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Positive pressure for obesity hypoventilation syndrome.

Chanda A, Kwon JS, Wolff AJ, Manthous CA - Pulm Med (2012)

Bottom Line: Despite its prevalence, OHS has not been studied well, but there is abundant evidence that it is tightly linked with sleep-disordered breathing, most commonly obstructive sleep apnea.This article reviews the pathophysiology of OHS as well as the literature regarding the benefits of treating this disorder with positive airway pressure.We also emphasize that while positive pressure treatments may temporize cardiopulmonary disease progression, simultaneous pursuit of weight reduction is central to long-term management of this condition.

View Article: PubMed Central - PubMed

Affiliation: Section of Pulmonary, Critical Care, and Sleep Medicine, Bridgeport Hospital, Bridgeport, CT 06610, USA.

ABSTRACT
Obesity is increasing world-wide; obesity hypoventilation syndrome (OHS), formerly Pickwickian syndrome, has increased in parallel. Despite its prevalence, OHS has not been studied well, but there is abundant evidence that it is tightly linked with sleep-disordered breathing, most commonly obstructive sleep apnea. This article reviews the pathophysiology of OHS as well as the literature regarding the benefits of treating this disorder with positive airway pressure. We also emphasize that while positive pressure treatments may temporize cardiopulmonary disease progression, simultaneous pursuit of weight reduction is central to long-term management of this condition.

No MeSH data available.


Related in: MedlinePlus

Our sleep lab's approach to patients with OHS. *As with positive pressure therapies, tracheostomy is not a cure—but rather a temporizing measure to reduce propensity for progressive cardiorespiratory failure until weight loss can be achieved. A consensus approach is presented in [42].
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Related In: Results  -  Collection


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fig1: Our sleep lab's approach to patients with OHS. *As with positive pressure therapies, tracheostomy is not a cure—but rather a temporizing measure to reduce propensity for progressive cardiorespiratory failure until weight loss can be achieved. A consensus approach is presented in [42].

Mentions: CPAP is appropriate first-line therapy for ambulatory OHS patients with stable chronic hypercapnic respiratory failure. If a trial of nocturnal CPAP titration fails to eliminate substantial oxygen desaturations (e.g., <88% for more than a few minutes each night)—as in roughly 20% of patients [36]-either addition of low-dose oxygen or a bi-level PAP trial are indicated even though the single small study comparing CPAP with bi-level PAP did not demonstrate long-term differences in patient outcomes (see Figure 1). Bi-level PAP should begin with EPAP = 4–10 cm H2O and pressure support of 4 cm H2O. Increases of one or both pressures in increments of 2-3 cm H2O until desaturations are eliminated, pressure support >10 cm H2O, or patient develops intolerance to therapy. If desaturations persist despite CPAP or bi-level PAP (roughly in 1/3 of patients) [36], supplemental oxygen should be administered during sleep to reach 90% saturations without frequent periods of >95% (to avoid hyperoxia-induced hypercapnia). When bi-level PAP is the chosen modality, some patients can be later safely switched to CPAP alone if they improve clinically. Ultimately weight loss is the definitive treatment. Since patient adherence is critical [36], great care should be taken to titrate therapies carefully and to customize treatment. Most important, noninvasive positive pressure therapies are a bridge to prevent worsening cardiopulmonary failure until patients lose weight; so clinicians must work tirelessly to help these patients lose the weight that is life threatening. With the current available data, noninvasive positive pressure therapies should never supplant endotracheal intubation and PPV for ACHRF if there are absolute indications (e.g., airway incompetence with aspiration, shock, profound excess work of breathing or tachypnea >35 breaths per minute with impending respiratory arrest) for securing the airway. Future studies may help to determine whether there are subsets of patients with ACHRF who benefit from positive pressure therapies, which should be used cautiously for such patients until such data are available.


Positive pressure for obesity hypoventilation syndrome.

Chanda A, Kwon JS, Wolff AJ, Manthous CA - Pulm Med (2012)

Our sleep lab's approach to patients with OHS. *As with positive pressure therapies, tracheostomy is not a cure—but rather a temporizing measure to reduce propensity for progressive cardiorespiratory failure until weight loss can be achieved. A consensus approach is presented in [42].
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475306&req=5

fig1: Our sleep lab's approach to patients with OHS. *As with positive pressure therapies, tracheostomy is not a cure—but rather a temporizing measure to reduce propensity for progressive cardiorespiratory failure until weight loss can be achieved. A consensus approach is presented in [42].
Mentions: CPAP is appropriate first-line therapy for ambulatory OHS patients with stable chronic hypercapnic respiratory failure. If a trial of nocturnal CPAP titration fails to eliminate substantial oxygen desaturations (e.g., <88% for more than a few minutes each night)—as in roughly 20% of patients [36]-either addition of low-dose oxygen or a bi-level PAP trial are indicated even though the single small study comparing CPAP with bi-level PAP did not demonstrate long-term differences in patient outcomes (see Figure 1). Bi-level PAP should begin with EPAP = 4–10 cm H2O and pressure support of 4 cm H2O. Increases of one or both pressures in increments of 2-3 cm H2O until desaturations are eliminated, pressure support >10 cm H2O, or patient develops intolerance to therapy. If desaturations persist despite CPAP or bi-level PAP (roughly in 1/3 of patients) [36], supplemental oxygen should be administered during sleep to reach 90% saturations without frequent periods of >95% (to avoid hyperoxia-induced hypercapnia). When bi-level PAP is the chosen modality, some patients can be later safely switched to CPAP alone if they improve clinically. Ultimately weight loss is the definitive treatment. Since patient adherence is critical [36], great care should be taken to titrate therapies carefully and to customize treatment. Most important, noninvasive positive pressure therapies are a bridge to prevent worsening cardiopulmonary failure until patients lose weight; so clinicians must work tirelessly to help these patients lose the weight that is life threatening. With the current available data, noninvasive positive pressure therapies should never supplant endotracheal intubation and PPV for ACHRF if there are absolute indications (e.g., airway incompetence with aspiration, shock, profound excess work of breathing or tachypnea >35 breaths per minute with impending respiratory arrest) for securing the airway. Future studies may help to determine whether there are subsets of patients with ACHRF who benefit from positive pressure therapies, which should be used cautiously for such patients until such data are available.

Bottom Line: Despite its prevalence, OHS has not been studied well, but there is abundant evidence that it is tightly linked with sleep-disordered breathing, most commonly obstructive sleep apnea.This article reviews the pathophysiology of OHS as well as the literature regarding the benefits of treating this disorder with positive airway pressure.We also emphasize that while positive pressure treatments may temporize cardiopulmonary disease progression, simultaneous pursuit of weight reduction is central to long-term management of this condition.

View Article: PubMed Central - PubMed

Affiliation: Section of Pulmonary, Critical Care, and Sleep Medicine, Bridgeport Hospital, Bridgeport, CT 06610, USA.

ABSTRACT
Obesity is increasing world-wide; obesity hypoventilation syndrome (OHS), formerly Pickwickian syndrome, has increased in parallel. Despite its prevalence, OHS has not been studied well, but there is abundant evidence that it is tightly linked with sleep-disordered breathing, most commonly obstructive sleep apnea. This article reviews the pathophysiology of OHS as well as the literature regarding the benefits of treating this disorder with positive airway pressure. We also emphasize that while positive pressure treatments may temporize cardiopulmonary disease progression, simultaneous pursuit of weight reduction is central to long-term management of this condition.

No MeSH data available.


Related in: MedlinePlus