1
|
Shi Y, Li W, Chen C, Yuan X, Yang Y, Wang S, Liu Z, Geng F, Wang J, Luo X, Wen X, Xia L, Liu H. Excessive Daytime Sleepiness and Insomnia Symptoms in Adolescents With Major Depressive Disorder: Prevalence, Clinical Correlates, and the Relationship With Psychiatric Medications Use. Psychiatry Investig 2023; 20:1018-1026. [PMID: 37997329 PMCID: PMC10678154 DOI: 10.30773/pi.2023.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/21/2023] [Accepted: 07/28/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Excessive daytime sleepiness (EDS) and insomnia symptoms are common in patients with major depressive disorder (MDD), which might lead to a poor prognosis and an increased risk of depression relapse. The current study aimed to investigate the prevalence, and sociodemographic and clinical correlates of EDS and insomnia symptoms among adolescents with MDD. METHODS The sample of this cross-sectional study included 297 adolescents (mean age=15.26 years; range=12-18 years; 218 females) with MDD recruited from three general and four psychiatric hospitals in five cities (Hefei, Bengbu, Fuyang, Suzhou, and Ma'anshan) in Anhui Province, China between January and August, 2021. EDS and insomnia symptoms, and clinical severity of depressive symptoms were assessed using Epworth sleepiness scale, Insomnia Severity Index, and Clinical Global Impression-Severity. RESULTS The prevalence of EDS and insomnia symptoms in adolescents with MDD was 39.7% and 38.0%, respectively. Binary logistic regression analyses showed that EDS symptoms were significantly associated with higher body mass index (odds ratio [OR]=1.097, 95% confidence interval [CI]=1.027-1.172), more severe depressive symptoms (OR=1.313, 95% CI=1.028-1.679), and selective serotonin reuptake inhibitors use (OR=2.078, 95% CI=1.199-3.601). And insomnia symptoms were positively associated with female sex (OR=1.955, 95% CI=1.052-3.633), suicide attempts (OR=1.765, 95% CI=1.037-3.005), more severe depressive symptoms (OR=2.031, 95% CI=1.523-2.709), and negatively associated with antipsychotics use (OR=0.433, 95% CI=0.196-0.952). CONCLUSION EDS and insomnia symptoms are common among adolescents with MDD. Considering their negative effects on the clinical prognosis, regular screening and clinical managements should be developed for this patient population.
Collapse
Affiliation(s)
- Yudong Shi
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui, China
| | - Wei Li
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Changhao Chen
- Department of Psychiatry, Suzhou Second People’s Hospital, Suzhou, Anhui, China
| | - Xiaoping Yuan
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yingying Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui, China
| | - Song Wang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui, China
| | - Zhiwei Liu
- Department of Psychiatry, Fuyang Third People’s Hospital, Fuyang, Anhui, China
| | - Feng Geng
- Department of Psychiatry, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Jiawei Wang
- Department of Psychiatry, Bozhou People’s Hospital, Bozhou, Anhui, China
| | - Xiangfen Luo
- Department of Psychiatry, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xiangwang Wen
- Department of Psychiatry, Ma’anshan Fourth People’s Hospital, Ma’anshan, Anhui, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
2
|
Huang YC, Huang SH, Chung RJ, Wang BL, Chung CH, Chien WC, Sun CA, Yu PC, Lu CH. Obese Patients Experience More Severe CSA than Non-Obese Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031289. [PMID: 35162313 PMCID: PMC8835470 DOI: 10.3390/ijerph19031289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
Objective: To investigate whether central sleep apnea (CSA) is associated with an increased risk of obesity. Materials and methods: From 1 January 2000 to 31 December 2015, we screened 24,363 obese patients from the 2005 longitudinal health insurance database, which is part of the Taiwan National Health Insurance Research Database. From the same database, 97,452 non-obese patients were also screened out. Age, gender, and index dates were matched. Multiple logistic regression was used to analyze the previous exposure risk of obese and CSA patients. A p-value of <0.05 was considered significant. Results: Obese patients were more likely to be exposed to CSA than non-obese patients would (AOR = 2.234, 95% CI = 1.483–4.380, p < 0.001). In addition, the closeness of the exposure time to the index time is positively correlated with the severity of obesity and has a dose–response effect (CSA exposure < 1 year, AOR = 2.386; CSA exposure ≥ 1 year and <5 years, AOR = 1.725; CSA exposure time ≥ 5 years, AOR = 1.422). The CSA exposure time of obese patients was 1.693 times that of non-obese patients. Longer exposure time is associated with more severe obesity and has a dose-response effect (CSA exposure < 1 year, AOR = 1.420; CSA exposure ≥ 1 year and <5 years, AOR = 2.240; CSA ≥ 5 years, AOR = 2.863). Conclusions: In this case-control study, patients with CSA had a significantly increased risk of obesity. Long-term exposure to CSA and obesity is more likely and has a dose-response effect.
Collapse
Affiliation(s)
- Yao-Ching Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Shi-Hao Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
| | - Ren-Jei Chung
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
| | - Bing-Long Wang
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei 11490, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (C.-H.L.)
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
- Big Data Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - Pi-Ching Yu
- Graduate Institute of Medicine, National Defense Medical Center, Taipei 11490, Taiwan;
- Cardiovascular Intersive Care Unit, Department of Critical Care Medicine, Far-Eastern Memorial Hospital, New Taipei City 10602, Taiwan
| | - Chieh-Hua Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (C.-H.L.)
| |
Collapse
|
3
|
Zheng Y, Phillips CL, Sivam S, Wong K, Grunstein RR, Piper AJ, Yee BJ. Cardiovascular disease in obesity hypoventilation syndrome - A review of potential mechanisms and effects of therapy. Sleep Med Rev 2021; 60:101530. [PMID: 34425490 DOI: 10.1016/j.smrv.2021.101530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
Cardiovascular disease is common in patients with obesity hypoventilation syndrome (OHS) and accounts in part for their poor prognosis. This narrative review article examines the epidemiology of cardiovascular disease in obesity hypoventilation syndrome, explores possible contributing factors and the effects of therapy. All studies that included cardiovascular outcomes and biomarkers were included. Overall, there is a higher burden of cardiovascular disease and cardiovascular risk factors among patients with obesity hypoventilation syndrome. In addition to obesity and sleep-disordered breathing, there are several other pathophysiological mechanisms that contribute to higher cardiovascular morbidity and mortality in OHS. There is evidence emerging that positive airway pressure therapy and weight loss have beneficial effects on the cardiovascular system in obesity hypoventilation syndrome patients, but further research is needed to clarify whether this translates to clinically important outcomes.
Collapse
Affiliation(s)
- Yizhong Zheng
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia; Department of Respiratory and Sleep Medicine, St George Hospital, Australia.
| | - Craig L Phillips
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Sheila Sivam
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Keith Wong
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Ronald R Grunstein
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia
| | - Amanda J Piper
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Brendon J Yee
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| |
Collapse
|
4
|
|
5
|
Masa JF, Mokhlesi B, Benítez I, Gomez de Terreros FJ, Sánchez-Quiroga MÁ, Romero A, Caballero-Eraso C, Terán-Santos J, Alonso-Álvarez ML, Troncoso MF, González M, López-Martín S, Marin JM, Martí S, Díaz-Cambriles T, Chiner E, Egea C, Barca J, Vázquez-Polo FJ, Negrín MA, Martel-Escobar M, Barbe F, Corral J. Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. Lancet 2019; 393:1721-1732. [PMID: 30935737 DOI: 10.1016/s0140-6736(18)32978-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity hypoventilation syndrome is commonly treated with continuous positive airway pressure or non-invasive ventilation during sleep. Non-invasive ventilation is more complex and costly than continuous positive airway pressure but might be advantageous because it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. We therefore aimed to determine the long-term comparative effectiveness of both treatment modalities. METHODS We did a multicentre, open-label, randomised controlled trial at 16 clinical sites in Spain. We included patients aged 15-80 years with untreated obesity hypoventilation syndrome and an apnoea-hypopnoea index of 30 or more events per h. We randomly assigned patients, using simple randomisation through an electronic database, to receive treatment with either non-invasive ventilation or continuous positive airway pressure. Both investigators and patients were aware of the treatment allocation. The research team was not involved in deciding hospital treatment, duration of treatment in the hospital, and adjustment of medications, as well as adjudicating cardiovascular events or cause of mortality. Treating clinicians from the routine care team were not aware of the treatment allocation. The primary outcome was the number of hospitalisation days per year. The analysis was done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01405976. FINDINGS From May 4, 2009, to March 25, 2013, 100 patients were randomly assigned to the non-invasive ventilation group and 115 to the continuous positive airway pressure group, of which 97 patients in the non-invasive ventilation group and 107 in the continuous positive airway pressure group were included in the analysis. The median follow-up was 5·44 years (IQR 4·45-6·37) for all patients, 5·37 years (4·36-6·32) in the continuous positive airway pressure group, and 5·55 years (4·53-6·50) in the non-invasive ventilation group. The mean hospitalisation days per patient-year were 1·63 (SD 3·74) in the continuous positive airway pressure group and 1·44 (3·07) in the non-invasive ventilation group (adjusted rate ratio 0·78, 95% CI 0·34-1·77; p=0·561). Adverse events were similar between both groups. INTERPRETATION In stable patients with obesity hypoventilation syndrome and severe obstructive sleep apnoea, non-invasive ventilation and continuous positive airway pressure have similar long-term effectiveness. Given that continuous positive airway pressure has lower complexity and cost, continuous positive airway pressure might be the preferred first-line positive airway pressure treatment modality until more studies become available. FUNDING Instituto de Salud Carlos III, Spanish Respiratory Foundation, and Air Liquide Spain.
Collapse
Affiliation(s)
- Juan F Masa
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain.
| | - Babak Mokhlesi
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Iván Benítez
- Respiratory Department, Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Francisco Javier Gomez de Terreros
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Maria Ángeles Sánchez-Quiroga
- Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Auxiliadora Romero
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - Candela Caballero-Eraso
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - Joaquin Terán-Santos
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, University Hospital, Burgos, Spain
| | - Maria Luz Alonso-Álvarez
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, University Hospital, Burgos, Spain
| | - Maria F Troncoso
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - Mónica González
- Respiratory Department, Valdecilla Hospital, Santander, Spain
| | | | - José M Marin
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain
| | - Sergi Martí
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Valld'Hebron Hospital, Barcelona, Spain
| | - Trinidad Díaz-Cambriles
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Doce de Octubre Hospital, Madrid, Spain
| | - Eusebi Chiner
- Respiratory Department, San Juan Hospital, Alicante, Spain
| | - Carlos Egea
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Alava University Hospital IRB, Vitoria, Spain
| | - Javier Barca
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain; Nursing Department, Extremadura University, Cáceres, Spain
| | | | - Miguel A Negrín
- Department of Quantitative Methods, Las Palmas de Gran Canarias University Canary Islands, Spain
| | - María Martel-Escobar
- Department of Quantitative Methods, Las Palmas de Gran Canarias University Canary Islands, Spain
| | - Ferran Barbe
- Respiratory Department, Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Jaime Corral
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| |
Collapse
|
6
|
Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, Sánchez-Quiroga MÁ. Obesity hypoventilation syndrome. Eur Respir Rev 2019; 28:180097. [PMID: 30872398 PMCID: PMC9491327 DOI: 10.1183/16000617.0097-2018] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Obesity hypoventilation syndrome (OHS) is defined as a combination of obesity (body mass index ≥30 kg·m-2), daytime hypercapnia (arterial carbon dioxide tension ≥45 mmHg) and sleep disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. OHS prevalence has been estimated to be ∼0.4% of the adult population. OHS is typically diagnosed during an episode of acute-on-chronic hypercapnic respiratory failure or when symptoms lead to pulmonary or sleep consultation in stable conditions. The diagnosis is firmly established after arterial blood gases and a sleep study. The presence of daytime hypercapnia is explained by several co-existing mechanisms such as obesity-related changes in the respiratory system, alterations in respiratory drive and breathing abnormalities during sleep. The most frequent comorbidities are metabolic and cardiovascular, mainly heart failure, coronary disease and pulmonary hypertension. Both continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) improve clinical symptoms, quality of life, gas exchange, and sleep disordered breathing. CPAP is considered the first-line treatment modality for OHS phenotype with concomitant severe obstructive sleep apnoea, whereas NIV is preferred in the minority of OHS patients with hypoventilation during sleep with no or milder forms of obstructive sleep apnoea (approximately <30% of OHS patients). Acute-on-chronic hypercapnic respiratory failure is habitually treated with NIV. Appropriate management of comorbidities including medications and rehabilitation programmes are key issues for improving prognosis.
Collapse
Affiliation(s)
- Juan F Masa
- San Pedro de Alcántara Hospital, Cáceres, Spain
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE) , Cáceres, Spain
| | - Jean-Louis Pépin
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France
- CHU de Grenoble, Laboratoire EFCR, Pôle Thorax et Vaisseaux, Grenoble, France
| | - Jean-Christian Borel
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France
- AGIR à dom. Association, Meylan, France
| | | | - Patrick B Murphy
- Guy's & St Thomas' NHS Foundation Trust, London, UK
- Centre for Human & Applied Physiological Sciences King's College London, London, UK
| | - Maria Ángeles Sánchez-Quiroga
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE) , Cáceres, Spain
- Virgen del Puerto Hospital, Cáceres, Spain
| |
Collapse
|
7
|
Obesity cardiomyopathy: the role of obstructive sleep apnea and obesity hypoventilation syndrome. Ir J Med Sci 2019; 188:783-790. [DOI: 10.1007/s11845-018-01959-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023]
|
8
|
Bouloukaki I, Mermigkis C, Michelakis S, Moniaki V, Mauroudi E, Tzanakis N, Schiza SE. The Association Between Adherence to Positive Airway Pressure Therapy and Long-Term Outcomes in Patients With Obesity Hypoventilation Syndrome: A Prospective Observational Study. J Clin Sleep Med 2018; 14:1539-1550. [PMID: 30176976 DOI: 10.5664/jcsm.7332] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/20/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the role of different levels of adherence and long-term effects of positive airway pressure (PAP) therapy on gas exchange, sleepiness, quality of life, depressive symptoms, and all-cause mortality in patients with obesity hypoventilation syndrome (OHS). METHODS A total of 252 patients with newly diagnosed OHS were followed up for a minimum of 2 years after PAP initiation. PAP adherence (h/night) was monitored. Arterial blood gas samples were taken with patients being alert for more than 4 hours after morning awakening. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (Short Form 36 [SF-36]) and patient's depressive symptoms (Beck Depression Inventory [BDI]) were assessed before and at the end of the follow-up period, along with all-cause mortality. RESULTS At the end of the follow-up period (median duration [25th-75th percentile], 30 [24-52] months), PaO2 increased from baseline (72.7 ± 10.3 versus 63.2 ± 10.6, P < .001) and both PaCO2 and HCO3- decreased (43.0 [39.2-45.0] versus 50.0 [46.7-55.4] and 27.5 ± 3.2 versus 31.4 ± 4.2, respectively, P < .001). In addition, PAP therapy significantly improved ESS (7 [4-9] versus 14 [11-16], P < .001), BDI (8.8 ± 4.9 versus 15.5 ± 7.3, P < .001) and SF-36 (82 [78-87] versus 74 [67-79], P < .001) scores. Over the follow-up period 11 patients died. Patients who used PAP for > 6 h/night had significant improvements (P < .05) in blood gases and SF-36 scores than less adherent patients. CONCLUSIONS Increased hours of use and long-term therapy with PAP are effective in the treatment of patients with OHS. Clinicians should encourage adherence to PAP therapy in order to provide a significant improvement in clinical status and gas exchange in these patients. COMMENTARY A commenary on this article appears in this issue on page 1455. CLINICAL TRIAL REGISTRATION Title: PAP Therapy in Patients With Obesity Hypoventilation Syndrome, Registry: ClinicalTrials.gov, Identifier: NCT03449641, URL: https://clinicaltrials.gov/ct2/show/NCT03449641.
Collapse
Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Charalampos Mermigkis
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Stylianos Michelakis
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Eleni Mauroudi
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Tzanakis
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Sophia E Schiza
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| |
Collapse
|
9
|
Lecube A, Simó R, Pallayova M, Punjabi NM, López-Cano C, Turino C, Hernández C, Barbé F. Pulmonary Function and Sleep Breathing: Two New Targets for Type 2 Diabetes Care. Endocr Rev 2017; 38:550-573. [PMID: 28938479 DOI: 10.1210/er.2017-00173] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
Population-based studies showing the negative impact of type 2 diabetes (T2D) on lung function are overviewed. Among the well-recognized pathophysiological mechanisms, the metabolic pathways related to insulin resistance (IR), low-grade chronic inflammation, leptin resistance, microvascular damage, and autonomic neuropathy are emphasized. Histopathological changes are exposed, and findings reported from experimental models are clearly differentiated from those described in humans. The accelerated decline in pulmonary function that appears in patients with cystic fibrosis (CF) with related abnormalities of glucose tolerance and diabetes is considered as an example to further investigate the relationship between T2D and the lung. Furthermore, a possible causal link between antihyperglycemic therapies and pulmonary function is examined. T2D similarly affects breathing during sleep, becoming an independent risk factor for higher rates of sleep apnea, leading to nocturnal hypoxemia and daytime sleepiness. Therefore, the impact of T2D on sleep breathing and its influence on sleep architecture is analyzed. Finally, the effect of improving some pathophysiological mechanisms, primarily IR and inflammation, as well as the optimization of blood glucose control on sleep breathing is evaluated. In summary, the lung should be considered by those providing care for people with diabetes and raise the central issue of whether the normalization of glucose levels can improve pulmonary function and ameliorate sleep-disordered breathing. Therefore, patients with T2D should be considered a vulnerable group for pulmonary dysfunction. However, further research aimed at elucidating how to screen for the lung impairment in the population with diabetes in a cost-effective manner is needed.
Collapse
Affiliation(s)
- Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Rafael Simó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Maria Pallayova
- Department of Medicine, Weill Cornell Medicine.,Department of Human Physiology and Sleep Laboratory, Faculty of Medicine, Pavol Jozef Šafárik University, Slovak Republic
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cecilia Turino
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cristina Hernández
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Ferran Barbé
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain
| |
Collapse
|
10
|
Borel JC, Guerber F, Jullian-Desayes I, Joyeux-Faure M, Arnol N, Taleux N, Tamisier R, Pépin JL. Prevalence of obesity hypoventilation syndrome in ambulatory obese patients attending pathology laboratories. Respirology 2017; 22:1190-1198. [DOI: 10.1111/resp.13051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/08/2017] [Accepted: 02/26/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Jean-Christian Borel
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University; Grenoble France
- AGIR à dom. Association; Meylan France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| | | | | | - Marie Joyeux-Faure
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University; Grenoble France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| | - Nathalie Arnol
- AGIR à dom. Association; Meylan France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| | | | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University; Grenoble France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University; Grenoble France
- EFCR Laboratory, Thorax and Vessels Division; Grenoble Alpes University Hospital; Grenoble France
| |
Collapse
|
11
|
Abstract
Obesity hypoventilation syndrome is becoming an increasingly encountered condition both in respiratory outpatient clinics and in hospitalized patients. The health consequences and social disadvantages of obesity hypoventilation syndrome are significant. Unfortunately, the diagnosis and institution of appropriate therapy is commonly delayed when the syndrome is not recognized or misdiagnosed. Positive airway pressure therapy remains the mainstay of treatment and is effective in controlling sleep-disordered breathing and improving awake blood gases in the majority of individuals. Evidence supporting one mode of therapy over another is limited. Both continuous and bilevel therapy modes can successfully improve daytime gas exchange, with adherence to therapy an important modifiable factor in the response to treatment. Despite adherence to therapy, these individuals continue to experience excess mortality primarily due to cardiovascular events compared with those with eucapnic sleep apnea using CPAP. This difference likely arises from ongoing systemic inflammation secondary to the morbidly obese state. The need for a comprehensive approach to managing nutrition, weight, and physical activity in addition to reversal of sleep-disordered breathing is now widely recognized. Future studies need to evaluate the impact of a more aggressive and comprehensive treatment plan beyond managing sleep-disordered breathing. The impact of early identification and treatment of sleep-disordered breathing on the development and reversal of cardiometabolic dysfunction also requires further attention.
Collapse
Affiliation(s)
- Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Camperdown, and Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
12
|
|
13
|
|
14
|
Castro-Añón O, Pérez de Llano LA, De la Fuente Sánchez S, Golpe R, Méndez Marote L, Castro-Castro J, González Quintela A. Obesity-hypoventilation syndrome: increased risk of death over sleep apnea syndrome. PLoS One 2015; 10:e0117808. [PMID: 25671545 PMCID: PMC4324970 DOI: 10.1371/journal.pone.0117808] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022] Open
Abstract
Aim To study whether mortality and cardiovascular morbidity differ in non-invasive ventilation (NIV)-treated patients with severe obesity-hypoventilation syndrome (OHS) as compared with CPAP-treated patients with obstructive sleep apnea syndrome (OSAS), and to identify independent predictors of mortality in OHS. Material and methods Two retrospective cohorts of OHS and OSAS were matched 1:2 according to sex, age (±10 year) and length of time since initiation of CPAP/NIV therapy (±6 months). Results Three hundred and thirty subjects (110 patients with OHS and 220 patients with OSAS) were studied. Mean follow-up time was 7±4 years. The five year mortality rates were 15.5% in OHS cohort and 4.5% in OSAS cohort (p< 0.05). Patients with OHS had a 2-fold increase (OR 2; 95% CI: 1.11–3.60) in the risk of mortality and 1.86 fold (OR 1.86; 95% CI: 1.14–3.04) increased risk of having a cardiovascular event. Diabetes, baseline diurnal SaO2 < 83%, EPAP < 7 cmH2O after titration and adherence to NIV < 4 hours independently predicted mortality in OHS. Conclusion Mortality of severe OHS is high and substantially worse than that of OSAS. Severe OHS should be considered a systemic disease that encompasses respiratory, metabolic and cardiovascular components that require a multimodal therapeutic approach.
Collapse
Affiliation(s)
- Olalla Castro-Añón
- Respiratory Division and Sleep Disorders Unit, Lucus Augusti University Hospital, Galician Health Service, Lugo, Spain
- * E-mail:
| | - Luis A. Pérez de Llano
- Respiratory Division and Sleep Disorders Unit, Lucus Augusti University Hospital, Galician Health Service, Lugo, Spain
| | | | - Rafael Golpe
- Respiratory Division and Sleep Disorders Unit, Lucus Augusti University Hospital, Galician Health Service, Lugo, Spain
| | - Lidia Méndez Marote
- Respiratory Division and Sleep Disorders Unit, Lucus Augusti University Hospital, Galician Health Service, Lugo, Spain
| | | | | |
Collapse
|
15
|
Abstract
Obesity hypoventilation syndrome is a respiratory consequence of morbid obesity that is characterized by alveolar hypoventilation during sleep and wakefulness. The disorder involves a complex interaction between impaired respiratory mechanics, ventilatory drive and sleep-disordered breathing. Early diagnosis and treatment is important, because delay in treatment is associated with significant mortality and morbidity. Available treatment options include non-invasive positive airway pressure (PAP) therapies and weight loss. There is limited long-term data regarding the effectiveness of such therapies. This review outlines the current concepts of clinical presentation, diagnostic and management strategies to help identify and treat patients with obesity-hypoventilation syndromes.
Collapse
|
16
|
Harada Y, Chihara Y, Azuma M, Murase K, Toyama Y, Yoshimura C, Oga T, Nakamura H, Mishima M, Chin K. Obesity hypoventilation syndrome in Japan and independent determinants of arterial carbon dioxide levels. Respirology 2014; 19:1233-40. [PMID: 25208458 DOI: 10.1111/resp.12367] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/07/2014] [Accepted: 06/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Obesity hypoventilation syndrome (OHS) prevalence was previously estimated at 9% in patients with obstructive sleep apnoea (OSA) in Japan. However, the definition of OSA in that study was based on an apnoea-hypopnoea index (AHI) of ≥ 20/h rather than ≥ 5/h. Therefore, the prevalence of OHS in OSA was not measured in the same way as for Western countries. Our study objectives were to investigate the characteristics of Japanese patients with OHS. METHODS Nine hundred eighty-one consecutive patients investigated for suspected OSA were enrolled. At least 90% of them were from urban areas, including 162 with obese OSA (body mass index (BMI) ≥ 30 kg/m(2) and AHI ≥ 5/h). RESULTS The prevalence of OHS (BMI 36.7 ± 4.9 kg/m(2) ) in OSA and that in obese OSA were 2.3% and 12.3%, respectively. Multiple regression analysis revealed that independent of age and BMI, arterial oxygen pressure (contribution rate (R(2) ) = 7.7%), 4% oxygen desaturation index (R(2) = 8.9%), carbon monoxide diffusing capacity/alveolar volume (R(2) = 8.3%), haemoglobin concentration (R(2) = 4.9%) and waist circumference (R(2) = 4.9%) were independently associated with arterial carbon dioxide pressure. After 12.3 ± 4.6 months of CPAP treatment, more than 60% of OHS patients no longer had hypercapnia. CONCLUSIONS The prevalence of OHS in OSA in Japan was 2.3%. The mean BMI of patients with OHS in Japan was lower than that in Western countries (36.7 kg/m(2) vs 44.0 kg/m(2) ).
Collapse
Affiliation(s)
- Yuka Harada
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
STUDY OBJECTIVES The study was performed to evaluate the hypothesis that the extremely obese manifest sleep disordered breathing with a preponderance of hypopneas and relative paucity of obstructive apneas. METHODS Retrospective review of 90 adults with obstructive sleep apnea-hypopnea syndrome (OSAHS) matched for age and gender, comparing two groups, Group A: body mass index (BMI) < 35, Group B: BMI ≥ 45. EXCLUSION CRITERIA age < 18 years, pregnancy, ≥ 5 central apneas/hour, BMI ≥ 35 < 45. PRIMARY OUTCOME MEASURE Hypopnea/apnea ratio (HAR); secondary measures: obstructive apnea-hypopnea index (AHI), obstructive and central apnea indices, hypopnea index (HI), oxygen saturation (SpO2) nadir, end-tidal carbon dioxide tension (PetCO2), and presence of obesity-hypoventilation syndrome (OHS). STATISTICAL METHODS t-test for independent samples; Mann-Whitney, linear regression with natural log transformation, and Kruskal-Wallis χ(2). Descriptive statistics were expressed as interquartile range, median and mean ± standard deviation, p < 0.05 considered significant. RESULTS Group A (n = 45): age = 50.6 ± 11.5 years, BMI = 28.9 ± 4 kg/m(2); Group B (n = 45): age = 47.4 ± 12.7 years, BMI = 54.5 ± 8 kg/m(2). HAR was significantly higher in Group B (38.8 ± 50.7) than Group A (10.6 ± 16.5), p = 0.0006, as was HI (28.7 ± 28.6 in B vs 12.6 ± 8.4 in A, p = 0.0005) and AHI (35.5 ± 33.8 vs 22 ± 23, p = 0.03), but not apnea index. HAR was significantly higher in Group B regardless of race, gender, or presence of OHS. The BMI was the only significant predictor of HAR (adjusted r(2) = 0.138; p = 0.002) in a linear regression model with natural log transformation of the HAR performed for age, gender, race, BMI, and PetCO2. CONCLUSION Extremely obese patients manifest OSAHS with a preponderance of hypopneas.
Collapse
Affiliation(s)
- Reeba Mathew
- University of Texas Health Science Center at Houston, Houston, TX ; Memorial Hermann Hospital-Texas Medical Center Sleep Disorders Center, Houston, TX
| | - Richard J Castriotta
- University of Texas Health Science Center at Houston, Houston, TX ; Memorial Hermann Hospital-Texas Medical Center Sleep Disorders Center, Houston, TX
| |
Collapse
|
18
|
Basoglu OK, Tasbakan MS. Comparison of clinical characteristics in patients with obesity hypoventilation syndrome and obese obstructive sleep apnea syndrome: a case-control study. CLINICAL RESPIRATORY JOURNAL 2013; 8:167-74. [DOI: 10.1111/crj.12054] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 08/02/2013] [Accepted: 09/08/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Ozen K. Basoglu
- Department of Chest Diseases; Ege University School of Medicine; Izmir Turkey
| | | |
Collapse
|
19
|
Central sleep apnea in obese children with sleep-disordered breathing. Int J Obes (Lond) 2013; 38:27-31. [PMID: 24048143 DOI: 10.1038/ijo.2013.184] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/08/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES In contrast to obstructive sleep apnea (OSA), central sleep apnea (CSA) in obese children has received lesser attention. As pediatric CSA is more prevalent than expected and adversely impacts health, this study aims to elucidate the major factors associated with central apnea index (CAI) and compare CSA between obese and non-obese children. METHODS Retrospective analysis was performed in a tertiary referral medical center. Children with sleep-disordered breathing (SDB) ranging from 2-18 years old were enrolled. All participants completed history taking, otolaryngological examination and overnight polysomnography. CSA was defined as having CAI exceeding 1 h(-1). CAI and the prevalence of CSA were analyzed in children of different age groups, weight statuses and adenotonsillar sizes. RESULTS A total of 487 cases were included. The prevalence of CSA was 13.3% (65/487). CAI was negatively correlated with age (r=-0.32, P<0.001). Obese children had a significantly lower CAI than that of non-obese ones (0.20 ± 0.36 vs 0.48 ± 0.82 h(-1), P<0.001). Multiple linear regression analysis demonstrated a relationship between CAI, age and obesity as 'CAI=0.883-0.055 × Age -0.22 × (Obesity)'. CONCLUSIONS In children with SDB, younger ones have a significantly higher CAI than older ones. Additionally, obese children had a lower CAI than non-obese ones.
Collapse
|
20
|
CASTRO-AÑÓN OLALLA, GOLPE RAFAEL, PÉREZ-DE-LLANO LUISA, LÓPEZ GONZÁLEZ MARÍAJESÚS, ESCALONA VELASQUEZ EDGARJ, PÉREZ FERNÁNDEZ RUTH, TESTA FERNÁNDEZ ANA, GONZÁLEZ QUINTELA ARTURO. Haemodynamic effects of non-invasive ventilation in patients with obesity-hypoventilation syndrome. Respirology 2012; 17:1269-74. [DOI: 10.1111/j.1440-1843.2012.02252.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
21
|
Abstract
We have coined the term 'malignant obesity hypoventilation syndrome' (MOHS) to describe a severe multisystem disease due to the systemic effects of obesity. Patients with this syndrome have severe obesity-related hypoventilation together with systemic hypertension, diabetes and the metabolic syndrome, left ventricular hypertrophy with diastolic dysfunction, pulmonary hypertension and hepatic dysfunction. This syndrome is largely unrecognized as physicians do not make the association between the patients' multiple medical problems and obesity. Because of the delayed diagnosis and progressive morbidities of this condition, all patients with a body mass index of more than 40 kg m(-2) should be screened for MOHS. The management of patients with MOHS includes short-term measures to improve the patients' medical condition and long-term measures to achieve enduring weight loss. Bariatric surgery reverses or improves the multiple metabolic and organ dysfunctions associated with MOHS and should be strongly considered in these patients.
Collapse
Affiliation(s)
- P E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
| |
Collapse
|
22
|
Marik PE, Desai H. Characteristics of patients with the "malignant obesity hypoventilation syndrome" admitted to an ICU. J Intensive Care Med 2012; 28:124-30. [PMID: 22564878 DOI: 10.1177/0885066612444261] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of obesity in westernized nations is increasing at an alarming rate. We have noted an increasing number of patients admitted to our intensive care unit (ICU) with hypercapnic respiratory failure and multisystem organ dysfunction related to obesity. We have coined the term the malignant obesity hypoventilation syndrome (MOHS) to describe this entity. METHODS We reviewed the hospital records of all patients who were admitted to our ICU over an 8-month period, with a body mass index (BMI) greater than 40 kg/m² and a PaCO₂ greater than 45 mm Hg. We excluded patients with musculoskeletal disease, intrinsic lung disease, and those with >20 pack-year smoking history. RESULTS Sixty-one patients (8% of all admissions) met the inclusion criteria for our study. The patients' mean BMI was 48.9 ± 8.6 kg/m². The patients' mean age was 59 ± 11; 47 (77%) were female and 56 (92%) were black. All patients were admitted to the ICU with hypercapnic respiratory failure. The patients had been admitted to our hospital on average 6 times over the previous 2 years; 75% had been erroneously diagnosed and treated for chronic obstructive pulmonary disease (COPD)/asthma and 86% had been treated with diuretics for congestive cardiac failure. All patients had type 2 diabetes and the metabolic syndrome. Three patients had a tracheotomy in place at admission and required mechanical ventilation. All of the remaining patients were treated with noninvasive bilevel positive airway pressure (BiPAP), with 23 patients failing BiPAP and requiring mechanical ventilation. Seven patients had a tracheotomy performed. On the basis of unexplained abnormalities of liver function tests, 39 patients (64%) were presumptively diagnosed with nonalcoholic steatohepatitis (NASH). Pulmonary function tests were suggestive of a restrictive pattern in all patients tested. By echocardiography 43 (71%) patients had left ventricular hypertrophy and 37 (61%) patients had features of left ventricular diastolic dysfunction. Forty-seven (77%) patients had pulmonary hypertension, which was moderate to severe (pulmonary systolic pressure >45 mm Hg) in 25 cases. All patients had an elevated C-reactive protein (9.4 ± 6.9 mg/dL), and all but 1 were vitamin D deficient (13.5 ± 8.5 ng/mL). Eleven patients (18%) died during the index hospitalization. CONCLUSIONS MOHS is a serious multisystem disorder with a high mortality that appears to be relatively common, frequently misdiagnosed, and inadequately treated.
Collapse
Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
| | | |
Collapse
|
23
|
BOREL JEANCHRISTIAN, BOREL ANNELAURE, MONNERET DENIS, TAMISIER RENAUD, LEVY PATRICK, PEPIN JEANLOUIS. Obesity hypoventilation syndrome: From sleep-disordered breathing to systemic comorbidities and the need to offer combined treatment strategies. Respirology 2012; 17:601-10. [DOI: 10.1111/j.1440-1843.2011.02106.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|