Predictors of early diagnosis of obesity hypoventilation syndrome among patients with sleep disordered breathing

Elsayed, Ahmad Younes; Elshafey, Mohsen; Abdelgawad, Taha Taha; Ali, Rasha Abdelhady

doi:10.1016/j.ejcdt.2016.12.009

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…Only two studies specified how serum bicarbonate level was measured (40,42). In two studies, bicarbonate level was calculated from blood gas measurements (45,46), and one study did not specify whether the bicarbonate was measured or calculated (41).…”

Section: Resultsmentioning

confidence: 99%

“…One of the four studies included a retrospective and prospective sample and provided diagnostic accuracy data for both samples at the cutoff of 27 mmol/L (40). Therefore, the pooled analysis includes five samples, with a total Nine studies evaluated hypoxemia by pulse oximetry (41,42,44,45,(47)(48)(49)(50)(51) and had prevalence of OHS between 17% and 66%. We identified 14 different measures of hypoxemia in these studies, including: awake oxygen saturation by pulse oximetry (Sp O 2 ) below a defined threshold (92-98%), sleep Sp O 2 below 90% for various percentages of sleep time (10-46%), nadir Sp O 2 during sleep below a defined threshold (76% or 80%), mean Sp O 2 during sleep below 90%, or a combination of Sp O 2 and bicarbonate level.…”

Section: Resultsmentioning

confidence: 99%

“…Of the remaining 13 articles we reviewed, 9 were full manuscripts ( 40 – 48 ) and 4 were in abstract form ( 49 – 52 ). Six were prospective ( 42 , 43 , 45 , 47 , 51 , 52 ), six were retrospective, and one had a retrospective and a prospective design ( 40 ).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies evaluated the bicarbonate level and provided enough data for analysis ( 40 – 43 , 45 , 46 ). We excluded one whose prevalence of OHS was very low (2%), because the sample comprised obese ambulatory patients undergoing blood tests for a variety of reasons ( 43 ).…”

Section: Resultsmentioning

confidence: 99%

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Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

Mokhlesi¹,

Masa²,

Brožek³

et al. 2019

Am J Respir Crit Care Med

188

146

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; on behalf of the American Thoracic Society Assembly on Sleep and Respiratory Neurobiology THIS OFFICIAL CLINICAL PRACTICE GUIDELINE OF THE AMERICAN THORACIC SOCIETY WAS APPROVED MAY 2019 Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS). Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations. Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level ,27 mmol/L to exclude the diagnosis of OHS in obese patients with sleepdisordered breathing when suspicion for OHS is not very high (,20%) but to measure arterial blood gases in patients strongly suspected of having OHS, 2) stable ambulatory patients with OHS receive positive airway pressure (PAP), 3) continuous positive airway pressure (CPAP) rather than noninvasive ventilation be offered as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, 4) patients hospitalized with respiratory failure and suspected of having OHS be discharged with noninvasive ventilation until they undergo outpatient diagnostic procedures and PAP titration in the sleep laboratory (ideally within 2-3 mo), and 5) patients with OHS use weight-loss interventions that produce sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS (which is more likely to be obtained with bariatric surgery). Conclusions: Clinicians may use these recommendations, on the basis of the best available evidence, to guide management and improve outcomes among patients with OHS.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

Mokhlesi¹,

Masa²,

Brožek³

et al. 2019

Am J Respir Crit Care Med

188

146

View full text Add to dashboard Cite

show abstract

“…A high suspicion of PS is critical for setting the PS diagnosis [7]. Our patient fulfilled the clinical criteria (SpO 2 44%, dyspnea on exertion, but also at rest, in unbecoming and uncomfortable positions of the body, facial plethora, elevated level of bicarbonates in the blood).…”

Section: Discussionmentioning

confidence: 75%

Pickwickian syndrome - "the tip of the iceberg" in extremely obese patients

Kašćak¹,

Andjelic²

2020

Srp Arh Celok Lek

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Introduction Pickwickian syndrome (PS), also known as hypoventilation syndrome in adults, consists of three factors: obesity [Body Mass Index (BMI) > 30 kg/m 2 ], daytime hypercapnia and sleep-disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. Timely recognition of PS is of utmost importance because such patients have significant morbidity and mortality. However, recent data indicate that PS is under-recognized and under-treated. We report a case of early-identified PS prehospitally with a favorable outcome after hospital treatment. Case outline A 67-year-old female patient was diagnosed prehospitally, and the diagnosis was later confirmed in hospital. Diagnostic criteria were as follows: BMI > 45,7 kg/m 2 (height 170 cm, weight 132 kg), hypercapnia, hypoxemia and respiratory acidosis (pCO 2-41 mmHg, pO 2-56 mmHg, pH 7.45) in the absence of other causes of hypoventilation. During hospitalization, the following diagnostic procedures were performed: standard laboratory analyses, chest radiography, electrocardiography, abdomen and heart echocardiography. An attempted sleep study (polysomnography) was interrupted due to a drop in oxygen saturation levels. Non-invasive mechanical ventilation and a diet were used as the first line of therapy. However, due to the development of a global respiratory insufficiency, the patient was intubated and placed on a mechanical ventilator. After 30 days of hospital treatment, the patient was released in a satisfactory general condition with recommendations for weight reduction and symptomatic therapy. Conclusion As obesity is becoming an epidemic of modern society, early recognition and treatment of PS is of crucial importance.

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Assessment of patients with obesity hypoventilation syndrome

Tulaimat

2020

Obesity Hypoventilation Syndrome

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Predictors of early diagnosis of obesity hypoventilation syndrome among patients with sleep disordered breathing

Cited by 6 publications

References 19 publications

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

Pickwickian syndrome - "the tip of the iceberg" in extremely obese patients

Assessment of patients with obesity hypoventilation syndrome

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