Search

Obesity hypoventilation syndrome (OHS) can often be underdiagnosed or misdiagnosed and has been shown to pose significant risks in perioperative situations. Patients with OHS have a higher prevalence of baseline morbid conditions like hypertension, congestive heart failure (CHF), diabetes mellitus, atrial fibrillation, and pulmonary hypertension (PH), which contribute to adverse postoperative outcomes. The potential challenges include difficult intubation and loss of airway, postoperative respiratory failure, worsening heart failure, pulmonary hypertensive crisis, and opioid-induced respiratory depression (OIRD). It is, therefore, important to screen all obese patients for obstructive sleep apnea (OSA) and OHS before elective surgical procedures. The aim of this review is to discuss the preoperative screening and evaluation and safe anesthetic and up-to-date ventilatory management of this complex group of patients. This review also intends to increase the awareness of OHS in the adult population among hospitalists, surgeons, and cardiologists who may find themselves taking care of these patients in complex multidisciplinary settings. [ABSTRACT FROM AUTHOR]

Obesity hypoventilation syndrome (OHS), also known as Pickwickian syndrome, is a combination of obesity (body mass index (BMI) >30 kg/m2), daytime hypercapnia (arterial carbon dioxide tension >45 mm Hg) and sleep-disordered breathing, after exclusion of other disorders that may cause alveolar hypoventilation. Management of OHS requires a multifaceted approach in the form of weight loss, treatment of existing co-illnesses, pulmonary rehabilitation, and Bi-level positive airway pressure (Bi-PAP) therapy. A 58-year-old lady with a BMI of 50 kg/m2 with symptoms of obstructive sleep apnea (OSA) and OHS presented to the hospital with respiratory distress. She gave a history of breathlessness, snoring, and sleep disturbances for the last 7 years. She was managed by a physician with a diagnosis of obstructive airway disease without further evaluation of sleep disturbance. On admission, she was started on non-invasive ventilation during her initial management. After 72 hours of admission, the patient became stable, and overnight polysomnography was performed to confirm the diagnosis of OHS. After confirmation of the diagnosis, she was started on Bi-PAP therapy along with other supportive therapy for 7 days. She was discharged after 10 days of admission with nocturnal Bi-PAP therapy at home and was enrolled in a comprehensive pulmonary rehabilitation program. Patient is on regular follow-up and has been doing well since then.

Objective: Unusual clinical course. Background: Numerous countries, Vietnam included, have persistently high annual rates of traffic accidents. Despite concerted government efforts to reduce the annual traffic accident rate, the toll of fatalities and consequential injuries from these accidents rises each year. Various factors contribute to these incidents, notably including alcohol consumption while driving, inadequate awareness of traffic regulations, and substandard traffic infrastructure. However, an under-recognized risk in developing nations such as Vietnam is the prevalence of sleep disorders. Conditions such as obstructive sleep apnea syndrome and obesity hypoventilation syndrome, while prevalent, remain inadequately assessed and treated. These disorders represent significant yet largely unaddressed contributors to the heightened risk of traffic accidents. Case Report: We describe the case of a 55-year-old Vietnamese man hospitalized due to long-standing respiratory complications and profound daytime sleepiness. Over the past 2 years, the patient gained 10 kg. Consequently, he frequently experienced drowsiness, leading to 4 traffic accidents. Despite previous hospitalizations, this sleep disorder had gone undiagnosed and untreated. Diagnostic assessments confirmed concurrent obstructive sleep apnea and obesity hypoventilation syndrome through polysomnography and blood gas analyses. Treatment involving non-invasive positive airway pressure therapy notably alleviated symptoms and substantially improved his quality of life within a concise 3-month period. Conclusions: Obstructive sleep apnea and obesity hypoventilation syndrome are contributory factors to excessive daytime somnolence, significantly increasing vulnerability to traffic accidents. Regrettably, this critical intersection remains inadequately addressed. Addressing these concerns comprehensively through dedicated research initiatives should be imperative before considering the universal issuance of driver's licenses to all road users in Vietnam. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Obesity is a major social and economic problem. Since the 1980s, the number of overweight and obese people has doubled. Treatment of such patients is 30% more expensive than for people of normal weight. The main aim of the article is to present the impact of the occurrence of respiratory diseases and the deterioration of the system function. In addition, the article reviews the impact of physical activity and diet on weight loss and the prevention of further weight gain. Review and Methods: Review and summary of studies and meta-analysis of studies available in open-source format on Google Scholar and PubMed. Abbreviated Description of the State of Knowledge: One of the most common diseases in the population is bronchial asthma. People with excess body weight have a more severe course, and numerous studies have been carried out to explain the cause. The main mechanism that worsens respiratory function is mechanical compression by fatty tissue. It has also been observed that the inflammatory response, underlying the etiopathogenesis of asthma, may be caused by the secretion of inflammatory mediators by adipocytes. This is currently being investigated. Obstructive sleep apnea is a disorder that results in a fragmentation of sleep, which has serious health consequences and leads to a reduction in quality of life. Obesity is a major risk factor. The severity of the condition is strongly related to excess body weight. Obese hypoventilation syndrome is a condition in which obesity impairs alveolar ventilation and CO2 removal, resulting in hypercapnia, which can lead to respiratory failure. Summary: Weight loss and interventions to prevent weight gain in people with a baseline BMI >25 kg/m2 are fundamental to good health. For best results, a calorie-restricted diet should be combined with physical activity. The WHO has created recommendations for the amount of physical activity needed each week.

Objectives: Scant data from India are available on the gender differences in presenting features of Obstructive Sleep Apnea (OSA) in India. This study aims to compare male and female patients with OSA for general characteristics and presenting symptoms. Methodology: Retrospective study was done in OSA patients diagnosed in our sleep lab. History, biochemical reports, and polysomnography variables were retrieved from the sleep registry and were compared between males and females. Results: Out of 514 patients of OSA (367 males; 147 females). Females were older (55.97 ± 9.73 v/s 50.2 + 12.70 years, P

PurposePatients with obesity and elevated serum bicarbonate suggesting obesity hypoventilation syndrome (OHS) undergoing bariatric surgery may represent a unique subgroup. Information regarding surgical outcomes in this population remains limited. We sought to test the hypothesis that an elevated bicarbonate would be an important predictor of perioperative complications (i.e., length of hospital stay) and postsurgical outcomes (i.e., weight loss at 1 year).Materials and methodsConsecutive patients undergoing bariatric surgery between January 2015 and December 2018 were included. Patients with a preoperative serum bicarbonate ≥ 27 mEq/L were classified as suspected OHS.ResultsOf 297 patients, the prevalence of suspected OHS based on an elevated bicarbonate was 19.5% (95% CI: 15.3 to 24.6%). Length of hospital stay was similar in the suspected OHS and non-OHS control group (1.50 vs 1.49 days, P = 0.98). The achieved weight loss from peak preoperative weight to 1 year post-surgery was less in the suspected OHS vs the control group (4.2% [95% CI 1.6 to 6.8]; P = 0.002).ConclusionPatients with serum bicarbonate ≥ 27 mEq/L as a surrogate marker for OHS experienced weight loss that was significantly less than their normal serum bicarbonate counterparts, but still achieved weight loss deemed clinically important by current guidelines. We observed no significant difference in length of hospital stay at time of surgery.

Introduction: There are studies about polysomnographic (PSG) characteristics of patients with either obesity hypoventilation syndrome (OHS) or addiction. We aimed to investigate the PSG characteristics of obstructive sleep apnea (OSA) patients with opium addiction, those on methadone maintenance treatment (MMT), and non-addicts for the treatment of addiction. Methods: In this cross-sectional study, we enrolled 75 patients with OHS in the Bamdad Respiratory and Sleep Research Center affiliated with the Isfahan University of Medical Sciences between January 2020 and February 2021. The patients were categorized into three groups: Opium addicts (OA), MMT, and non-addicts (NA). All patients completed screening questionnaires for OSA. This included the Epworth sleepiness scale (ESS), stop-bang questionnaire, and Berlin questionnaire and the data analyzed by SPSS software, version 24. Results: A total of 75 OHS patients (54 men [72%] and 21 women [28%]) were studied in three groups, including OA (n=30), MMT (n=15), and NA (n=30). The apnea hypopnea index was not significantly different between the three groups. The longest apnea duration was higher in the OA than in other groups (P=0.001). Central apnea index (P=0.01), longest hypopnea duration (P=0.04), PaCO2 (P=0.04), and time with SpO2?90% (T90) (P=0.009) were higher in the MMT than in other groups. Furthermore, the minimum SpO2 was lower in the MMT than in other groups (P=0.03). Conclusion: Some of the sleep disturbances were worse in the MMT than in the OA group. This suggests the need for further studies to compare the effects of opium and methadone on sleep in OHS patients. [ABSTRACT FROM AUTHOR]

Exercise intolerance is a common feature of many cardiopulmonary diseases including pulmonary hypertension (PH) and sleep disordered breathing (SDB), which includes obstructive sleep apnea and obesity hypoventilation syndrome. Physiologic abnormalities in both PH and SDB can drive exercise intolerance, and biological mechanisms overlap among the conditions including systemic inflammation, oxidative stress, metabolic dysfunction, and endothelial dysfunction. Despite this understanding, evidence establishing clear causal relationships among PH, SDB, and exercise intolerance is lacking. Data show that treatment of SDB may improve exercise capacity, and exercise training likely improves SDB, although these relationships specifically in PH remain understudied. In this manuscript, we summarize existing data of mechanisms and clinical observations in PH, SDB and exercise and identify gaps and opportunities for future investigation. [ABSTRACT FROM AUTHOR]

Rationale: Sleep-disordered breathing (SDB) is associated with increased complications and length of stay (LOS) after surgery. SDB-related adverse consequences for nonsurgical admissions are not well defined. Objectives: Evaluate associations between SDB and subtypes and LOS, cost, and mortality in nonsurgical patients. Methods: This retrospective cohort analysis used adult nonsurgical admissions from the 2017 National Inpatient Sample of the Healthcare Costs and Utilization Project. SDB associations with LOS (primary outcome), costs, and mortality were evaluated via logistic regression. Covariates included age, sex, Elixhauser Comorbidity Index, socioeconomic status, hospital type, and insurance type. Results: The cohort included 6,046,544 hospitalizations. Compared with those without SDB, patients with SDB were older (63.6613.5 vs. 57.4620.7 yr), higher proportion male (55.8% vs. 40.9%), and more likely to be White (75.7% vs. 66.5%). SDB was associated with increased odds of increased LOS and hospitalization costs (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.16-1.17 and OR, 1.67; 95% CI, 1.66-1.67 in adjusted analyses, respectively) but lower mortality (OR, 0.79; 95% CI, 0.77-0.81). The results for obstructive sleep apnea (OSA) echoed those for SDB. Obesity hypoventilation syndrome had substantially increased LOS (OR, 3.05; 95% CI, 2.98-3.13), mortality (1.76; 95% CI, 1.66-1.86), and costs (OR, 2.67; 95% CI, 2.60-2.73) even after adjustment. Conclusions: Obesity hypoventilation syndrome is associated with higher LOS, mortality, and costs during hospitalization, whereas OSA, despite higher LOS and costs, is associated with decreased mortality. Investigation is warranted on whether paradoxically higher costs but lower mortality in OSA may be indicative of less vigilance in hospitalized patients with undiagnosed SDB. [ABSTRACT FROM AUTHOR]

Abstract Background Continuous positive airway pressure (CPAP) therapy has profound effects in obesity hypoventilation syndrome (OHS). Current therapy initiation focuses on upper airway patency rather than the assessment of altered respiratory mechanics due to increased extrapulmonary mechanical load. Methods We aimed to examine the viability of intra-breath oscillometry in optimizing CPAP therapy for OHS. We performed intra-breath oscillometry at 10 Hz in the sitting and supine positions, followed by measurements at increasing CPAP levels (none-5-10-15-20 cmH2O) in awake OHS patients. We plotted intra-breath resistance and reactance (Xrs) values against flow (V’) and volume (V) to identify tidal expiratory flow limitation (tEFL). Results Thirty-five patients (65.7% male) completed the study. We found a characteristic looping of the Xrs vs V’ plot in all patients in the supine position revealing tEFL: Xrs fell with decreasing flow at end-expiration. Intra-breath variables representing expiratory decrease of Xrs became more negative in the supine position [end-expiratory Xrs (mean ± SD): -1.9 ± 1.8 cmH2O·s·L− 1 sitting vs. -4.2 ± 2.2 cmH2O·s·L− 1 supine; difference between end-expiratory and end-inspiratory Xrs: -1.3 ± 1.7 cmH2O·s·L− 1 sitting vs. -3.6 ± 2.0 cmH2O·s·L− 1 supine, p

Background: Continuous positive airway pressure (CPAP) therapy has profound effects in obesity hypoventilation syndrome (OHS). Current therapy initiation focuses on upper airway patency rather than the assessment of altered respiratory mechanics due to increased extrapulmonary mechanical load. Methods: We aimed to examine the viability of intra-breath oscillometry in optimizing CPAP therapy for OHS. We performed intra-breath oscillometry at 10 Hz in the sitting and supine positions, followed by measurements at increasing CPAP levels (none-5-10-15-20 cmH2O) in awake OHS patients. We plotted intra-breath resistance and reactance (Xrs) values against flow (V') and volume (V) to identify tidal expiratory flow limitation (tEFL). Results: Thirty-five patients (65.7% male) completed the study. We found a characteristic looping of the Xrs vs V' plot in all patients in the supine position revealing tEFL: Xrs fell with decreasing flow at end-expiration. Intra-breath variables representing expiratory decrease of Xrs became more negative in the supine position [end-expiratory Xrs (mean ± SD): -1.9 ± 1.8 cmH2O·s·L− 1 sitting vs. -4.2 ± 2.2 cmH2O·s·L− 1 supine; difference between end-expiratory and end-inspiratory Xrs: -1.3 ± 1.7 cmH2O·s·L− 1 sitting vs. -3.6 ± 2.0 cmH2O·s·L− 1 supine, p < 0.001]. Increasing CPAP altered expiratory Xrs values and loop areas, suggesting diminished tEFL (p < 0.001). 'Optimal CPAP' value (able to cease tEFL) was 14.8 ± 4.1 cmH2O in our cohort, close to the long-term support average of 13.01(± 2.97) cmH2O but not correlated. We found no correlation between forced spirometry values, patient characteristics, apnea-hypopnea index and intra-breath oscillometry variables. Conclusions: tEFL, worsened by the supine position, can be diminished by stepwise CPAP application in most patients. Intra-breath oscillometry is a viable method to detect tEFL during CPAP initiation in OHS patients and tEFL is a possible target for optimizing therapy in OHS patients. [ABSTRACT FROM AUTHOR]

There is a strong relationship between obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). When OHS is combined with severe OSA, treatment consists of continuous positive airway pressure (CPAP), followed by noninvasive ventilation (NIV) in the case of CPAP failure. Currently, the impact of a previous use of CPAP on the quality of NIV is unknown. We conducted a cross-sectional study with OHS patients, to assess the quality of NIV according to previous CPAP use. We included 75 patients with OHS on NIV (65 women, 87%). Among these, 40 patients (53.3%) who had had prior CPAP (CPAP+ group) were compared to the remaining 35 patients (46.7%) (CPAP− group). Key characteristics were comparable between the CPAP+ and the CPAP− groups: age at diagnosis of OHS was 67 ± 3 vs. 66 ± 4 years (p = 0.8), age at inclusion was 73 ± 15 vs. 69 ± 15 years (p = 0.29), number of comorbidities was 3.7 ± 1.2 vs. 3.3 ± 1.5, the Charlson index was 5.1 ± 2 vs. 4.6 ± 1.8, and BMI was 41.6 ± 7.6 kg/m2 vs. 41.2 ± 8.2, respectively, all p > 0.05. Follow-up length was greater in CPAP+ vs. CPAP− patients (5.6 ± 4.2 vs. 2.9 ± 2.9 years, p = 0.001). The quality of NIV based on daily adherence, pressure support, apnea–hypopnea index (AHI) and leaks was similar in both groups. Reduced adherence (less than 4 h daily) was found in 10 CPAP+ patients (25%) versus 7 CPAP− patients (20%), p = 0.80. NIV efficacy was also similar. This study found no difference in the quality of NIV or in adherence between patients who had had prior CPAP and those who had not. Previous CPAP does not appear to improve the quality of NIV. [ABSTRACT FROM AUTHOR]

Regular and unobstructed breathing during the night is the prerequisite for an undisturbed and restful sleep. The most prevalent nocturnal breathing disturbance with morbid consequences is obstructive sleep apnea syndrome. The prevalence of obstructive sleep apnea (OSA) is increasing, and a significant number of patients with OSA are undiagnosed. On the other hand, the "obesity epidemic" is a growing concern globally. A sleep test is required to diagnose sleep apnea and to individualize therapy. A multidisciplinary approach is the key to success. This narrative review presents a debate on whether surgery is a friend or a foe in the treatment of sleep apnea. Depending on the type and severity of the apnea, the causal factor, and the presence of obesity and hypercapnia as well as the associated pathologies, the optimal therapeutic method is determined for each individual case. The article concludes that each case is unique, and there is no ideal method. Positive pressure ventilation, although a therapeutic gold standard, has its disadvantages extensively discussed in this paper. Nevertheless, it is necessary prior to any surgical intervention, either for the curative treatment of the causal factor of apnea or for elective surgery for another condition. The anesthetic risks associated with the presence of apnea and obesity should not be neglected and should form the basis for decision making regarding surgical interventions for the treatment of sleep apnea. [ABSTRACT FROM AUTHOR]