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Obesity hypoventilation syndrome

Obesity Hypoventilation Syndrome Overview: – Definition: Obesity hypoventilation syndrome (OHS) is characterized by respiratory insufficiency in obese individuals. – Signs and Symptoms: Include snoring, interrupted […]

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Obesity Hypoventilation Syndrome Overview:
– Definition: Obesity hypoventilation syndrome (OHS) is characterized by respiratory insufficiency in obese individuals.
– Signs and Symptoms: Include snoring, interrupted sleep, excessive daytime sleepiness, depression, and hypertension.
– Physiological Effects: Strain on the heart leading to cor pulmonale, jugular venous pressure, hepatomegaly, ascites, and leg edema.
– Mechanism: Resulting from increased work of breathing due to chest movement restriction by adipose tissue, leading to inadequate carbon dioxide removal.
– Epidemiology: Prevalence unknown, more common in severe obesity, especially in men, and expected to rise with increasing obesity rates.

Diagnosis and Confirmation:
– Criteria: Body mass index over 30kg/m² and arterial carbon dioxide levels over 45mmHg.
– Exclusion: Ruling out other causes of hypoventilation and differentiating from lung diseases.
– Tests: Arterial blood gas measurement, polysomnography, blood tests, imaging, and spirometry.

Treatment and Management:
– Weight Loss: Primary and most effective treatment, often requiring bariatric surgery.
– Positive Airway Pressure Therapy: CPAP as a first-line treatment, lifestyle modifications, and regular monitoring.
– Complications: Heart failure, cor pulmonale, pulmonary hypertension, edema, and ascites.
– Other Treatments: Medications, hospital admission for severe cases, and bi-level positive airway pressure.

Prognosis and Complications:
– Impact on Quality of Life: Reduced quality of life and increased healthcare costs.
– Complications: Heart failure, increased mortality risk if untreated, and reduced risk with PAP treatment.
– Prognosis: Improved with weight loss, compliance with therapy, and individual treatment response variability.

Specific Treatment Approaches:
– Positive Airway Pressure: CPAP effectiveness, bi-level positive pressure, oxygen therapy, and tracheostomy in extreme cases.
– Other Treatments: Tracheotomy for severe cases, avoidance of certain medications, and risks associated with specific treatments.

Obesity hypoventilation syndrome (Wikipedia)

Obesity hypoventilation syndrome (OHS) is a condition in which severely overweight people fail to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide (CO2) levels. The syndrome is often associated with obstructive sleep apnea (OSA), which causes periods of absent or reduced breathing in sleep, resulting in many partial awakenings during the night and sleepiness during the day. The disease puts strain on the heart, which may lead to heart failure and leg swelling.

Obesity hypoventilation syndrome
Other namesPickwickian syndrome
Obesity hypoventilation syndrome often improves with positive airway pressure treatment administered overnight by a machine such as this device.
SpecialtyRespirology
Risk factorsObesity

Obesity hypoventilation syndrome is defined as the combination of obesity and an increased blood carbon dioxide level during the day that is not attributable to another cause of excessively slow or shallow breathing.

The most effective treatment is weight loss, but this may require bariatric surgery to achieve. Weight loss of 25 to 30% is usually required to resolve the disorder. The other first-line treatment is non-invasive positive airway pressure (PAP), usually in the form of continuous positive airway pressure (CPAP) at night. The disease was known initially in the 1950s, as "Pickwickian syndrome" in reference to a Dickensian character.

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