obesity hypoventilation syndrome
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Etiology
- obesity, sleep-disordered breathing & daytime hypercapnia
Epidemiology
- 1/3 of patients with BMI >= 35 exhibit sleep-related hypoventilation
Pathology
- hypercapnia due to hypoventilation
- diminished ventilatory drive
- diminished vital capacity
- pulmonary hypertension is common
- polycythemia is common
- obstructive sleep apnea is common (90%)
- right heart failure is common
- hypoxemia
Clinical manifestations
- obesity
- hypoventilation
- hypoxemia
- daytime hypercapnia
- obstructive sleep apnea
- pulmonary hypertension
- polycythemia
Laboratory
* for obese patients with sleep-disordered breathing with likely OHS,
* if < 20% likelihood of OHS & serum bicarbonate < 27 mmol/L, pCO2 less unseful
Diagnostic procedures
- polysomnography
- pulmonary function testing with lung volumes & DLCO
- ambulatory oximetry not useful[11]
Complications
- acute-on-chronic hypercapnic respiratory failure
- postoperative respiratory failure
- volume overload is common
Management
- weight reduction, including bariatric surgery
- CPAP or BiPap for hypercapneic respiratory failure, nocturnal hypercapnia, obstructive sleep apnea &/or hypoxemia
- BiPAP may be more effective than CPAP
- hypoxemia may be resistant to CPAP
- improves hypercapnia in hospitalized patients
- BiPAP may be more effective than CPAP
- supplemental oxygen as needed
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc. 2008 Feb 15;5(2):218-25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18250215
- ↑ Kaw R, Bhateja P, Paz Y et al. Postoperative complications in patients with unrecognized obesity hypoventilation syndrome undergoing elective noncardiac surgery. Chest 2016 Jan; 149:84 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25996642 <Internet> http://www.sciencedirect.com/science/article/pii/S0012369215001166
- ↑ Chau EH, Lam D, Wong J, Mokhlesi B, Chung F. Obesity hypoventilation syndrome: a review of epidemiology, pathophysiology, and perioperative considerations. Anesthesiology. 2012 Jul;117(1):188-205. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22614131
- ↑ Manthous CA, Mokhlesi B. Avoiding Management Errors in Patients with Obesity Hypoventilation Syndrome. Ann Am Thorac Soc. 2016 Jan;13(1):109-14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26512908
- ↑ Mokhlesi B. Obesity hypoventilation syndrome: a state-of-the-art review. Respir Care. 2010 Oct;55(10):1347-62; Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20875161 Free Article
- ↑ Olson AL, Zwillich C. The obesity hypoventilation syndrome. Am J Med 2005 Sep; 118:948. Review PMID: https://www.ncbi.nlm.nih.gov/pubmed/16164877
- ↑ Piper AJ, BaHammam AS, Javaheri S. Obesity Hypoventilation Syndrome: Choosing the Appropriate Treatment of a Heterogeneous Disorder. Sleep Med Clin. 2017 Dec;12(4):587-596. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29108613
- ↑ Mokhlesi B, Masa JF, Brozek JL et al Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med.200(3), Aug 1, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31368798 https://www.atsjournals.org/doi/full/10.1164/rccm.201905-1071ST
- ↑ Masa JF, Pepin JL, Borel JC, et al. Obesity hypoventilation syndrome. Eur Respir Rev. 2019;28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30872398
- ↑ 11.0 11.1 NEJM Knowledge+