Chest
Clinical InvestigationsSleep and BreathingObesity Hypoventilation Syndrome as a Spectrum of Respiratory Disturbances During Sleep
Section snippets
Materials and Methods
Patients included in the study were identified by reviewing the records of the Bellevue Hospital Pulmonary Function Laboratory and the New York University Sleep Disorders Center from 1991 to 2000. Forty-nine obese patients with excessive daytime somnolence and both chronic awake hypercapnia and a respiratory sleep disorder were identified. Chronic hypercapnia was defined as an awake Paco2 level of > 45 mm Hg. A respiratory sleep disorder was defined as either an apnea-hypopnea index (AHI) of >
Results
Patient characteristics are illustrated in Table 1. The study included 23 patients with an average age of 54 years. All patients were hypercapnic with an average Paco2 of 55 mm Hg and an average serum HCO3 of 33 mEq/L. The ventilatory response to CO2 was uniformly low (< 1.2 L/min/mm Hg) with the exception of one patient. The average FEV1/FVC ratio was 74%, and eight patients had significant obstruction with a ratio of < 70%. Nine of 15 patients without obstruction demonstrated a significantly
Discussion
The present study identifies a variety of ventilatory sleep disorders that occur in chronically hypercapnic patients with OHS. Four disorders were identified through the use of a NPSG protocol. These disorders include SHVS, OSAHS, prolonged obstructive hypoventilation due to partial upper airway obstruction, and the overlap of associated pulmonary disease with a ventilatory sleep disturbance. Although a retrospective analysis does not allow the delineation of the specific contribution of each
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Cited by (184)
Targeting Hypercapnia in Chronic Lung Disease and Obesity Hypoventilation: Benefits and Challenges
2024, Sleep Medicine ClinicsEffectiveness of CPAP vs. Noninvasive Ventilation Based on Disease Severity in Obesity Hypoventilation Syndrome and Concomitant Severe Obstructive Sleep Apnea
2022, Archivos de BronconeumologiaCitation Excerpt :Ambulatory patients with OHS are typically treated with nocturnal positive airway pressure (PAP) therapy during sleep such as noninvasive ventilation (NIV), usually with bilevel pressure settings, or continuous positive airway pressure (CPAP). The effectiveness of NIV has been evaluated in several long-term, observational studies;4,6,7,16–23 and medium-term randomized trials.3,24,25 CPAP prevents upper airway obstructive events, but it is not the treatment of choice for non-obstructive sleep hypoventilation.21
Management of Obesity Hypoventilation Syndrome
2021, Encyclopedia of Respiratory Medicine, Second Edition
This study was supported by the National Heart, Lung, and Blood Institute (grant No. HL-09686) and by the National Institutes of Health (grant No. NCRR M01 RR00096).