Diagnosis Of Obesity Hypoventilation Syndrome Research Articles

Predictors of early diagnosis of obesity hypoventilation syndrome among patients with sleep disordered breathing

BackgroundDetermine predictors of early diagnosis and prevalence of OHS among patient with sleep disordered breathing (SDB) at Mansoura SDB unit. Aim of workDetermine predictors of early diagnosis and prevalence of OHS among patient with sleep disordered breathing (SDB) diagnosed at Mansoura SDB unit. Patients and methodsThe study population consists of 212 patients referred to Mansoura University SDB unit for investigation of possible SDB. All patients were subjected to the following: Clinical evaluation, Pulse oximeter, Erect awake ABG, Spirometry and Polysomnography. ResultsIt was found that; The overall prevalence of OHS in studied cases was 13.2% (28 out of 212) and the prevalence of SDB in all studied cases was 83.02% (176 out of 212), 15.91% (28 out of 176) with OHS. The following predictors can be used for early diagnosis of OHS; a cutoff point of 93% of erect awake SpO2 with sensitivity of 97.1%, Specificity of 100%, p<0.001, a cutoff point of 28mmol/dL of serum HCO3 with sensitivity of 85.7%, specificity of 95.6%, p<0.001, and a cutoff point of 46.40 of AHI with sensitivity of 78.6%, specificity of 77.9 p=0.001. ConclusionThe prevalence of OHS among patients with SDB diagnosed at Mansoura SDB unit was 15.91% and 16.67% among obese patients with SDB. The following cutoff points can be used as promising predictors for early diagnosis of OHS: Erect awake SpO2<93%, Serum HCO3>28mmol/L and AHI>46.4.

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

In reply: We thank Drs Lemyze and Esquinas for their interest in our work.[1][1] The International Classification of Sleep Disorders, 3rd edition,[2][2] defines obesity hypoventilation syndrome (OHS) as the combined presence of obesity (body mass index >30 kg/m2) with awake arterial hypercapnia (

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

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. Demographics, body mass index (BMI), Epworth Sleepiness Scale score, polysomnographic data, ABG, spirometric measurements, and serum bicarbonate levels were recorded. 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(pO2) < 90% (P < .001) compared with subjects with pure OSA (n = 88). They also had lower daytime PaO2 (P < .001), sleep efficiency (P = .032), mean S(pO2) (P < .001), and nadir S(pO2) (P < .001). Serum bicarbonate levels and nadir S(pO2) 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(pO2) 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(pO2) of < 80% as a screening measure, only 3 of 64 subjects with OHS were missed. Serum bicarbonate level and nadir saturation were independent predictive factors for the diagnosis of OHS.

The lady who presented as a “sleep emergency”

The case of a 74 years old hypertensive and obese lady is reported. She had repeated hospitalizations following episodes of left ventricular failure A polysomnographic study confirmed the diagnosis of obesity hypoventilation syndrome. This condition is briefly reviewed.

The Problems of Sleep-Related Respiratory Disorders

The incidence of respiratory abnormalities during sleep continues to increase as more physicians are becoming aware of these clinical entities. However, the medical literature on this subject is somewhat confusing in that different problems have been tied together under the diagnosis of obesity-hypoventilation syndrome or Pickwickian syndrome. These terms were useful in calling our attention to previously seldom-recognized clinical problems. Precise definitions of these sleep-related problems are now needed to understand better the physiological processes involved in the evolution of primary (central) alveolar hypoventilation, central apnea, upper airway occlusion, and mixed apnea. This will eventually lead to the proper noninvasive treatment regimens for these entities, which can present with the exact awake-symptom complex. Elsewhere in this issue, Strohl et al (p 1230) describe the use of medroxyprogesterone acetate as a therapeutic agent in patients with mainly sleep-associated upper airway occlusions. Only four of nine responded, but in these four a