NERO: a pilot study but important step towards comprehensive management of obesity hypoventilation syndrome

The primary goal of treatment for obesity hypoventilation syndrome (OHS) has been to correct sleep-related breathing abnormalities, thereby reversing chronic respiratory failure. Nocturnal non-invasive ventilation (NIV) can achieve this and thus represents the cornerstone of respiratory management for this condition.1–4 While the effectiveness of NIV in improving clinical symptoms and quality of life has been convincingly demonstrated,2 3 5 the mortality rate of patients with OHS treated with NIV remains substantially higher than that of patients with obstructive sleep apnoea.6 Cardiovascular and metabolic comorbidities are the key determinants of a poorer prognosis.6 7 For several years, clinicians have suggested NIV treatment should be integrated into a comprehensive treatment plan that includes lifestyle modification and rehabilitation to further improve outcomes.8–10 In Thorax , Mandal and colleagues11 report the first randomised controlled trial evaluating the impact of a 3-month inpatient–outpatient multidisciplinary rehabilitation programme in addition to NIV compared with NIV alone in patients with OHS. Since weight loss is obviously the main treatment for OHS, the primary outcome chosen by the authors was change in weight at 12 months. Although no statistical difference between treatment …