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Saturday, 16 August 2014

Obesity Complication of Hypoventilation Syndrome

By Kyle J. Norton

Obesity is defined as a medical condition of excess body fat accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, and a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

How to calculate your BMI index
BMI= weight (kg)/ height (m2)

Obesity hypoventilation syndrome is defined as a condition of low blood oxygen levels and high blood carbon dioxide (CO2) levels in the body of severe obese people who can not breath rapidly and deeply.

How Obesity associates with Obesity Hypoventilation Syndrome
1. In a study of "[Obesity and Sleep-related Breathing Disorders]" Luo JM, Xiao Y., posted in PubMed, researchers wrote that Obesity, with an increasing prevalence,has become one of the most common metabolic diseases. Obesity is associated with many respiratory diseases, especially sleep-related breathing disorders including obstructive sleep apnea-hypopnea syndrome, obesity hypoventilation syndrome, and overlap syndrome. This article reviews the association between obesity and these sleep-related breathing disorders.

2. According to a study of "The pickwickian syndrome-obesity hypoventilation syndrome" by Littleton SW, Mokhlesi B., posted in PubMed, researchers wrote that Obesity-hypoventilation syndrome (OHS), also historically described as the Pickwickian syndrome, consists of the triad of obesity, sleep disordered breathing, and chronic hypercapnia during wakefulness in the absence of other known causes of hypercapnia. Its exact prevalence is unknown, but it has been estimated that 10% to 20% of obese patients with obstructive sleep apnea have hypercapnia

3. In the abstract of the study of "Respiratory complications of obesity" [Article in English, Spanish] by Rabec C, de Lucas Ramos P, Veale D., posted in PubMed, researchers indicated that Obesity, well known as a cardiovascular risk factor, can also lead to significant respiratory complications. The respiratory changes associated with obesity extend from a simple change in respiratory function, with no effect on gas exchange, to the more serious condition of hypercapnic respiratory failure, characteristic of obesity hypoventilation syndrome. More recently, it has been reported that there is an increased prevalence of asthma which is probably multifactorial in origin, but in which inflammation may play an important role.

4. In a study of "Influence of body mass index on treatment of breathing-related sleep disorders" by Dzieciolowska-Baran E, Gawlikowska-Sroka A, Poziomkotska-Gesicka I, Teul-Swiniarska I, Sroczynski T., posted in PubMed, researchers found that the analysis demonstrated a significant influence of body mass on snoring, particularly in complicated and severe types of breathing disorders, such obstructive sleep apnea or hypopnea, and the obesity hypoventilation syndrome. Corrective interventions carried out to eliminate anatomical abnormalities causing obstruction of upper airways provided the best therapeutic effects in patients with normal body mass.

5. According to the study of "Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects" by Resta O, Foschino-Barbaro MP, Legari G, Talamo S, Bonfitto P, Palumbo A, Minenna A, Giorgino R, De Pergola G., posted in PubMed, researchers concluded that OSA is present in more than 50% of a population of obese patients with a mean BMI higher than 40.0, this percentage being much higher than that commonly reported in previous studies, particularly in women. Neck circumference in men and BMI in women seem to be the strongest predictors of the severity of OSA in obese patients. Nocturnal hypoventilation seems to be present in more than 29% of a severe obese population. Moreover, this study indicates that morbid obesity can be associated with excessive daytime sleepiness even in the absence of sleep apnea.

6. Etc.

Treatments of Obesity and Obesity Hypoventilation Syndrome
1. According to the study of "Noninvasive Ventilation in Mild obesity hypoventilation syndrome: A randomized controlled trial" by Borel JC, Tamisier R, Gonzalez-Bermejo J, Baguet JP, Monneret D, Arnol N, Roux-Lombard P, Wuyam B, Levy P, Pepin JL, posted in PubMed, researchers found that NIV group patients (n=18) were older (58±11 versus 54±6 years) with a higher baseline PaCO(2) (47.9±4.2 versus 45.2±3 mmHg). In intention to treat analysis, compared to control group, NIV significantly reduced daytime PaCO(2) (difference between treatments: -3.5 mmHg; 95%CI:-6.2 to -0.8) and apnea-hypopnea-index (-40.3/h 95%CI:-62.4 to -18.2). Sleep architecture was restored although non-respiratory micro-arousals increased (+9.4/hour of sleep; 95%CI: 1.9 to 16.9) and daytime sleepiness was not completely normalized. Despite a dramatic improvement in sleep hypoxemia, glucidic and lipidic metabolism parameters as well as cytokines profiles did not vary significantly. Accordingly, neither RH-PAT (+0.02; 95%CI: -0.24 to 0.29) nor arterial stiffness (+0.22m.s(-1); 95%CI: -1.47 to 1.92) improved.

2. According to the study of "Obesity hypoventilation syndrome" by Al Dabal L, Bahammam AS., posted in PubMed, researchers indicated that Despite its major impact on health, this disorder is under-recognized and under-diagnosed. Available management options include aggressive weight reduction, oxygen therapy and using positive airway pressure techniques. In this review, we will go over the epidemiology, pathophysiology, presentation and diagnosis and management of OHS.

3. In the abstract of the study of "Diagnosis and management of obesity hypoventilation syndrome in the ICU" by Lee WY, Mokhlesi B., posted in PubMed, researchers concluded that Because of the global obesity epidemic and the high prevalence of obstructive sleep apnea in the general population, critical care physicians are likely to encounter patients who have acute-on-chronic respiratory failure attributable to OHS in their clinical practice. In this article we define the clinical characteristics of OHS, review its pathophysiology, and discuss the morbidity and mortality associated with OHS. Finally, we offer treatment strategies during ICU management using noninvasive positive pressure ventilation that may guide the physician in the care of these challenging patients.


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