Obesity Hypoventilation Syndrome: Early Detection of Nocturnal-Only Hypercapnia in an Obese Population.
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TLDR
A cross-sectional study to identify obese patients who are at risk for developing obesity hypoventilation syndrome (OHS) by investigating the relationship between daytime measures (including supine hypercapnia, distribution of body fat and lung volumes) with the presence of hypventilation during sleep.Abstract:
STUDY OBJECTIVES Hypoventilation in obesity is now divided into five stages; stage 0 (pure obstructive sleep apnea; OSA), stages I/II (obesity-related sleep hypoventilation; ORSH) and stages III/IV (awake hypercapnia, obesity hypoventilation syndrome; OHS). Hypercapnia during the day may be preceded by hypoventilation during sleep. The goal of this study was to determine the prevalence and to identify simple clinical measures that predict stages I/II ORSH. The effect of supine positioning on selected clinical measures was also evaluated. METHODS Ninety-four patients with a body mass index > 40 kg/m2 and a spirometric ratio > 0.7 were randomized to begin testing either in the supine or upright seated position on the day of their diagnostic sleep study. Arterialized capillary blood gases were measured in both positions. Oxygen saturation measured by pulse oximetry was also obtained while awake. Transcutaneous CO2 monitoring was performed during overnight polysomnography. RESULTS Stages I/II ORSH had a prevalence of 19% in an outpatient tertiary hospital setting compared with 61%, 17%, and 3% for stages 0, III/IV, and no sleep-disordered breathing respectively. Predictors for sleep hypoventilation in this group were an awake oxygen saturation of ≤ 93% (sensitivity 39%, specificity 98%, positive likelihood ratio of 22) and a partial pressure of carbon dioxide ≥ 45 mmHg (sensitivity 44%, specificity 98%, positive likelihood ratio of 24) measured in the supine position. CONCLUSIONS ORSH has a similar prevalence to OHS. Awake oxygen saturation and partial pressure of carbon dioxide performed in the supine position may help predict obese patients with sleep hypoventilation without awake hypercapnia. COMMENTARY A commentary on this article appears in this issue on page 1455. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry, Identifier: ACTRN 12615000135516, URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367493&isReview=true, Title: A cross-sectional study to identify obese patients who are at risk for developing obesity hypoventilation syndrome (OHS) by investigating the relationship between daytime measures (including supine hypercapnia, distribution of body fat and lung volumes) with the presence of hypoventilation during sleep.read more
Citations
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Effects of Intermittent Hypoxia on Pulmonary Vascular and Systemic Diseases.
TL;DR: How IH influences pulmonary circulation to cause pulmonary hypertension during sleep in association with sleep state-specific change in OSA is demonstrated and 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.
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Diagnosing obstructive sleep apnea patients with isolated nocturnal hypoventilation and defining obesity hypoventilation syndrome using new European Respiratory Society classification criteria: an Indian perspective.
TL;DR: One in six OSA Patients and one in three obese OSA patients (BMI >30 kg/m2) have OHS according to new criteria, and screening for sleep hypoventilation should be carried out in all obese Osa patients.
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Predictors of obesity hypoventilation syndrome among patients with sleep-disordered breathing in India.
TL;DR: The prevalence of OHS in Indian patients is similar to Caucasians even at a lower BMI and lower spirometric parameters.
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Defining obesity hypoventilation syndrome
TL;DR: Obesity hypoventilation syndrome is defined as daytime alveolar hypventilation in obese patients in the absence of other causes of hypovents, and classifications of severity are now needed to target treatment at the most appropriate individuals.
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Severe paediatric obesity and sleep: A mutual interactive relationship!
Mariam Ischander,Robert D. Lloyd +1 more
TL;DR: Targeting childhood obesity is important in the prevention and management of obstructive sleep‐disordered breathing, and short sleep duration and poor sleep quality are associated with childhood obesity and cardiometabolic risks.
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