Cardiovascular disease in obesity hypoventilation syndrome – A review of potential mechanisms and effects of therapy

Zheng, Yizhong; Phillips, Craig L.; Sivam, Sheila; Wong, Keith; Grunstein, Ronald R.; Piper, Amanda J.; Yee, Brendon J.

doi:10.1016/j.smrv.2021.101530

Cited by 15 publications

(6 citation statements)

References 91 publications

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“…Cardiovascular and metabolic comorbidities are a major burden of OHS [ 11 ]. Cardiovascular risk in OSA has been widely investigated, and there is an excess risk, reportedly mediated by mechanisms such as neuro-hormonal dysregulation, endothelial dysfunction and inflammation [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Previous CPAP and Comorbidities at Diagnosis of Obesity-Hypoventilation Syndrome Associated with Obstructive Sleep Apnea: A Comparative Retrospective Observational Study

Agossou

Awanou

Inamo

et al. 2023

JCM

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Obesity-hypoventilation syndrome (OHS) is associated with many comorbidities. The aim of this study was to evaluate the association between previous continuous positive airway pressure (CPAP) and the prevalence of comorbidities in OHS associated with obstructive sleep apnea (OSA). We performed a retrospective, single-center study at the University Hospital of Martinique, the referral hospital for the island of Martinique. A total of 97 patients with OHS associated with severe OSA on non-invasive ventilation (NIV) were included; 54 patients (56%) had previous treatment of OSA with a positive airway pressure (PAP) device before shifting to NIV (PAP group) and 43 (44%) had no previous treatment of OSA with a PAP device before initiating NIV PAP (no PAP group). Sociodemographic characteristics were similar between groups; there were 40 women (74%) in the PAP group versus 34 (79%) in the no PAP group, mean age at OHS diagnosis was 66 ± 15 versus 67 ± 16 years, respectively, and the mean age at inclusion 72 ± 14 versus 71 ± 15 years, respectively. The average number of comorbidities was 4 ± 1 in the PAP group versus 4 ± 2 in the no PAP group; the mean Charlson index was 5 ± 2 in both groups. The mean BMI was 42 ± 8 kg/m2 in both groups. The mean follow-up duration was 5.8 ± 4.4 years in the PAP group versus 4.7 ± 3.5 years in the no PAP group. Chronic heart failure was less common in patients who had a previous PAP 30% versus 53% (p = 0.02). It is also noted that these patients were diagnosed less often in the context of acute respiratory failure in patients with previous PAP: 56% versus 93% (p < 0.0001). In contrast, asthma patients were more frequent in patients with previous treatment of OSA with a PAP device at the time of OHS diagnosis but not significantly: 37% versus 19% (p = 0.07). Early treatment of severe OSA with a PAP device prior to diagnosis of OHS seems to be associated with a reduced prevalence of cardiac diseases, notably chronic heart failure, in patients diagnosed with OHS associated with severe OSA.

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Section: Discussionmentioning

confidence: 99%

Association between Previous CPAP and Comorbidities at Diagnosis of Obesity-Hypoventilation Syndrome Associated with Obstructive Sleep Apnea: A Comparative Retrospective Observational Study

Agossou

Awanou

Inamo

et al. 2023

JCM

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“…Another explanation is the alteration of respiratory functions during sleep, respiratory alterations can occur due to the physiological changes in obesity amplified during supine sleep. The excessive fat surrounding the upper airway and the reduction in lung volume can cause the pharynx to collapse [ 31 ]. Patients with OHS have been observed to experience obstructive apneas and hypopneas of longer duration compared to patients with OSA alone, indicating a poorly compensated ventilatory response.…”

Section: Pathophysiologymentioning

confidence: 99%

Obesity hypoventilation syndrome, literature review

Orozco González,

Rodriguez Plascencia,

Palma Zapata

et al. 2024

Sleep Advances

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Obesity is a global health concern that has been increasing over the years, and it is associated with several pathophysiological changes affecting the respiratory system, including alveolar hypoventilation. Obesity hypoventilation syndrome (OHS) is one of the six subtypes of sleep-hypoventilation disorders. It is defined as the presence of obesity, chronic alveolar hypoventilation leading to daytime hypercapnia and hypoxia, and sleep-disordered breathing. The existence of a sleep disorder is one of the characteristics that patients with OHS present. Among them, 90% of patients have obstructive sleep apnea (OSA), and the remaining 10% of patients with OHS have non-obstructive sleep hypoventilation without OSA or with mild OSA. This review aims to provide a comprehensive understanding of the epidemiological and pathophysiological impact of OHS and to highlight its clinical features, prognosis, and severity, as well as the available treatment options.

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“…10 While discussion of KDs and OHS raise interesting physiology discussion points, there are other treatments that potentially offer greater weight loss benefits for patients with this serious disorder associated with major morbidity and mortality risk. 11 From a clinical perspective, bariatric surgery offers sustainable weight loss with a clear benefit in reduction of sleepdisordered breathing. 12 More recently, the advent of incretins such as semaglutide and tirzepatide has transformed the dynamic of managing obesity and related conditions.…”

Section: E D I T O R I a Lmentioning

confidence: 99%

Ketogenic diets for obesity‐hypoventilation syndrome? Interesting physiology but a long way to go

Cayanan

Grunstein

2023

Respirology

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Cardiovascular disease in obesity hypoventilation syndrome – A review of potential mechanisms and effects of therapy

Cited by 15 publications

References 91 publications

Association between Previous CPAP and Comorbidities at Diagnosis of Obesity-Hypoventilation Syndrome Associated with Obstructive Sleep Apnea: A Comparative Retrospective Observational Study

Association between Previous CPAP and Comorbidities at Diagnosis of Obesity-Hypoventilation Syndrome Associated with Obstructive Sleep Apnea: A Comparative Retrospective Observational Study

Obesity hypoventilation syndrome, literature review

Ketogenic diets for obesity‐hypoventilation syndrome? Interesting physiology but a long way to go

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