scholarly journals Defining obesity hypoventilation syndrome

Breathe ◽  
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.

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

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A465-A465
Author(s):  
Grace Wang ◽  
Jay Guevarra ◽  
Jason Bronstein
Keyword(s):  
Pulmonary Hypertension ◽  
Case Reports ◽  
Right Atrial ◽  
Pediatric Endocrinology ◽  
Low Oxygen ◽  
Obesity Hypoventilation Syndrome ◽  
Presenting Symptoms ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

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.

scholarly journals Obstructive Sleep Apneu (OSA), Obesitas Hypoventilation Syndrome (OHS) dan Gagal Napas

2019 ◽  
Vol 1 (3) ◽  
pp. 94
Author(s):  
Mokhammad Mukhlis ◽  
Arief Bakhtiar
Keyword(s):  
Obstructive Sleep Apnea ◽  
Respiratory Failure ◽  
Sleep Apnea ◽  
Disease Management ◽  
Literature Review ◽  
Upper Airway ◽  
Obesity Hypoventilation Syndrome ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Background: Obstructive sleep apnea (OSA) is a state of the occurrence of upper airway obstruction periodically during sleep that causes breathing to stop intermittently, either complete (apnea) or partial (hipopnea). Obesity hypoventilation syndrome (OHS) is generally defined as a combination of obesity (BMI ≥ 30 kg / mc) with arterial hypercapnia while awake (PaCO2 > 45 mmHg) in the absence of other causes of hypoventilation. Purpose: In order for the pulomonologis can understand the pathogenesis and pathophysiology of OSA and its complications. Literature review: Several studies have been expressed about the link between OSA, OHS with respiratory failure disease. Pathophysiology of OSA, OHS in respiratory failure were difficult to detect, can cause respiratory failure disease management becomes less effective. Conclusion: A good understanding can help with the diagnosis and management of the appropriate conduct to prevent complications of respiratory failure associated with OSA.

scholarly journals Obesity Hypoventilation Syndrome

2012 ◽  
Vol 117 (1) ◽  
pp. 188-205 ◽  
Author(s):  
Edmond H. L. Chau ◽  
David Lam ◽  
Jean Wong ◽  
Babak Mokhlesi ◽  
Frances Chung ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Adult Population ◽  
Upper Airway ◽  
Respiratory Drive ◽  
Obese Patients ◽  
Obesity Hypoventilation Syndrome ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Obesity hypoventilation syndrome (OHS) is defined by the triad of obesity, daytime hypoventilation, and sleep-disordered breathing without an alternative neuromuscular, mechanical, or metabolic cause of hypoventilation. It is a disease entity distinct from simple obesity and obstructive sleep apnea. OHS is often undiagnosed but its prevalence is estimated to be 10-20% in obese patients with obstructive sleep apnea and 0.15-0.3% in the general adult population. Compared with eucapnic obese patients, those with OHS present with severe upper airway obstruction, restrictive chest physiology, blunted central respiratory drive, pulmonary hypertension, and increased mortality. The mainstay of therapy is noninvasive positive airway pressure. Currently, information regarding OHS is extremely limited in the anesthesiology literature. This review will examine the epidemiology, pathophysiology, clinical characteristics, screening, and treatment of OHS. Perioperative management of OHS will be discussed last.

scholarly journals Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea

Thorax ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 459-467 ◽  
Author(s):  
Juan F Masa ◽  
Babak Mokhlesi ◽  
Iván Benítez ◽  
Francisco Javier Gómez de Terreros Caro ◽  
M-Ángeles Sánchez-Quiroga ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Primary Outcome ◽  
Cost Effective ◽  
Sleep Apnoea ◽  
Obesity Hypoventilation Syndrome ◽  
Obstructive Sleep ◽  
The Mean ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

BackgroundObesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities.ObjectivesWe performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure.MethodsHospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed.ResultsIn total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91–3.14) years for NIV group and 3.00 (2.92–3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups.ConclusionCPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA.Trial registration numberNCT01405976

scholarly journals SINDROM PICKWICKIAN-SINDROM HIPOVENTILASI PADA OBESITAS: LAPORAN KASUS DENGAN PENDEKATAN DIAGNOSIS KLINIS

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Ni Luh Putu Dirasandhi Semedi Putri ◽  
Desak Ketut Indrasari Utami ◽  
I Gusti Ngurah Budiarsa ◽  
Sri Yenni Trisnawati
Keyword(s):  
Morbid Obesity ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Apnea Hypopnea Index ◽  
Blood Gas ◽  
Obesity Hypoventilation Syndrome ◽  
The Past ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

   OBESITY HYPOVENTILATION SYNDROME–THE PICKWICKIAN SYNDROME A CLINICALLY DIAGNOSTIC APPROACH CASE REPORTABSTRACTA 36-year-old man complained about snoring in the past 3 years with a very loud snoring interspersed with choking. This recurs throughout the night, thus, he often experiences excessive drowsiness during the day. He also experienced generalized tonic-clonic seizure in the past six months during sleeping at night or immediately after wake up in the morning. It happened three to four times a week. In the past one month he also experienced a morning headache. He was classified as morbid obesity and had 47.2 cm wide of neck circumference. STOP-BANG score and Snoring Severity Score (SSS) indicated high risk of Obstructive Sleep Apnea. Apnea Hypopnea Index (AHI) was 55.5. The Epworth Sleepiness Scale (ESS) score was 15 indicated to have an excessive sleepiness during the day. Blood gas analysis showed a hypercapnia and chronic hypoventilation condition characterized by the increasing of pCO2 and HCO3- with normal pH. A complete blood count examination showed polycythemia. The patient was diagnosed as Obesity Hypoventilation Syndrome (OHS) based on obesity, OSA, and chronic hypoventilation. With a limited gold standard diagnostic tools, such as polysomnography (PSG), a clinical approach using sleep tools and blood gas analysis to detect early stage OHS still can be made.Keywords: Chronic hypoventilation, morbid obesity, Obesity Hypoventilation Syndrome, obstructive sleep apneaABSTRAKSeorang laki-laki 36 tahun dikeluhkan selalu mendengkur sejak 3 tahun dengan suara dengkuran yang sangat keras diselingi tersedak. Hal ini berulang sepanjang malam hingga pasien sering mengantuk berlebihan di siang hari. Pasien juga mengalami bangkitan umum tonik klonik sejak enam bulan, saat sedang tidur malam hari atau segera setelah terbangun di pagi hari. Sejak 1 bulan, pasien mengeluh sakit kepala saat bangun pagi. Pasien tergolong morbid obesity dan lingkar leher 47,2cm. Skor STOP-BANG dan skor Snoring Severity Score (SSS) menunjukkan risiko tinggi obstructive sleep apneu (OSA), serta Apnea Hypopnea Index (AHI) adalah 55,5. Skor Epworth Sleepiness Scale (ESS) 15 menunjukkan mengantuk berlebihan di siang hari. Pemeriksaan analisis gas darah didapatkan kondisi hiperkapnia dan hipoventilasi kronik berupa peningkatan pCO2 dan HCO3- dengan pH darah cenderung normal. Pemeriksaan darah lengkap menunjukkan polisitemia. Pasien didiagnosis sebagai Sindrom Hipoventilasi pada Obesitas (SHO) karena adanya obesitas, OSA, dan hipoventilasi kronik. Meskipun memiliki keterbatasan alat diagnostik baku emas seperti polisomnografi (PSG), namun pendekatan klinis beserta sleep tools dan analisis gas darah dapat digunakan untuk mendeteksi dini SHO.Kata kunci: Hipoventilasi kronik, morbid obesity, Obesity Hypoventilation Syndrome, obstructive sleep apneu  

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