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obesity hypoventilation syndrome

Etiology: - obesity, sleep-disordered breathing & daytime hypercapnia Epidemiology: - 1/3 of patients with BMI >= 35 exhibit sleep-related hypoventilation Pathology: - hypercapnia due to hypoventilation - diminished ventilatory drive - diminished vital capacity - pulmonary hypertension is common - polycythemia is common - obstructive sleep apnea is common (90%) - right heart failure is common - hypoxemia Clinical manifestations: - obesity - hypoventilation - hypoxemia - daytime hypercapnia - obstructive sleep apnea - pulmonary hypertension - peripheral edema - polycythemia Laboratory: - arterial blood gas - pCO2* > 45 mm Hg - hypoxemia - bicarbonate in serum - complete blood count may show polycythemia * for obese patients with sleep-disordered breathing with likely OHS, * if < 20% likelihood of OHS & serum bicarbonate < 27 mmol/L, pCO2 less unseful Special laboratory: - polysomnography - pulmonary function testing with lung volumes & DLCO - ambulatory oximetry not useful [11] Complications: - acute-on-chronic hypercapnic respiratory failure - dyspnea, somnolence - postoperative respiratory failure - volume overload is common Management: - weight reduction, including bariatric surgery - CPAP or BiPap for hypercapneic respiratory failure, nocturnal hypercapnia, obstructive sleep apnea &/or hypoxemia - BiPAP may be more effective than CPAP - hypoxemia may be resistant to CPAP - improves hypercapnia in hospitalized patients - supplemental oxygen as needed

Related

obstructive sleep apnea (OSA)

General

sleep-related hypoventilation syndrome obesity syndrome; disorders associated with obesity

References

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