Obesity Hypoventilation Syndrome: Early Detection of Nocturnal-Only Hypercapnia in an Obese Population

Sivam, Sheila; Yee, Brendon J.; Wong, Keith; Wang, David; Grunstein, Ronald R.; Piper, Amanda J.

doi:10.5664/jcsm.7318

Cited by 23 publications

(19 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During sleep, however, these protective mechanisms are generally impaired because of atonia in both the postural muscles and the upper airway dilating muscles, and ventilation is only maintained by diaphragmatic activity and central drive [7]. Patients with the hypoventilation phenotype, typically with obesity hypoventilation syndrome (OHS), fail to maintain their respiratory drives during sleep and this can eventually lead to daytime hypercapnia and hypoventilation [8].…”

Section: Introductionmentioning

confidence: 99%

Effects of Intermittent Hypoxia on Pulmonary Vascular and Systemic Diseases

Kimura

Ota

Kimura

et al. 2019

IJERPH

View full text Add to dashboard Cite

Obstructive sleep apnea (OSA) causes many systemic disorders via mechanisms related to sympathetic nerve activation, systemic inflammation, and oxidative stress. OSA typically shows repeated sleep apnea followed by hyperventilation, which results in intermittent hypoxia (IH). IH is associated with an increase in sympathetic activity, which is a well-known pathophysiological mechanism in hypertension and insulin resistance. In this review, we show the basic and clinical significance of IH from the viewpoint of not only systemic regulatory mechanisms focusing on pulmonary circulation, but also cellular mechanisms causing lifestyle-related diseases. First, we demonstrate how IH influences pulmonary circulation to cause pulmonary hypertension during sleep in association with sleep state-specific change in OSA. We also clarify how nocturnal IH activates circulating monocytes to accelerate the infiltration ability to vascular wall in OSA. Finally, the effects of IH on insulin secretion and insulin resistance are elucidated by using an in vitro chamber system that can mimic and manipulate IH. The obtained data implies that glucose-induced insulin secretion (GIS) in pancreatic β cells is significantly attenuated by IH, and that IH increases selenoprotein P, which is one of the hepatokines, as well as TNF-α, CCL-2, and resistin, members of adipokines, to induce insulin resistance via direct cellular mechanisms. Clinical and experimental findings concerning IH give us productive new knowledge of how lifestyle-related diseases and pulmonary hypertension develop during sleep.

show abstract

Section: Introductionmentioning

confidence: 99%

Effects of Intermittent Hypoxia on Pulmonary Vascular and Systemic Diseases

Kimura

Ota

Kimura

et al. 2019

IJERPH

View full text Add to dashboard Cite

show abstract

“…This represents the early stage of hypoventilation in obesity which may eventually progress to OHS. [14] The implication of ORSH on long-term consequences and management are not known.…”

Section: Introductionmentioning

confidence: 99%

Predictors of obesity hypoventilation syndrome among patients with sleep-disordered breathing in India

et al. 2019

View full text Add to dashboard Cite

Introduction:No study has been done in India to evaluate obesity hypoventilation syndrome (OHS) among patients with sleep-disordered breathing (SDB). The known predictors of OHS, i.e., body mass index (BMI) >35 kg/m2 and forced vital capacity (FVC) <3.5 L for men and <2.3 L for women from western countries, cannot be applied to Indian patients.Objectives:To find out the prevalence of OHS and to determine the predictors of OHS among Indian SDB patients.Materials and Methods:It was a retrospective observational study conducted in a tertiary care institute from September 1, 2017, to August 31, 2018. All the patients who underwent polysomnography were analyzed for the presence of OHS. Of 85 patients referred for polysomnography, 76 had SDB. Thirteen patients were excluded because of hypoventilation due to other known causes or could not perform spirometry.Results:The prevalence of OHS among SDB after excluding the other causes of hypoventilation was 15.87% (10/63). The predictors were determined using univariate analysis between daytime partial pressure of carbon dioxide (PaCO2) and other predictors. PaCO2 significantly correlated with minimum nocturnal oxygen saturation by pulse oximetry (SpO2), FVC %predicted, BMI, daytime SpO2, forced expiratory volume %predicted, and partial pressure of oxygen (PaO2). Following a stepwise multiple regression, minimum nocturnal SpO2, FVC %predicted, and BMI were found to be independent predictors of OHS. A minimum nocturnal SpO2 threshold of 60%, FVC %predicted <74.5%, BMI >30.95 kg/m2, and absolute FVC <2.33 L for men and <1.68 L for women were found to be predictors of OHS.Conclusion:The prevalence of OHS in Indian patients is similar to Caucasians. OHS is seen in Indian patients even at a lower BMI and lower spirometric parameters.

show abstract

“…The ERS Task Force proposed to use these parameters—hypercapnia during sleep, hypercapnia during wakefulness, and serum bicarbonate level—to differentiate the four stages of obesity-associated hypoventilation ( 7 ). Sivam and colleagues found that in a group of persons with severe obesity (BMI > 40 kg/m 2 ), sleep hypoventilation (ERS stages I and II) was present in 19% of individuals, awake hypoventilation without comorbidities (III) in 17%, and awake hypoventilation with comorbidities (IV) in 3% ( 8 ). Predictors for sleep hypoventilation were awake oxygen saturation of ≤93% and a partial pressure of CO 2 ≥ 45 mm Hg measured in the supine position.…”

mentioning

confidence: 99%