The Obesity-Hypoventilation Syndrome Revisited

Kessler, Romain; Chaouat, Ari; Schinkewitch, Philippe; Faller, M; Casel, Simone; Krieger, J; Weitzenblum, E

doi:10.1378/chest.120.2.369

Cited by 358 publications

(72 citation statements)

References 28 publications

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“…9,17,18 In 60 healthy obese men with normal FEV 1 /FVC ratio and with age and BMI similar to those of our study subjects, Sahebjami and Gartside 7 showed that 25% of them suffered from unexpected hypercapnia and were affected by more severe abnormalities of respiratory function.…”

Section: Discussionsupporting

confidence: 82%

Diurnal PaCO2 tension in obese women: relationship with sleep disordered breathing

et al. 2003

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OBJECTIVE: Several obese subjects show a wide array of respiratory disturbances during sleep due to an increased upper-airway resistance. The aim of the present study was to evaluate diurnal PaCO 2 tension in nonsmoking obese women and the possible relationship of this parameter with the presence of sleep disordered breathing (SDB). DESIGN: Cross-sectional study of PaCO 2 tension in obese women. PATIENTS AND METHODS: A total of 91 nonsmoking obese women (BMI Z30 kg/m 2 , aged 42.8715.7 y) were recruited and evaluated for general and anthropometric parameters, respiratory function, sleep-related symptoms, and sleep disorders of breathing. RESULTS: A total of 10 subjects (10.9%) had diurnal hypercapnia (PaCO 2 Z43 mmHg). Age, BMI, neck circumference, apnoea/ hypopnoea index, and nocturnal desaturation (expressed as TST SaO 2o90% ; TST SaO 2o90% ¼ percentage of total sleep time with oxyhaemoglobin saturation o90%) were significantly higher in obese patients with diurnal hypercapnia, compared to normocapnic women. Moreover, hypercapnic patients had reduced forced expiratory volume in 1 s compared to normocapnic individuals. By using multiple regression analysis, the best fitting model (r ¼ 0.62, Po0.001) for predicting diurnal PaCO 2 tension in the study population showed that 24.23% of the variance may be explained by TST SaO 2o90% , according to the equation: PaCO 2 ¼ 0.09 age+0.07 TST SaO 2o90% +33.00. CONCLUSIONS: This study suggests that severity of SDB is the most important factor in determining diurnal PaCO 2 tension in apparently healthy nonsmoking obese women.

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Section: Discussionsupporting

confidence: 82%

Diurnal PaCO2 tension in obese women: relationship with sleep disordered breathing

et al. 2003

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“…Obesity hypoventilation syndrome (OHS) is a clinical entity characterized by the coexistence of obesity and hypercapnia during wakefulness [1]. Although its prevalence is currently unknown, hypoventilation has frequently been seen to complicate severe obesity in hospitalized adults and is associated with excess morbidity and mortality [2].…”

Section: Introductionmentioning

confidence: 99%

Clinical Heterogeneity among Patients with Obesity Hypoventilation Syndrome: Therapeutic Implications

et al. 2007

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Background: Obesity hypoventilation syndrome (OHS) can be treated with noninvasive positive pressure ventilation (NIPPV). Once clinical stability is achieved, continuous positive airway pressure (CPAP) can be recommended in many cases. However, some patients respond only partially to CPAP and NIPPV is a better option for them. Objectives: To assess treatment effectiveness in 2 groups of patients: those who could be switched to CPAP after polysomnographic titration and those who required NIPPV. Methods: A prospective study of 24 OHS patients was conducted, 11 were treated with CPAP and 13 with NIPPV. Morning and evening arterial blood gases were measured. Daytime and overnight oximetric recordings were performed. A post hoc analysis compared both groups. Results: Neither group exhibited deterioration on morning-to-evening blood gases. All patients in the CPAP group presented SaO₂ of less than 90% (CT90%) for <15% of the time on nocturnal and daytime recordings. In the NIPPV group, 8 patients had either daytime or nocturnal CT90% ≧15%. There were no intergroup differences regarding age, body mass index, Epworth scale values or PaO₂/PaCO₂ prior to treatment. FVC in the NIPPV group was lower than in the CPAP group (p = 0.01). Apnea-hypopnea index was higher (56 ± 23 vs. 36 ± 23, p = 0.049) and baseline CT90% was lower (76 ± 19% vs. 92 ± 14%, p = 0.03) in the CPAP group. Conclusions: Two patient subtypes can be identified. Those controlled with CPAP have better spirometry and a significantly higher apnea-hypopnea index. None of these patients showed daytime hypoxemia and all exhibited satisfactory overnight oxygenation. However, 61% of the NIPPV group had suboptimal oximetry results. Nocturnal/diurnal oximetries should be made to assess treatment efficacy in stable OHS patients who fail to achieve good control with CPAP.

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“…1 Obesity-hypoventilation syndrome (OHS) is a clinical entity that is characterized by the coexistence of obesity and hypercapnia during wakefulness. 2 Patients with OHS are heavy users of health-care resources prior to receiving treatment of their disorder. 3 Noninvasive positivepressure ventilation (NIPPV) has been successfully used in treating patients with other diseases,…”

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confidence: 99%

Short-term and Long-term Effects of Nasal Intermittent Positive Pressure Ventilation in Patients With Obesity-Hypoventilation Syndrome

Llano

Golpe²,

Piquer

et al. 2005

Chest

245

179

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The Obesity-Hypoventilation Syndrome Revisited

Cited by 358 publications

References 28 publications

Diurnal PaCO2 tension in obese women: relationship with sleep disordered breathing

Diurnal PaCO2 tension in obese women: relationship with sleep disordered breathing

Clinical Heterogeneity among Patients with Obesity Hypoventilation Syndrome: Therapeutic Implications

Short-term and Long-term Effects of Nasal Intermittent Positive Pressure Ventilation in Patients With Obesity-Hypoventilation Syndrome

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