Diagnostic approach to sleep disordered-breathing among patients with grade III obesity

Perger, Elisa; Aron‐Wisnewsky, Judith; Arnulf, Isabelle; Oppert, Jean‐Michel; Redolfi, Stefania

doi:10.1016/j.sleep.2021.03.024

Cited by 8 publications

(4 citation statements)

References 17 publications

(25 reference statements)

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“…The mechanisms of diurnal hypercapnia in OHS are complex, and include hypoventilation during nighttime sleep and especially, persisting during the daytime [15,16]. There is also a reduced ventilatory response to hypercapnia [16] and overproduction of carbon dioxide that is not compensated for by an increase in alveolar ventilation [17].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Efficiency of Home Non-Invasive Ventilation in Patients with Obesity-Hypoventilation Syndrome in Martinique

Agossou,

Barzu,

Awanou

et al. 2023

JCM

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Obesity-hypoventilation syndrome (OHS) is a respiratory complication of obesity characterized by chronic hypercapnic respiratory failure. It is often associated with several comorbidities and is treated by positive airway pressure (PAP) therapy. This study aimed to identify factors associated with persistent hypercapnia in patients receiving home non-invasive ventilation (NIV). We performed a retrospective study including patients with documented OHS. In total, 143 patients were included (79.7% women, age 67 ± 15.5 years, body mass index 41.6 ± 8.3 kg/m2). After 4.6 ± 4.0 years of follow-up, 72 patients (50.3%) remained hypercapnic. In bivariable analysis, clinical data showed no difference in follow-up duration, number of comorbidities, comorbidities, or circumstance of discovery. Patients with persistent hypercapnia on NIV were generally older, with lower BMI and more comorbidities. (5.5 ± 1.8 versus 4.4 ± 2.1, p = 0.001), female sex (87.5% versus 71.8%), was treated by NIV (100% versus 90.1%, p < 0.01), had lower FVC (56.7 ± 17.2 versus 63.6 ± 18% of theoretical value, p = 0.04), lower TLC (69.1 ± 15.3 versus 74.5 ± 14.6% of theoretical value, p = 0.07), lower RV (88.4 ± 27.1 versus 102.5 ± 29.4% of theoretical value, p = 0.02), higher pCO2 at diagnosis (59.7 ± 11.7 versus 54.6 ± 10.1 mmHg, p = 0.01) and lower pH (7.38 ± 0.03 versus 7.40 ± 0.04, p = 0.007), higher pressure support (12.6 ± 2.6 versus 11.5 ± 2.4 cmH2O, p = 0.04) and lower EPAP (8.2 ± 1.9 versus 9 ± 2.0 cmH2O, p = 0.06). There was no difference in non-intentional leaks and daily use between patients between both groups. By multivariable analysis, sex, BMI, pCO2 at diagnosis, and TLC were independent risk factors for persistent hypercapnia on home NIV. In individuals with OHS, persistent hypercapnia on home NIV therapy is frequent. Sex, BMI, pCO2 at diagnosis, and TLC were all associated with an increased risk of persistent hypercapnia in persons treated with home NIV.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with the Efficiency of Home Non-Invasive Ventilation in Patients with Obesity-Hypoventilation Syndrome in Martinique

Agossou,

Barzu,

Awanou

et al. 2023

JCM

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“…Sleep hypoventilation in obese persons may develop as a consequence of sleep-breathing disorders, including OSA syndrome [ 24 , 25 ]. Thus, our patients were asked the questions of the STOP-Bang questionnaire in order to estimate the probability of OSA syndrome, and in two patients with nocturnal hypoventilation, the results were positive.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Hypoventilation in the Patients Submitted to Thoracic Surgery

Majchrzak,

Daroszewski,

Błasiak

et al. 2023

Canadian Respiratory Journal

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Introduction. Nocturnal hypoventilation may occur due to obesity, concomitant chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and/or the use of narcotic analgesics. The aim of the study was to evaluate the risk and severity of nocturnal hypoventilation as assessed by transcutaneous continuous capnography in the patients submitted to thoracic surgery. Materials and Methods. The material of the study consisted of 45 obese (BMI 34.8 ± 3.7 kg/m2) and 23 nonobese (25.5 ± 3.6 kg/m2) patients, who underwent thoracic surgery because of malignant (57 patients) and nonmalignant tumors. All the patients received routine analgesic treatment after surgery including intravenous morphine sulfate. Overnight transcutaneous measurements of CO2 partial pressure (tcpCO2) were performed before and after surgery in search of nocturnal hypoventilation, i.e., the periods lasting at least 10 minutes with tcpCO2 above 55 mmHg. Results. Nocturnal hypoventilation during the first night after thoracic surgery was detected in 10 patients (15%), all obese, three of them with COPD, four with high suspicion of moderate-to-severe OSA syndrome, and one with chronic daytime hypercapnia. In the patients with nocturnal hypoventilation, the mean tcpCO2 was 53.4 ± 6.1 mmHg, maximal tcpCO2 was 59.9 ± 8.4 mmHg, and minimal tcpCO2 was 46.4 ± 6.7 mmHg during the first night after surgery. In these patients, there were higher values of minimal, mean, and maximal tcpCO2 in the preoperative period. Nocturnal hypoventilation in the postoperative period did not influence the duration of hospitalization. Among 12 patients with primary lung cancer who died during the first two years of observation, there were 11 patients without nocturnal hypoventilation in the early postoperative period. Conclusion. Nocturnal hypoventilation may occur in the patients after thoracic surgery, especially in obese patients with bronchial obstruction, obstructive sleep apnea, or chronic daytime hypercapnia, and does not influence the duration of hospitalization.

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“…Một đặc điểm đáng lưu ý ở người béo phì mắc OSA là hội chứng béo phì -giảm thông khí OHS (xác định bởi PCO2 trong máu động mạch lúc thức ≥45 mmHg), trong đó, giảm thông khí đơn độc khi ngủ ở người béo phì (ORHS) được coi là giai đoạn đầu của OHS [20]. Giảm thông khí được định nghĩa là PtcCO2 >55 mmHg hoặc >50 mmHg nếu PtcCO2 tăng hơn 10 mmHg trong hơn 10 phút ngủ so với giá trị nằm ngửa khi thức.…”

Section: Công Cụunclassified

Tiếp Cận Chẩn Đoán Và Điều Trị Ngưng Thở Khi Ngủ Do Tắc Nghẽn Ở Người Béo Phì

Võ,

Phan,

Trần

2023

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Đặt vấn đề: Ngưng thở khi ngủ do tắc nghẽn là rối loạn hô hấp phổ biến liên quan đến giấc ngủ, thường đồng mắc với bệnh lý chuyển hóa. Người béo phì thuộc nhóm nguy cơ cao mắc ngưng thở khi ngủ do tắc nghẽn với tỉ lệ mắc 45%, dẫn đến kết cục xấu về tim mạch, thậm chí đột tử. Nội dung tổng quan: Ngưng thở khi ngủ do tắc nghẽn được biểu hiện bởi tình trạng ngưng thở hoặc giảm thở kèm giảm độ bão hòa oxy, có tiêu chuẩn chẩn đoán là chỉ số ngưng thở - giảm thở ≥ 5/ giờ. Béo phì là tình trạng tăng khối lượng mỡ quá mức, chỉ số khối cơ thể ≥ 25 kg/m2. Béo phì làm nặng thêm tình trạng ngưng thở khi ngủ do tắc nghẽn do tác động đến sự xẹp đường hô hấp trên qua cơ chế cơ học hoặc thần kinh cơ. Ngược lại, ngưng thở khi ngủ do tắc nghẽn thúc đẩy béo phì do giảm hoạt động thể chất, giảm chuyển hóa năng lượng. Việc sàng lọc ngưng thở khi ngủ do tắc nghẽn ở người béo phì có thể được thực hiện bằng bảng điểm Epwworth, Berlin, STOP-BANG hoặc kỹ thuật đo đa ký giấc ngủ type 3, type 4. Việc điều trị ngưng thở khi ngủ do tắc nghẽn ở người béo phì gồm điều trị tư thế; giảm cân bằng thay đổi lối sống, dùng thuốc, phẫu thuật; thở áp lực dương liên tục khi ngủ. Kết luận: Ngưng thở khi ngủ do tắc nghẽn và béo phì là hai tình trạng có tác động lẫn nhau. Chẩn đoán ngưng thở khi ngủ do tắc nghẽn ở người béo phì có thể được xem xét từ các bảng điểm sàng lọc đến đa ký giấc ngủ type 3, type 4. Điều trị ngưng thở khi ngủ do tắc nghẽn ở người béo phì nên phối hợp nhiều phương thức: tư thế ngủ, giảm cân và cân nhắc kết hợp thở áp lực dương liên tục khi ngủ.

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Diagnostic approach to sleep disordered-breathing among patients with grade III obesity

Cited by 8 publications

References 17 publications

Factors Associated with the Efficiency of Home Non-Invasive Ventilation in Patients with Obesity-Hypoventilation Syndrome in Martinique

Factors Associated with the Efficiency of Home Non-Invasive Ventilation in Patients with Obesity-Hypoventilation Syndrome in Martinique

Nocturnal Hypoventilation in the Patients Submitted to Thoracic Surgery

Tiếp Cận Chẩn Đoán Và Điều Trị Ngưng Thở Khi Ngủ Do Tắc Nghẽn Ở Người Béo Phì

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