OBESITY HYPOVENTILATION SYNDROME, OSA, AND COVID-19 INFECTION IN A YOUNG MALE

Abstract

TYPE: Case Report TOPIC: Sleep Disorders INTRODUCTION: Obesity is one of the comorbidities associated with an increased risk for mortality in COVID-19. CASE PRESENTATION: a case of a 23-year-old male with no previous diagnosed disease, morbidly obese (Body mass index (BMI) of 86 kg/m2), admitted in the intensive care unit (ICU) for shortness of breath. Chest x-ray showed bilateral infiltrates suggestive of pneumonia and COVID-19 Reverse transcription – polymerase chain reaction (RT-PCR) oronasopharyngeal swab showed positive results. Arterial blood gas showed elevated PaCO2 and HCO3 levels. COVID-19 treatment regimen and Bilevel positive airway pressure (BiPAP) was provided. Once condition improved and serial COVID-19 RT-PCR swab was negative, polysomnogram was done showed an elevated apnea-hypopnea index (AHI) of 34.7 events/hour and maximum end tidal CO2 of 56 mmHg during sleep. He was prescribed use of bi-level PAP device every night during sleep, weight reduction, lifestyle management and possible bariatric surgery. DISCUSSION: Risk for severe COVID-19 infection is observed in obesity (BMI more than 40 kg/m2).1-3 Obesity Hypoventilation Syndrome (OHS) is the combination of obesity and daytime hypercapnia occurring in the absence of alternative explanation of hypoventilation accompanied by a breathing disorder during sleep.2 It is diagnosed when there is acute-on-chronic hypercapnic respiratory failure in a morbidly obese patient.2 The interplay of impaired immune response, systemic chronic inflammation, and compromised lung ventilation brought by abdominal obesity poses a challenge to their management. Treatment of OHS are reversal of sleep breathing disorder, weight reduction and possibly pharmacotherapy.1-3 CONCLUSIONS: Timely multi-disciplinary management of OHS, OSA, and COVID are necessary in order to achieve good outcomes. DISCLOSURE: Nothing to declare. KEYWORD: obesity hypoventilation syndrome