TY - JOUR
T1 - Obesity hypoventilation syndrome
T2 - Hypoxemia during continuous positive airway pressure
AU - Banerjee, Dev
AU - Yee, Brendon J.
AU - Piper, Amanda J.
AU - Zwillich, Clifford W.
AU - Grunstein, Ronald R.
PY - 2007/6
Y1 - 2007/6
N2 - Background: Polysomnography findings between matched groups with obstructive sleep apnea (OSA) and OSA plus obesity-hypoventilation syndrome (OHS) before and after continuous positive airway pressure (CPAP), particularly in the extremely severe obese (body mass index [BMI] ≥ 50 kg/m2), are unclear. Design: Prospective study of subjects (BMI ≥ 50 kg/m 2) undergoing diagnostic polysomnography. Subjects with an apnea-hypopnea index (AHI) ≥ 15/h underwent a second polysomnography with CPAP. The effect of 1 night of CPAP on sleep architecture, AHI, arousal indexes, and nocturnal oxygenation was assessed. OHS was defined as those subjects with obesity, Paco2 > 45 mm Hg, and Pao2 < 70 mm Hg in the absence of lung disease. Results: Twenty-three subjects with moderate-to-severe OSA and 23 subjects with moderate-to-severe OSA plus OHS underwent a 1-night trial of CPAP. Both groups were matched for spirometry, BMI, and AHI, but oxygen desaturation was worse in the OSA-plus-OHS group. CPAP significantly improved rapid eye movement (REM) duration (p < 0.005), AHI (p < 0.005), arousal indexes (p < 0.005), and percentage of total sleep time (TST) with oxygen saturation (Spo2) < 90% (p < 0.005) in both groups. In subjects with OSA plus OHS, 43% continued to spend > 20% of TST with Spo2 < 90%, compared to 9% of the OSA group, despite the adequate relief of upper airway obstruction. Conclusions: Extremely severe obese subjects (BMI ≥ 50 kg/m2) with moderate-to-severe OSA plus OHS exhibit severe oxygen desaturation but similar severities of AHI, arousal indexes, and sleep architecture abnormalities when compared to matched subjects without OHS. CPAP significantly improves AHI, REM duration, arousal indexes, and nocturnal oxygen desaturation. Some subjects with OHS continued to have nocturnal desaturation despite the control of upper airway obstruction; other mechanisms may contribute. Further long-term studies assessing the comparative role of CPAP and bilevel ventilatory support in such subjects with OHS is warranted.
AB - Background: Polysomnography findings between matched groups with obstructive sleep apnea (OSA) and OSA plus obesity-hypoventilation syndrome (OHS) before and after continuous positive airway pressure (CPAP), particularly in the extremely severe obese (body mass index [BMI] ≥ 50 kg/m2), are unclear. Design: Prospective study of subjects (BMI ≥ 50 kg/m 2) undergoing diagnostic polysomnography. Subjects with an apnea-hypopnea index (AHI) ≥ 15/h underwent a second polysomnography with CPAP. The effect of 1 night of CPAP on sleep architecture, AHI, arousal indexes, and nocturnal oxygenation was assessed. OHS was defined as those subjects with obesity, Paco2 > 45 mm Hg, and Pao2 < 70 mm Hg in the absence of lung disease. Results: Twenty-three subjects with moderate-to-severe OSA and 23 subjects with moderate-to-severe OSA plus OHS underwent a 1-night trial of CPAP. Both groups were matched for spirometry, BMI, and AHI, but oxygen desaturation was worse in the OSA-plus-OHS group. CPAP significantly improved rapid eye movement (REM) duration (p < 0.005), AHI (p < 0.005), arousal indexes (p < 0.005), and percentage of total sleep time (TST) with oxygen saturation (Spo2) < 90% (p < 0.005) in both groups. In subjects with OSA plus OHS, 43% continued to spend > 20% of TST with Spo2 < 90%, compared to 9% of the OSA group, despite the adequate relief of upper airway obstruction. Conclusions: Extremely severe obese subjects (BMI ≥ 50 kg/m2) with moderate-to-severe OSA plus OHS exhibit severe oxygen desaturation but similar severities of AHI, arousal indexes, and sleep architecture abnormalities when compared to matched subjects without OHS. CPAP significantly improves AHI, REM duration, arousal indexes, and nocturnal oxygen desaturation. Some subjects with OHS continued to have nocturnal desaturation despite the control of upper airway obstruction; other mechanisms may contribute. Further long-term studies assessing the comparative role of CPAP and bilevel ventilatory support in such subjects with OHS is warranted.
KW - Continuous positive airway pressure
KW - Obesity-hypoventilation syndrome
KW - Obstructive sleep apnea
KW - Severe obesity
UR - http://www.scopus.com/inward/record.url?scp=34250890778&partnerID=8YFLogxK
U2 - 10.1378/chest.06-2447
DO - 10.1378/chest.06-2447
M3 - Article
C2 - 17565018
AN - SCOPUS:34250890778
SN - 0012-3692
VL - 131
SP - 1678
EP - 1684
JO - Chest
JF - Chest
IS - 6
ER -