1217 Obesity Hypoventilation Syndrome in a 4-Year-Old Child

Abstract Introduction four-year-old boy with morbid obesity was referred to pediatric sleep for nocturnal hypoxemia during inpatient admissions. He was found to have daytime hypoventilation, likely secondary to obesity hypoventilation syndrome (OHS). Report of Case During two inpatient admissions (wheezing, gastroenteritis), he desaturated to the 70s during sleep. At home, he received blow-by oxygen as he could not tolerate other interfaces. He underwent adenotonsillectomy. However, snoring, daytime sleepiness, hyperactivity and aggressive behavior persisted. Birth history was unremarkable, though he became progressively more obese over time. His father had obesity and obstructive sleep apnea. Physical exam was notable for elevated blood pressure of 122/68 mmHg (above 99th percentile), weight and height above 99th percentile, and BMI of 32 kg/m2 (z-score ~4.3). Despite extensive counseling, family declined polysomnography and labs. Awake end-tidal CO2s were elevated at 47 mmHg. Echocardiogram showed half-systemic PA pressures, right ventricular hypertrophy, and right atrial dilation. Family began desensitization protocol in preparation for future PAP therapy and polysomnography. Pediatric endocrinology consultation revealed low suspicion for hormonal/metabolic concerns. He entered a pediatric weight loss program. Conclusion This 4-year-old boy demonstrated daytime hypoventilation, systemic and pulmonary hypertension, likely consequences of his severe obesity. OHS is defined as BMI >95th percentile in children and awake hypercapnia (PaCO2 > 45 mmHg) in absence of alternative hypoventilation causes (e.g. pulmonary, cardiac, neurologic, pharmacologic). Presenting symptoms may include hypersomnolence, morning headaches, cognitive deficits, and signs of cor pulmonale1. The literature consists primarily of case reports; prevalence of pediatric OHS is unknown. Obesity afflicts 18.5% of children in the United States2. Given the severity of OHS sequelae, maintaining a high index of suspicion is crucial. Consider further work-up in patients with unexplained low oxygen saturations, signs of pulmonary hypertension (unexplained dyspnea on exertion, pedal edema), polycythemia, and elevated bicarbonate1.

Download Full-text

Obesity and Pulmonary Hypertension: A Review of Pathophysiologic Mechanisms

Journal of Obesity ◽

10.1155/2012/505274 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 44

Author(s):

Scott E. Friedman ◽

Bruce W. Andrus

Keyword(s):

Pulmonary Hypertension ◽

Thromboembolic Disease ◽

Obesity Hypoventilation Syndrome ◽

Obstructive Sleep ◽

Wide Range ◽

Threatening Condition ◽

Life Threatening ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation ◽

Pathophysiologic Mechanisms

Pulmonary hypertension (PH) is a potentially life-threatening condition arising from a wide variety of pathophysiologic mechanisms. Effective treatment requires a systematic diagnostic approach to identify all reversible mechanisms. Many of these mechanisms are relevant to those afflicted with obesity. The unique mechanisms of PH in the obese include obstructive sleep apnea, obesity hypoventilation syndrome, anorexigen use, cardiomyopathy of obesity, and pulmonary thromboembolic disease. Novel mechanisms of PH in the obese include endothelial dysfunction and hyperuricemia. A wide range of effective therapies exist to mitigate the disability of PH in the obese.

Download Full-text

Is Obesity Hypoventilation Syndrome A Postmenopausal Disorder?

The Open Respiratory Medicine Journal ◽

10.2174/1874306401913010051 ◽

2019 ◽

Vol 13 (1) ◽

pp. 51-54 ◽

Cited By ~ 1

Author(s):

Ahmed S. BaHammam ◽

Aljohara S. Almeneessier

Keyword(s):

Diabetes Mellitus ◽

Obstructive Sleep Apnea ◽

Pulmonary Hypertension ◽

Risk Factor ◽

Postmenopausal Women ◽

Obesity Hypoventilation Syndrome ◽

Obstructive Sleep ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation

Previous studies have assessed the role of gender and menopause in Obstructive Sleep Apnea (OSA). It is well known that menopause is a major risk factor for OSA. However, analogous studies on obesity Hypoventilation Syndrome (OHS) are limited. Recent studies have suggested that OHS is more prevalent in postmenopausal women. Moreover, women with OHS seem to have excess comorbidities, including hypothyroidism, hypertension, pulmonary hypertension, and diabetes mellitus, compared to men. In the present perspective, we discuss recent data on the prevalence and comorbidities associated with OHS in women, as well as the use of noninvasive ventilation in women with OHS, and try to answer the question, “Is OHS a disorder of postmenopausal women?”

Download Full-text

Defining obesity hypoventilation syndrome

Breathe ◽

10.1183/20734735.0089-2021 ◽

2021 ◽

Vol 17 (3) ◽

pp. 210089

Author(s):

Neeraj M. Shah ◽

Sonia Shrimanker ◽

Georgios Kaltsakas

Keyword(s):

Case Reports ◽

Upper Airway ◽

Classification Systems ◽

Substantial Contribution ◽

List Type ◽

Obesity Hypoventilation Syndrome ◽

Obstructive Sleep ◽

Definition Of ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation

With increasing prevalence of obesity, the substantial contribution of obesity hypoventilation syndrome (OHS) to morbidity and mortality is likely to increase. It is therefore crucial that the condition has a clear definition to allow timely identification of patients. OHS was first described as “Pickwickian syndrome” in the 1950s; in subsequent decades, case reports did not clearly delineate between patients suffering from OHS and those suffering from obstructive sleep apnoea. In 1999, the American Academy of Sleep Medicine published a guideline that delineated the cause of daytime hypercapnia as either predominantly upper airway or predominantly hypoventilation. This was the first formal definition of OHS as the presence of daytime alveolar hypoventilation (arterial carbon dioxide tension >45 mmHg) in patients with body mass index >30 kg·m−2 in the absence of other causes of hypoventilation. This definition is reflected in the most recent guidelines published on OHS. Recent developments in defining OHS include proposed classification systems of severity and demonstrating the value of using serum bicarbonate to exclude OHS in patients with a low index of suspicion.Educational aimsTo provide an overview of the historical basis of the definition of obesity hypoventilation syndrome.To explain the rationale for the current definition of obesity hypoventilation syndrome.To demonstrate areas that need further investigation in defining obesity hypoventilation syndrome.

Download Full-text