Hypoventilation in Obesity*

Kaufman, Bradley J.; Ferguson, Marion H.; Cherniack, Reuben M.

doi:10.1172/jci103827

Cited by 103 publications

(17 citation statements)

References 20 publications

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“…1 However, the clinician is frequently asked to determine whether these findings are simply caused by obesity alone or whether they represent a respiratory illness.…”

mentioning

confidence: 99%

Obesity and pulmonary function testing

Beuther

Sutherland

2005

Journal of Allergy and Clinical Immunology

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“…1 However, the clinician is frequently asked to determine whether these findings are simply caused by obesity alone or whether they represent a respiratory illness.…”

mentioning

confidence: 99%

Obesity and pulmonary function testing

Beuther

Sutherland

2005

Journal of Allergy and Clinical Immunology

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“…La compliance du système respiratoire est réduite chez l'obèse (24,25) et principalement la compliance de la paroi thoracique (24) : chez les obèses hypercapniques (SOH) la compliance totale du système respiratoire (compliance pulmonaire + compliance de la paroi thoracique) est réduite de 60 % au lieu de 20 % chez les obèses normocapniques (24). La chute de la compliance du système respiratoire et l'élévation de la résistance thoracique expliquent l'augmentation du travail respiratoire chez les obèses (26,27). Le travail mécanique lié à la respiration est augmenté considérablement chez les obèses hypercapniques et modérément chez les obèses « simples ».…”

Section: Conséquences Mécaniques De L'obésité Coût Excessif Du Travaunclassified

“…Le travail mécanique lié à la respiration est augmenté considérablement chez les obèses hypercapniques et modérément chez les obèses « simples ». Il existe une bonne corrélation entre le travail respiratoire et la PaCO2 (28) entre l'élévation du coût en oxygène de la ventilation et la PaCO2 (27).…”

Section: Conséquences Mécaniques De L'obésité Coût Excessif Du Travaunclassified

Le syndrome d’hypoventilation alvéolaire dans l’obésité : le « syndrome obésité-hypoventilation »

Weitzenblum

Kessler

Chaouat

et al. 2015

Obes

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Le syndrome obésité-hypoventilation (SOH) ou hypoventilation alvéolaire des obèses est défini par la pré-sence d'une PaCO2 diurne ≥ 45 mmHg chez un patient obèse (IMC ≥ 30 kg/m 2 ) ne présentant pas d'affection respiratoire susceptible d'expliquer les anomalies gazométriques. La grande majorité des obèses, y inclus les obèses sévères (> 40 kg/m 2 ), n'est pas hypercapnique. Le mécanisme principal du SOH est le coût excessif du travail respiratoire et la faiblesse des muscles respiratoires. L'hyposensibilité au stimulus hypercapnique et la répétition des apnées obstructives nocturnes chez certains malades jouent un rôle moins important. Le SOH a longtemps été considéré comme une affection rare mais sa prévalence a nettement augmenté au cours de ces dernières années du fait sans doute de l'« épidémie » actuelle d'obésité. Le SOH est généralement observé chez les sujets de plus de 50 ans. Il est souvent révélé par un épisode d'insuffisance respiratoire sévère. Les comorbidités associées sont fré-quentes (diabète, hypertension artérielle, cardiopathies, etc.).Le SOH ne doit pas être confondu avec le syndrome d'apnées obstructives du sommeil (SAOS) même si les deux affections sont souvent associées. Les apnées obstructives peuvent être absentes chez certains patients SOH (dans 15 % des cas environ). Ces patients ont au cours du sommeil des épisodes d'hypoventilation non apnéique.Le traitement logique du SOH est la perte de poids mais elle est très difficile à obtenir. La ventilation nocturne (pression positive continue comme dans le SAOS, et surtout ventilation non invasive à 2 niveaux de pression) est le traitement de référence et donne d'excellents résultats sur les symptômes et les gaz du sang artériel à court et long terme.Mots clés Obésité-hypoventilation · Insuffisance respiratoire hypercapnique · Syndrome d'apnées du sommeil · Ventilation non invasive Abstract The obesity-hypoventilation syndrome (OHS) is defined by the presence of diurnal hypercapnia (PaCO2 ≥ 45 mmHg) in an obese patient (BMI ≥ 30 kg/m 2 ) who has no other respiratory disease explaining the hypercapnia.The large majority of obese subjects, including cases of severe obesity (> 40 kg/m 2 ), are not hypercapnic. The principal mechanism of OHS is the high cost of respiration and the weakness of the respiratory muscles. The diminished chemosensitivity to CO2 and the long-term effects of repeated episodes of obstructive sleep apnoeas may play a role in some patients.OHS has long been considered as a rare disease but its prevalence has markedly increased in recent years, probably due to the present "epidemy" of obesity. OHS is generally observed in subjects over 50 years. The diagnostic is often made after an episode of severe respiratory failure. Comorbidities favored by obesity are very frequent (diabetes, hypertension, heart diseases, etc.).OHS must be distinguished from obstructive sleep apnoea syndrome (OSAS) even if the two conditions are often associated. OSAS may be absent in some OHS patients (about 15%); these patients exhibit episodes of n...

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“…Kaufman et al (84) were among the first to systematically examine gas exchange in upright obese subjects. They measured arterial blood gases in 18 obese subjects with a mean BMI of 41 (range 30.5 – 50.8).…”

Section: Obesity and Gas Exchangementioning

confidence: 99%

“…In contrast, average PaCO 2 was 41 mm Hg, within the normal range. Analysis of data from 6 studies of obese subjects studied in the upright posture and for which individual values of height, weight, and PaO 2 were reported (57, 70, 84, 101, 141, 144), indicates that even mild obesity can be associated with hypoxemia (Figure 10). Obese subjects also undergo more desaturation at altitude than lean subjects (133).…”

Section: Obesity and Gas Exchangementioning

confidence: 99%

Environmental Perturbations: Obesity

Shore

2010

Comprehensive Physiology

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Obesity currently affects about one third of the U.S. population, while another one third is overweight. The importance of obesity for certain conditions such as heart disease and type 2 diabetes is well appreciated. The effects of obesity on the respiratory system have received less attention and are the subject of this chapter. Obesity alters the static mechanic properties of the respiratory system leading to a reduction in the functional residual capacity (FRC) and the expiratory reserve volume (ERV). There is substantial variability in the effects of obesity on FRC and ERV, at least some of which is related to the location, rather than the total mass of adipose tissue. Obesity also results in airflow obstruction, which is only partially attributable to breathing at low lung volume, and can also promote airway hyperresponsiveness and asthma. Hypoxemia is common is obesity, and correlates well with FRC, as well as with measures of abdominal obesity. However, obese subjects are usually eucapnic, indicating that hypoventilation is not a common cause of their hypoxemia. Instead, hypoxemia results from ventilation perfusion mismatch caused by closure of dependent airways at FRC. Many obese subjects complain of dyspnea either at rest or during exertion, and the dyspnea score also correlates with reductions in FRC and ERV. Weight reduction should be encouraged in any symptomatic obese individual, since virtually all of the respiratory complications of obesity improve with even moderate weight loss.

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Hypoventilation in Obesity*

Cited by 103 publications

References 20 publications

Obesity and pulmonary function testing

Obesity and pulmonary function testing

Le syndrome d’hypoventilation alvéolaire dans l’obésité : le « syndrome obésité-hypoventilation »

Environmental Perturbations: Obesity

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