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Review
. 2018 Nov-Dec;44(6):510-518.
doi: 10.1590/S1806-37562017000000332.

Obesity hypoventilation syndrome: a current review

[Article in English, Portuguese]
Rodolfo Augusto Bacelar de Athayde  1   2 , José Ricardo Bandeira de Oliveira Filho  1 , Geraldo Lorenzi Filho  2 , Pedro Rodrigues Genta  2
Affiliations
Review

Obesity hypoventilation syndrome: a current review

[Article in English, Portuguese]
Rodolfo Augusto Bacelar de Athayde et al. J Bras Pneumol. 2018 Nov-Dec.

Abstract
in English, Portuguese

Obesity hypoventilation syndrome (OHS) is defined as the presence of obesity (body mass index ≥ 30 kg/m²) and daytime arterial hypercapnia (PaCO2 ≥ 45 mmHg) in the absence of other causes of hypoventilation. OHS is often overlooked and confused with other conditions associated with hypoventilation, particularly COPD. The recognition of OHS is important because of its high prevalence and the fact that, if left untreated, it is associated with high morbidity and mortality. In the present review, we address recent advances in the pathophysiology and management of OHS, the usefulness of determination of venous bicarbonate in screening for OHS, and diagnostic criteria for OHS that eliminate the need for polysomnography. In addition, we review advances in the treatment of OHS, including behavioral measures, and recent studies comparing the efficacy of continuous positive airway pressure with that of noninvasive ventilation.

A síndrome de obesidade-hipoventilação (SOH) é definida pela presença de obesidade (índice de massa corpórea ≥ 30 kg/m2) e hipercapnia arterial diurna (PaCO2 ≥ 45 mmHg), na ausência de outras causas. A SOH é frequentemente negligenciada e confundida com outras patologias associadas à hipoventilação, em particular à DPOC. A importância do reconhecimento da SOH se dá por sua elevada prevalência, assim como alta morbidade e mortalidade se não tratada. Na presente revisão, abordamos os recentes avanços na fisiopatologia e no manejo da SOH. Revisamos a utilidade da medição do bicarbonato venoso como rastreamento e os critérios diagnósticos que descartam a necessidade de polissonografia. Destacamos ainda os avanços no tratamento da SOH, incluindo medidas comportamentais, e estudos recentes que comparam a eficácia do uso de pressão positiva contínua nas vias aéreas e de ventilação não invasiva.

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Figures

Figure 1
Figure 1. Female patient with a body mass index of 45 kg/m2, PaCO2 = 55.6 mmHg, obstructive sleep apnea, and obesity hypoventilation syndrome presenting with persistent hypoxemia and frequent desaturations, which were more pronounced at three time points (at between 2 and 3 h of sleep, at between 4 and 5 h of sleep, and at 7 h of sleep), suggestive of occurring during REM sleep.
Figure 2
Figure 2. Pathophysiology of obesity hypoventilation syndrome. OSA: obstructive sleep apnea. Adapted from Mokhlesi.
Figure 3
Figure 3. Influence of obstructive sleep events on hypercapnia. Adapted from Berger et al.
Figure 4
Figure 4. Suggested algorithm for the screening and perioperative management of patients with suspected or confirmed obesity hypoventilation syndrome (OHS). PAP: positive airway pressure; and RV: right ventricle. Adapted from Chau et al.
See this image and copyright information in PMC

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