Influence of noninvasive positive pressure ventilation on inspiratory muscle activity in obese subjects

Pankow, Wulf; Hijjeh, N; Schüttler, Frank; Penzel, Thomas; Hf, Becker; Peter, J H; Wichert, P. von

doi:10.1183/09031936.97.10122847

Cited by 93 publications

(58 citation statements)

References 28 publications

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“…Studies have suggested that both CPAP and bilevel noninvasive ventilation (NIV) are useful modes of treatment for OHS. 23,24 NIV maintains upper airway patency, reduces respiratory muscle loading and improves gas exchange leading to an improvement in daytime symptoms and QoL.…”

Section: Respiratory Management Of Obesity-related Respiratory Failurementioning

confidence: 99%

Respiratory complications of obesity

Mandal

Hart

2012

Clinical Medicine

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The burden of obesity in the UK has increased significantly over the past 15 years. In 2008, the Health Survey for England demonstrated that 25% of the population were obese. 1 Furthermore, only 36.8% of the population were considered to have a normal body mass index (BMI) and 61.4% were classified as either overweight or obese, with a yearon-year increase in the percentage of overweight and obese adults. The cost of obesity to the NHS, currently estimated to be £4.2 billion, is predicted to double by 2050. 2 Obesity is associated with comorbidities such as systemic hypertension and diabetes mellitus, but over recent years the clinical effect of obesity upon the respiratory system has been highlighted. In addition to exertional breathlessness and limited exercise capacity, the adverse changes in pulmonary mechanics due to obesity can impact on patients with concomitant chronic respiratory illnesses, including asthma and chronic obstructive pulmonary disease. More importantly, it can result in sleep-disordered breathing, including obstructive sleep apnoea (OSA) and obesity-related respiratory failure (ORRF).This article reviews the respiratory complications of obesity, with particular attention to the changes in pulmonary mechanics and sleep-disordered breathing as these have significant clinical consequences. Changes to pulmonary mechanics in obesityObesity has significant effects upon the pulmonary mechanics. BMI has a direct relationship with the degree of airways resistance and work of breathing, and is inversely correlated with thoracic lung volumes. Specifically, the reductions in functional residual capacity (FRC) and expiratory reserve volume are associated with early airway closure and resultant gas trapping, causing ventilation-perfusion mismatching and subsequent hypoxia. Obesity also imposes a restrictive defect due to the mass loading on the chest wall, with resultant reduction in chest wall compliance. Studies in anaesthetised obese patients have demonstrated a direct relationship between the degree of obesity and static lung compliance because of the reduction in FRC. Finally, breathing at low lung volumes causes expiratory flow limitation due to early airway closure with the generation of intrinsic positive end-expiratory pressure, again resulting in an increased work of breathing.All these changes are further exaggerated during sleep due to the negative impact on the pulmonary mechanics of obese patients adopting the supine position. [3][4][5] Sleep-disordered breathingSleep-disordered breathing is common in obese patients, with studies estimating the prevalence of OSA as 2-24% of the population. 6,7 Obstructive sleep apnoea syndrome OSA is defined as recurrent partial or complete upper airway obstruction during sleep. The clinical features have been discussed in a recent review article in this journal. 8 Patients presenting with symptoms of OSA (eg snoring and witnessed apnoeas) should be screened for daytime hypersomnolence using the Epworth Sleepiness Scale. 9 The combination of daytime sympt...

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Section: Respiratory Management Of Obesity-related Respiratory Failurementioning

confidence: 99%

Respiratory complications of obesity

Mandal

Hart

2012

Clinical Medicine

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“…When analyzing the effects of NIV on the activity of inspiratory muscles in obese patients, Pankow et al 34 found a 46% reduction in diaphragm's activity with the use of the BiPAP. The authors concluded that the assisted NIV can cause partial inactivation of the respiratory muscles in patients with severe obesity 34 .…”

Section: Discussionmentioning

confidence: 99%

Ventilação não invasiva no pós-operatório imediato de derivação gastrojejunal com bypass em Y de Roux

Pessoa¹,

Araújo²,

Pinheiro³

et al. 2010

Rev. bras. fisioter.

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“…The fact that the bi-level pressure support ventilation may unload the respiratory muscles in patients with class III obesity was demonstrated by PANKOW et al [71], who studied 18 patients with simple obesity, OHS or OSAHS, measured trans-diaphragmatic pressure and pressure-time index, and, with low inspiratory positive airway pressure values up to 1.2 kPa, found a 46% reduction in diaphragmatic activity.…”

Section: Ventilatory Support In Patients With Ohs: Cpap Bi-level Prementioning

confidence: 99%

Ventilatory support and pharmacological treatment of patients with central apnoea or hypoventilation during sleep: FIGURE 1.

Pevernagie¹,

Janssens²,

Backer³

et al. 2007

Eur Respir Rev

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The concept of central sleep apnoea or hypoventilation encompasses hypercapnic central hypoventilation, such as obesity hypoventilation syndrome and eucapnic or hypocapnic central sleep apnoea.Among subjects with eucapnic or hypocapnic central sleep apnoea, several therapeutic options are available for those with Cheyne-Stokes respiration (CSR). CSR is frequent in patients with New York Heart Association stage III and IV chronic heart failure, and in various neurological disorders. In these patients, treatment modalities include optimising cardiac condition and drugs, such as theophylline, acetazolamide and/or oxygen. Ventilatory support, such as nasal continuous positive airway pressure (CPAP), bi-level pressure support, or adaptive servoventilation (ASV), has been shown to improve CSR in patients with cardiac failure; however, convincing evidence that nasal CPAP improves life expectancy in these patients is lacking. Nevertheless, the treatment of associated obstructive sleep-disordered breathing is indicated per se, as it may improve cardiac function.There is currently no proof that bi-level ventilation is superior to nasal CPAP. The few available studies that have focused on ASV have shown satisfactory control of CSR in cardiac failure patients. While ASV is not a first-line treatment choice, it appears to be superior to oxygen, CPAP and bi-level pressure ventilation in controlling the apnoea/hypopnea index and probably sleep fragmentation. As yet there are no data on mortality and, as such, firm conclusions cannot be drawn as to the role of ASV in the management of cardiac failure patients suffering from CSR.Obesity-related hypoventilation has increased dramatically over recent decades due to the epidemic increase in obesity in the developed countries. Obesity hypoventilation syndrome predisposes to the development of pulmonary hypertension and cor pulmonale. Noninvasive home ventilation is increasingly applied in obese patients with hypercapnic respiratory failure, however, initial mechanical ventilatory support can be reduced to nasal continuous positive airway pressure in only a subset of these individuals.

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Influence of noninvasive positive pressure ventilation on inspiratory muscle activity in obese subjects

Cited by 93 publications

References 28 publications

Respiratory complications of obesity

Respiratory complications of obesity

Ventilação não invasiva no pós-operatório imediato de derivação gastrojejunal com bypass em Y de Roux

Ventilatory support and pharmacological treatment of patients with central apnoea or hypoventilation during sleep: FIGURE 1.

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