Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Ophthalmology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
ASH 2024 Annual Meeting 2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on adolescent vaping

LIVE: Wednesday 29th January, 18:00-19:30 CET

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?
ADVANCED SEARCH
Log in
Top
Multidisciplinary Respiratory Medicine
Published in:

Open Access 01-12-2017 | Original research article

Using PaCO2 values to grade obesity-hypoventilation syndrome severity: a retrospective study

Authors: Mario Francesco Damiani, Vito Antonio Falcone, Pierluigi Carratù, Cristina Scoditti, Elioda Bega, Silvano Dragonieri, Alfredo Scoditti, Onofrio Resta

Published in: Multidisciplinary Respiratory Medicine | Issue 1/2017

Login to get access

Abstract

Background

To date, an important aspect that has still not been clarified is the assessment of OHS severity. The purpose of this retrospective study was to evaluate whether grading OHS severity according to PaCO2 values may be useful in order to provide a more definite characterization and targeted management of patients. In this regard, baseline anthropometric and sleep polygraphic characteristics, treatment options, and follow up outcomes, were compared between OHS patients with different degree of severity (as assessed according to PaCO2 values).

Methods

Patients were classified into three groups, according to PaCO2 values: 1) mild (46 mmHg ≤ PaCO2 ≤ 50 mmHg), moderate (51 mmHg ≤ PaCO2 ≤ 55 mmHg), severe (PaCO2 ≥ 56 mmHg). Therefore, differences among the groups in terms of baseline anthropometric, and sleep polygraphic characteristics, treatment modalities and follow up outcomes were retrospectively evaluated.

Results

Patients with more severe degree of hypercapnia were assessed to have increased BMI and bicarbonate levels, worse diurnal and nocturnal hypoxemia, and a more severe impairment in pulmonary mechanics compared to milder OHS. CPAP responders rate significantly decreased from mild to severe OHS. After follow up, daytime sleepiness (as measure by the ESS), PaO2, and PaCO2 significantly improved with PAP therapy in all three groups.

Discussion and Conclusions

Classification of OHS severity according to PaCO2 levels may be useful to provide a more defined characterization and, consequently, a more targeted management of OHS patients. Further studies are needed to confirm our findings.
Literature
1.
2.
3.
Kessler R, Chaouat A, Schinkewitch P, Faller M, Casel S, Krieger J, et al. The obesity hypoventilation syndrome revisited: a prospective study of 34 patients consecutive cases. Chest. 2001;120:369–76.CrossRefPubMed
4.
Pérez De Llano LA, Golpe R, Ortiz Piquer M, Veres Racamonde A, Vázquez Caruncho M, Caballero Muinelos O, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity hypoventilation syndrome. Chest. 2005;128:587–94.CrossRefPubMed
5.
Cabrera Lacalzada C, Diaz-Lobato S. Grading obesity hypoventilation syndrome severity. Eur Respir J. 2008;32:817–8.CrossRefPubMed
6.
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC, Official Statement of the European Respiratory Society. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Eur Respir J Suppl. 1993;16:5–40.CrossRefPubMed
7.
Patruno V, Bosi M, Sanna A, Fanfulla F, Braghiroli A, Insalaco G. Indices for the instrumental diagnosis of sleep apneas: standardization of the calculation with polysomnography and cardiorespiratory monitoring. Rassegna di Patologia dell’Apparato Respiratorio. 2006;21:22–7.
8.
Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans AT. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007;11:117–24.CrossRefPubMed
9.
Kaw R, Hernandez AV, Walker E, Aboussouan L, Mokhlesi B. Determinants of hypercapnia in obese patients with obstructive sleep apnea: a systematic review and metaanalysis of cohort studies. Chest. 2009;136:787–96.CrossRefPubMed
10.
Collins LC, Hoberty PD, Walker JF, Fletcher EC, Peiris AN. The effect of body fat distribution on pulmonary function tests. Chest. 1995;107:1298–302.CrossRefPubMed
11.
Lazarus R, Sparrow D, Weiss ST. Effects of obesity and fat distribution on ventilatory function: the normative aging study. Chest. 1997;111:891–8.CrossRefPubMed
12.
Ladosky W, Botelho MAM, Albuquerque JP. Chest mechanics in morbidly obese non-hypoventilated patients. Respir Med. 2001;95:281–6.CrossRefPubMed
13.
Resta O, Foschino-Barbaro MP, Bonfitto P, Talamo S, Legari G, De Pergola G, et al. Prevalence and mechanisms of diurnal hypercapnia in a sample of morbidly obese subjects with obstructive sleep apnea. Respir Med. 2000;94:240–6.CrossRefPubMed
14.
Pankow W, Podszus T, Gutheil T, Penzel T, Peter J, Von Wichert P. Expiratory flow limitation and intrinsic positive end-expiratory pressure in obesity. J Appl Physiol. 1998;85:1236–43.PubMed
15.
Resta O, Foschino Barbaro MP, Bonfitto P, Talamo S, Mastrosimone V, Stefano A, et al. Hypercapnia in obstructive sleep apnoea syndrome. Neth J Med. 2000;56(6):215–22.CrossRefPubMed
16.
Lee S-D, Nakano H, Farkas GA. Adenosinergic modulation of ventilation in obese Zucker rats. Obes Res. 2005;13:545–55.CrossRefPubMed
17.
Yang AL, Lo MJ, Ting H, Chen JS, Huang CY, Lee SD. GABA(a) and GABA(b) receptors differentially modulate volume and frequency in ventilatory compensation in obese Zucker rats. J Appl Physiol. 2007;102:350–7.CrossRefPubMed
18.
Piper AJ, Grunstein RR. Obesity hypoventilation syndrome. Mechanisms and management. Am J Respir Crit Care Med. 2011;183:292–8.CrossRefPubMed
19.
Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans AT. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007;11(2):117–24.CrossRefPubMed
20.
Piper AJ, Grunstein RR. Current perspectives on the obesity hypoventilation syndrome. Curr Opin Pulm Med. 2007;13(6):490–6.PubMed
21.
Rapoport DM, Garay SM, Epstein H, Goldring RM. Hypercapnia in the obstructive sleep apnea syndrome. A reevaluation of the “Pickwickian syndrome”. Chest. 1986;89(5):627–35.CrossRefPubMed
22.
American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the report of an American Academy of Sleep Medicine task force. Sleep. 1999;22:667–89.CrossRef
23.
Norman RG, Goldring RM, Clain JM, Oppenheimer BW, Charney AN, Rapoport DM, et al. Transition from acute to chronic hypercapnia in patients with periodic breathing: predictions from a computer model. J Appl Physiol. 2006;100(5):1733–41.CrossRefPubMed
24.
Berger KI, Norman RG, Ayappa I, Oppenheimer BW, Rapoport DM, Goldring RM. Potential mechanism for transition between acute hypercapnia during sleep to chronic hypercapnia during wakefulness in obstructive sleep apnea. Adv Exp Med Biol. 2008;605:431–6.CrossRefPubMed
25.
Campo A, Frühbeck G, Zulueta JJ, Iriarte J, Seijo LM, Alcaide AB, et al. Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients. Eur Respir J. 2007;30(2):223–31.CrossRefPubMed
26.
Metadata
Title
Using PaCO2 values to grade obesity-hypoventilation syndrome severity: a retrospective study
Authors
Mario Francesco Damiani
Vito Antonio Falcone
Pierluigi Carratù
Cristina Scoditti
Elioda Bega
Silvano Dragonieri
Alfredo Scoditti
Onofrio Resta
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Multidisciplinary Respiratory Medicine / Issue 1/2017
Electronic ISSN: 2049-6958
DOI
https://doi.org/10.1186/s40248-017-0093-4

Other articles of this Issue 1/2017

Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community acquired pneumonia: review of recommendations

  • Open Access
  • Research Article

Once daily aerosolised tobramycin in adult patients with cystic fibrosis in the management of Pseudomonas aeruginosa chronic infection

  • Open Access
  • Letter to the Editor

Recent advances in capsule-based dry powder inhaler technology

  • Open Access
  • Review

Nasal Muco-ciliary transport time alteration: efficacy of 18 B Glycyrrhetinic acid

  • Open Access
  • Research Article

A pilot study with early adolescents: dealing with diet, tobacco and air pollution using practical experiences and biological markers

  • Open Access
  • Short Report

Case-finding for alpha1-antitrypsin deficiency in Kazakh patients with COPD

  • Open Access
  • Original research article

Keynote webinar | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the broader systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

  • Live
  • Webinar | 29-01-2025 | 18:00 (CET)

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Watch it live: Wednesday 29th January, 18:00-19:30 CET
 

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Join the webinar

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more
Image Credits