APAP use in OHS\u2009+\u2009sOSA should be approached cautiously. A larger study with protocol modifications is required to confirm these preliminary findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ACTRN12618000379213.\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=374259\">https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=374259<\/jats:ext-link>\n                      . Assessing the Efficacy of Auto\u2010titrating versus Fixed Continuous Positive Airway Pressure in Obesity Hypoventilation Syndrome\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/resp70151-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/resp.70151","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T04:20:51Z","timestamp":1762143651000},"page":"204-213","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Pilot Randomised Non\u2010Inferiority Trial of Auto\u2010Titrating Versus Fixed Continuous Positive Airway Pressure for Obesity Hypoventilation Syndrome With Severe Obstructive Sleep Apnoea"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6562-2693","authenticated-orcid":false,"given":"Yizhong","family":"Zheng","sequence":"first","affiliation":[{"name":"Woolcock Institute of Medical Research  Sydney Australia"},{"name":"Department of Respiratory and Sleep Medicine St George Hospital  Sydney Australia"},{"name":"School of Clinical Medicine University of New South Wales  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3824-6172","authenticated-orcid":false,"given":"Amanda","family":"Piper","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Wong","sequence":"additional","affiliation":[{"name":"Woolcock Institute of Medical Research  Sydney Australia"},{"name":"Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital  Sydney Australia"},{"name":"Central Clinical School University of Sydney  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gislaine","family":"Gauthier","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital  Sydney Australia"},{"name":"Central Clinical School University of Sydney  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig L.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Woolcock Institute of Medical Research  Sydney Australia"},{"name":"Macquarie Medical School Macquarie University  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6682-5812","authenticated-orcid":false,"given":"Ronald","family":"Grunstein","sequence":"additional","affiliation":[{"name":"Woolcock Institute of Medical Research  Sydney Australia"},{"name":"Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital  Sydney Australia"},{"name":"Central Clinical School University of Sydney  Sydney Australia"},{"name":"Macquarie Medical School Macquarie University  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendon J.","family":"Yee","sequence":"additional","affiliation":[{"name":"Woolcock Institute of Medical Research  Sydney Australia"},{"name":"Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital  Sydney Australia"},{"name":"Central Clinical School University of Sydney  Sydney Australia"},{"name":"Macquarie Medical School Macquarie University  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0097-2018"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1222439"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2007.081315"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201410-1900OC"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208559"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201905-1071ST"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/19.suppl_9.S131"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.4578"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-011-0626-6"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-1-20"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2015-207700"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7332"},{"issue":"2","key":"e_1_2_10_14_1","first-page":"148","article-title":"The Use of Auto\u2010Titrating Continuous Positive Airway Pressure for Treatment of Adult Obstructive Sleep Apnea","volume":"25","author":"Berry R. B.","year":"2002","journal-title":"Sleep"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/31.1.141"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.27941"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7640"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.27133"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2006.07.002"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/14.6.540"},{"issue":"10","key":"e_1_2_10_21_1","first-page":"835","article-title":"An Instrument to Measure Functional Status Outcomes for Disorders of Excessive Sleepiness","volume":"20","author":"Weaver T. E.","year":"1997","journal-title":"Sleep"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(03)00088-X"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.10.1152"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32978-7"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2017.03.019"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.3.704"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2009.07.001"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/25.2.143"},{"issue":"19","key":"e_1_2_10_29_1","doi-asserted-by":"crossref","first-page":"2338","DOI":"10.1093\/eurheartj\/ehq165","article-title":"Determinants of Pulse Wave Velocity in Healthy People and in the Presence of Cardiovascular Risk Factors:\u2018Establishing Normal and Reference Values","volume":"31","author":"Collaboration RVfAS","year":"2010","journal-title":"European Heart Journal"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy339"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2019.00041"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2011.59"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2009.234"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/28.5.604"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1291\/hypres.29.475"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1291\/hypres.31.1109"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2012.01.002"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2404881"}],"container-title":["Respirology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/resp.70151","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/resp.70151","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/resp.70151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T08:47:43Z","timestamp":1770108463000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/resp.70151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,2]]},"references-count":37,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/resp.70151"],"URL":"https:\/\/doi.org\/10.1002\/resp.70151","archive":["Portico"],"relation":{},"ISSN":["1323-7799","1440-1843"],"issn-type":[{"value":"1323-7799","type":"print"},{"value":"1440-1843","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,2]]},"assertion":[{"value":"2025-06-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}