Treatment Effects on Carbon Dioxide Retention in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome

Han, Fang; Chen, Erzhang; Wei, Hailing; He, Quan-ying; Ding, Defang; Strohl, Kingman P.

doi:10.1378/chest.119.6.1814

Cited by 80 publications

(53 citation statements)

References 21 publications

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“…The hypoxic ventilatory response is also blunted in subjects with OHS. This abnormality is, however, not familial and improves with treatment as well [107, 108]. …”

Section: Obesity Hypoventilation Syndromementioning

confidence: 99%

Upper Airway Mechanics

Verbraecken¹,

Backer²

2009

Respiration

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This review discusses the pathophysiological aspects of sleep-disordered breathing, with focus on upper airway mechanics in obstructive and central sleep apnoea, Cheyne-Stokes respiration and obesity hypoventilation syndrome. These disorders constitute the end points of a spectrum with distinct yet interrelated mechanisms that lead to substantial pathology, i.e. increased upper airway collapsibility, control of breathing instability, increased work of breathing, disturbed ventilatory system mechanics and neurohormonal changes. Concepts are changing. Although sleep apnoea is considered more and more to be an increased loop gain disorder, the central type of apnoea is now considered as an obstructive event, because it causes pharyngeal narrowing, associated with prolonged expiration. Although a unifying concept for the pathogenesis is lacking, it seems that these patients are in a vicious circle. Knowledge of common patterns of sleep-disordered breathing may help to identify these patients and guide therapy.

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“…The hypoxic ventilatory response is also blunted in subjects with OHS. This abnormality is, however, not familial and improves with treatment as well [107, 108]. …”

Section: Obesity Hypoventilation Syndromementioning

confidence: 99%

Upper Airway Mechanics

Verbraecken¹,

Backer²

2009

Respiration

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“…Moreover, long-term NIPPV has been found to increase serum leptin levels [26]. Patients with OSA and hypercapnia exhibited an increased chemo-responsiveness to CO 2 and hypoxaemia under CPAP [23,26,27]. NIPPV was shown to have a positive effect on the haemodynamics of patients with alveolar hypoventilation due to thoracic restriction [28].…”

Section: Introductionmentioning

confidence: 99%

Functional impact of pulmonary hypertension due to hypoventilation and changes under noninvasive ventilation

Held

Walthelm

Baron

et al. 2013

European Respiratory Journal

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We aimed to characterise the association of pulmonary hypertension due to hypoventilation and exercise capacity, and the haemodynamic and functional changes under noninvasive ventilation.A retrospective analysis was carried out to assess haemodynamics and functional capacity in 18 patients with daytime pulmonary hypertension, due to hypoventilation, at baseline and after 3 months of noninvasive ventilation.Patients presented with a mean¡SD pulmonary artery pressure of 49¡13 mmHg, preserved cardiac index (3.2¡0.66 L?min -1 ?m -2 ), 6-min walking distance of 303¡134 m and severely elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Mean pulmonary artery pressure correlated negatively with maximum work rate (R5 -0.72; p50.03) and 6-min walking distance (R5 -0.62; p50.01). Following noninvasive ventilation we found a significant reduction of mean pulmonary artery pressure (-18 mmHg; p,0.001) and NT-proBNP levels (-2110 pg?mL -1 ; p50.001), and improvement in the 6-min walking distance (+66 m; p50.008) and maximum work rate (+18 W; p50.028). Changes in work rate correlated inversely with pulmonary artery pressure (R5 -0.75; p50.031).In this specific cohort with hypoventilation and severe pulmonary hypertension, pulmonary hypertension was associated with reduced exercise capacity. Following noninvasive ventilation, haemodynamics and exercise capacity improved significantly. @ERSpublications Pulmonary hypertension due to alveolar hypoventilation is associated with functional impairment and improved by NIPPV

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“…Obesity itself has also been proposed as a possible mechanism underlying the depression of ventilatory responses since significant weight loss can produce improvements in awake PaCO 2 levels [72]. However, this is not the case, as both respiratory drive and HCVR are increased in eucapnic obesity [73,74], and decrease back towards the normal range with weight loss [73]. It is more likely that diminished chemoresponsiveness as an acquired phenomenon arising from the presence of SDB.…”

Section: Ventilatory Controlmentioning

confidence: 99%