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Obesity Hypoventilation Syndrome

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Complex Sleep Breathing Disorders

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Abstract

Obesity hypoventilation syndrome (OHS) is a diagnosis of exclusion where the afflicted patient has an elevated BMI (>30 kg/m2) and chronic carbon dioxide retention. Most patients have obstructive sleep apnea and may develop cor pulmonale. The pathophysiology is complex and includes excessive load on the respiratory system, altered ventilator control, and functional respiratory impairment. Screening for OHS should include elevated serum bicarbonate levels in obese individuals; a low resting pulse oximetry reading (<94%) should also raise suspicion. OHS should be confirmed with an overnight polysomnography, ideally with CO2 monitoring and an resting arterial blood gas documenting elevated carbon dioxide levels. Most patients can be adequately managed with positive airway pressure during sleep and bariatric surgery, or weight loss programs should be strongly encouraged.

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References

  1. Berg G, Delaive K, Manfreda J, et al. The use of health-care resources in obesity-hypoventilation syndrome. Chest. 2001;120:377–83.

    Article  CAS  Google Scholar 

  2. Nowbar S, Burkhart KM, Gonzales R, et al. Obesity associated hypoventilation in hospitalized patients (prevalence, impact, and outcome). Am J Med. 2004;116:1–7.

    Article  Google Scholar 

  3. Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491.

    Article  Google Scholar 

  4. Balachandran JS, Masa JF, Mokhlesi B. Obesity hypoventilation syndrome epidemiology and diagnosis. Sleep Med Clin. 2014;9(3):341–7.

    Article  Google Scholar 

  5. Bülbül Y, Ayik S, Ozlu T, Orem A. Frequency and predictors of obesity hypoventilation in hospitalized patients at a tertiary health care institution. Ann Thorac Med. 2014;9(2):87–91.

    Article  Google Scholar 

  6. Littleton SW, Mokhlesi B. The Pickwickian syndrome - obesity hypoventilation syndrome. Clin Chest Med. 2009;30(3):467–78.

    Article  Google Scholar 

  7. Kessler R, Chaouat A, Weitzenblum E, et al. Pulmonary hypertension in the obstructive sleep apnea syndrome (prevalence, causes, and therapeutic consequences). Eur Respir J. 1996;9:787–94.

    Article  CAS  Google Scholar 

  8. Manuel ARG, Hart N, Stradling JR. Is a raised bicarbonate, without hypercapnia, part of the physiologic spectrum of obesity-related hypoventilation? Chest. 2015;147(2):362–8.

    Article  Google Scholar 

  9. Mortimore IL, Marshall I, Wraith PK, et al. Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med. 1998;157(1):280–3.

    Article  CAS  Google Scholar 

  10. Nairnark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377–82.

    Article  Google Scholar 

  11. Lin CK, Lin CC. Work of breathing and respiratory drive in obesity. Respirology. 2012;17(3):402–11.

    Article  Google Scholar 

  12. Piper AJ, Yee BJ. Hypoventilation syndromes. Compr Physiol. 2014;4(4):1639–76.

    Article  Google Scholar 

  13. Tankersley CG, O’Donnell C, Daood MJ, et al. Leptin attenuates respiratory complications associated with the obese phenotype. J Appl Physiol. 1998;85(6):2261–9.

    Article  CAS  Google Scholar 

  14. Phipps PR, Starritt E, Caterson I, et al. Association of serum leptin with hypoventilation in human obesity. Thorax. 2002;57(1):75–6.

    Article  CAS  Google Scholar 

  15. Pierce AM, Brown LK. Obesity hypoventilation syndrome: current theories of pathogenesis. Curr Opin Pulm Med. 2015;21(6):557–62.

    Article  CAS  Google Scholar 

  16. Norman RG, Goldring RM, Clain JM, et al. Transition from acute to chronic hypercapnia in patients with periodic breathing: predictions from a computer model. J Appl Physiol. 2006;100(5):1733–41.

    Article  CAS  Google Scholar 

  17. Piper AJ, Grunstein RR. Obesity hypoventilation syndrome—mechanisms and management. Am J Respir Crit Care Med. 2011;183(3):292–8.

    Article  Google Scholar 

  18. Mokhlesi B, Tulaimat A. Recent advances in obesity hypoventilation syndrome. Chest. 2007;132(4):1322–36.

    Article  Google Scholar 

  19. Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring). 2009;17:S1–S70.

    Article  Google Scholar 

  20. Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans A. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007;11:117–24.

    Article  Google Scholar 

  21. Piper AJ, Sullivan CE. Effects of short-term NIPPV in the treatment of patients with severe obstructive sleep apnea and hypercapnia. Chest. 1994;105:434–40.

    Article  CAS  Google Scholar 

  22. Hollier CA, Harmer AR, Maxwell LJ, et al. Moderate concentrations of supplemental oxygen worsen hypercapnia in obesity hypoventilation syndrome: a randomised crossover study. Thorax. 2014;69(4):346–53.

    Article  Google Scholar 

  23. Wijesinghe M, Williams M, Perrin K, et al. The effect of supplemental oxygen on hypercapnia in subjects with obesity-associated hypoventilation: a randomized crossover clinical study. Chest. 2011;139(5):1018–24.

    Article  Google Scholar 

  24. Mokhlesi, Masa, Brozek et al. Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2019;200(3):e6–24.

    Google Scholar 

  25. Zhang Y, Wang W, Yang C, Shen J, Shi M, Wang B. Improvement in nocturnal hypoxemia in obese patients with obstructive sleep apnea after bariatric surgery: a meta-analysis. Obes Surg. 2018;29:601–8. [epub ahead of print].

    Article  Google Scholar 

  26. Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122:535–42.

    Article  Google Scholar 

  27. Gupta A, Stierer T, Zuckerman R, et al. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg. 2004;98(3):632–41.

    Article  CAS  Google Scholar 

  28. Lftikhar IH, Roland J. Obesity hypoventilation syndrome. Clin Chest Med. 2018;39(2):427–36.

    Article  Google Scholar 

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Authors and Affiliations

  1. Emory University, Atlanta, GA, USA

    Aditya Chada, Faisal Zahiruddin & Nancy Collop

  2. Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Hospital, Houston, TX, USA

    Faisal Zahiruddin

Authors
  1. Aditya Chada
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  2. Faisal Zahiruddin
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  3. Nancy Collop
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Corresponding author

Correspondence to Nancy Collop .

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Editors and Affiliations

  1. Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA

    Christine Won

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Chada, A., Zahiruddin, F., Collop, N. (2021). Obesity Hypoventilation Syndrome. In: Won, C. (eds) Complex Sleep Breathing Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-57942-5_11

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  • DOI: https://doi.org/10.1007/978-3-030-57942-5_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-57941-8

  • Online ISBN: 978-3-030-57942-5

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