Diagnostic Predictors of Obesity-Hypoventilation Syndrome in Patients Suspected of Having Sleep Disordered Breathing

Macavei, Vladimir; Spurling, Kristofer J; Loft, J; Makker, Himender

doi:10.5664/jcsm.2986

Cited by 91 publications

(81 citation statements)

References 26 publications

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“…In our study, OHS prevalence was 42.1% in OSA subjects with class II and III obesity, which is higher than in previous studies. 2,[8][9][10][11][12][13][14][22][23][24][25] The mean BMI of our subjects was higher than in most previous studies. [9][10][11][12]14,[23][24][25] This might be the reason for our higher rate.…”

Section: Discussioncontrasting

confidence: 51%

“…14,24,25 Similarly, the most common comorbidities were hyperlipidemia, hypertension, and diabetes mellitus in our subjects with OHS (54.6%, 50%, and 31.2%, respectively). However, there was no significant difference in comorbidities between subjects with OHS and pure OSA.…”

Section: Discussionmentioning

confidence: 99%

“…They also reported that subjects with OHS were more obese and more somnolent; had higher neck, waist, and hip circumferences and waist/hip ratios; had lower P aO 2 , P aCO 2 , and mean and nadir S pO 2 during sleep; and spent more time with S pO 2 Ͻ 90% during sleep. 14 Macavei et al 25 compared the data of subjects with OHS and normocapnic obese subjects. They reported that subjects with OHS were older and heavier and had higher anthropometric measurements, lower spirometric values, and worse ABG and nocturnal oxygenation parameters (ODI, mean and nadir S pO 2 , time spent with S pO 2 Ͻ 90%).…”

Section: Discussionmentioning

confidence: 99%

“…OHS prevalence in patients with OSA varies from 11 to 38%. 2,[7][8][9][10][11][12][13][14][22][23][24][25] The prevalence increases with obesity severity. In our study, OHS prevalence was 42.1% in OSA subjects with class II and III obesity, which is higher than in previous studies.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Predictors of Obesity Hypoventilation Syndrome in Obese Subjects With Obstructive Sleep Apnea

Bingöl¹,

Pıhtılı

Çağatay

et al. 2015

Respir Care

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BACKGROUND: Arterial blood gas (ABG) analysis is not a routine test in sleep laboratories due to its invasive nature. Therefore, the diagnosis of obesity hypoventilation syndrome (OHS) is underestimated. We aimed to evaluate the differences in subjects with OHS and pure obstructive sleep apnea (OSA) and to determine clinical predictors of OHS in obese subjects. METHODS: Demographics, body mass index (BMI), Epworth Sleepiness Scale score, polysomnographic data, ABG, spirometric measurements, and serum bicarbonate levels were recorded. RESULTS: Of 152 obese subjects with OSA (79 females/73 males, mean age of 50.3 ؎ 10.6 y, BMI of 40.1 ؎ 5.6 kg/m 2 , 51.9% with severe OSA), 42.1% (n ‫؍‬ 64) had OHS. Subjects with OHS had higher BMI (P ‫؍‬ .02), neck circumference (P < .001), waist circumference (P < .001), waist/hip ratio (P ‫؍‬ .02), Epworth Sleepiness Scale scores (P ‫؍‬ .036), ABG and serum bicarbonate levels (P < .001), apnea-hypopnea index (P ‫؍‬ .01), oxygen desaturation index (P < .001), and total sleep time with S pO 2 < 90% (P < .001) compared with subjects with pure OSA (n ‫؍‬ 88). They also had lower daytime P aO 2 (P < .001), sleep efficiency (P ‫؍‬ .032), mean S pO 2 (P < .001), and nadir S pO 2 (P < .001) . Serum bicarbonate levels and nadir S pO 2 were the only independent predictive factors for OHS. A serum bicarbonate level of > 27 mmol/L as the cutoff gives a satisfactory discrimination for the diagnosis of OHS (sensitivity of 76.6%, specificity of 74.6%, positive predictive value of 54.5%, negative predictive value of 88.9%). A nadir S pO 2 of < 80% as the cutoff gives a satisfactory discrimination for the diagnosis of OHS (sensitivity of 82.8%, specificity of 54.5%, positive predictive value of 56.9%, negative predictive value of 81.4%). When we used a serum bicarbonate level of > 27 mmol/L and/or a nadir S pO 2 of < 80% as a screening measure, only 3 of 64 subjects with OHS were missed. CONCLUSIONS: Serum bicarbonate level and nadir saturation were independent predictive factors for the diagnosis of OHS.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Predictors of Obesity Hypoventilation Syndrome in Obese Subjects With Obstructive Sleep Apnea

Bingöl¹,

Pıhtılı

Çağatay

et al. 2015

Respir Care

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“…7,8 Obese patients are mostly referred to the sleep laboratory due to suspicion of OSA. Another problem is that OHS has been incorrectly considered to be a severe form of OSA.…”

Section: Bicarbonate Level For Early Diagnosis Of Obesity Hypoventilamentioning

confidence: 99%

Bicarbonate Level for Early Diagnosis of Obesity Hypoventilation Syndrome: Still Defining Boundaries—Reply

Bingöl

Kıyan

2015

Respir Care

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Hypoventilation Syndromes

Piper

Yee

2014

Comprehensive Physiology

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In patients with impaired inspiratory muscle function or altered respiratory system mechanics, an imbalance between load and capacity can arise. The ventilatory control system normally compensates for this by increasing drive to maintain adequate alveolar ventilation levels, thereby keeping arterial CO2 within its normal range. To reduce work of breathing, a pattern of reduced tidal volume and increased respiratory rate occurs. This pattern itself may eventually reduce effective ventilation by increasing dead space ventilation. However, the impact of sleep on breathing and its role in the development of diurnal respiratory failure is often overlooked in this process. Sleep not only reduces respiratory drive, but also diminishes chemoresponsiveness to hypoxia and hypercapnia creating an environment where significant alterations in oxygenation and CO2 can occur. Acute increases in CO2 load especially during rapid eye movement sleep can initiate the process of bicarbonate retention which further depresses ventilatory responsiveness to CO2. Treatment of hypoventilation needs to be directed toward factors underlying its development. Nocturnal noninvasive positive pressure therapy is the most widely used and reliable strategy currently available to manage hypoventilation syndromes. Although this may not consistently alter respiratory muscle strength or the mechanical properties of the respiratory system, it does appear to reset chemosensitivity by reducing bicarbonate, resulting in a more appropriate ventilatory response to CO2 during wakefulness. Not only is diurnal hypoventilation reduced with noninvasive ventilation, but quality of life, functional capacity and survival are also improved. However, close attention to how therapy is set up and used are key factors in achieving clinical benefits.

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Diagnostic Predictors of Obesity-Hypoventilation Syndrome in Patients Suspected of Having Sleep Disordered Breathing

Cited by 91 publications

References 26 publications

Clinical Predictors of Obesity Hypoventilation Syndrome in Obese Subjects With Obstructive Sleep Apnea

Clinical Predictors of Obesity Hypoventilation Syndrome in Obese Subjects With Obstructive Sleep Apnea

Bicarbonate Level for Early Diagnosis of Obesity Hypoventilation Syndrome: Still Defining Boundaries—Reply

Hypoventilation Syndromes

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