Chest
Clinical InvestigationsHypercapnia in the Obstructive Sleep Apnea Syndrome: A Reevaluation of the “Pickwickian Syndrome”
Section snippets
Methods
Eight chronically hypercapnic patients with obstructive sleep apnea syndrome were evaluated before and after therapy for their apneas. Therapy consisted of permanent tracheostomy in seven patients; one patient was successfully treated with nightly use of a nasal mask which delivered continuous positive airway pressure (nasal CPAP). In each case, the patient was able to reduce his arterial Pco2 below 40 mm Hg by voluntary hyperventilation. All patients were obese and hypersomnolent. Six of the
Results
Table 1 lists anthropometric data and arterial blood gas levels of the patients before treatment, establishing the degree of chronic hypercapnia. Data from the pretreatment all-night sleep studies are also shown, documenting that each patient had severe obstructive sleep apnea.
Tracheostomy and nasal CPAP resulted in relief of hypersomnolence and disappearance of snoring in all cases. Peripheral edema disappeared or decreased in those in whom it was present.
Sleep pattern before treatment was
Discussion
In the present study, tracheostomy or chronic nocturnal use of nasal CPAP produced complete correction of the obstructive sleep apnea syndrome in all eight hypercapnic patients. However, correction of the chronic hypercapnia occurred in only four of the eight. The association of chronic hypercapnia with obstructive sleep apnea is now well recognized,6 and a variable response of this hypercapnia after correction of the upper airway obstruction has been observed by others.14, 15, 16
Possible
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This study was supported by grants from the National Institutes of Health, Division of Research Resources RR 96 and from the New York Lung Association.
Manuscript received September 16; revision accepted November 21.