Obesity hypoventilation syndrome: symptoms, causes and treatment

Hypoventilation syndrome due to obesity is a medical condition associated, as its name suggests, with advanced overweight. The person who suffers from it has difficulty breathing during the day, causing problems sleeping at night.

It is a disease that affects many people with obesity, therefore, a key aspect to avoid and treat it is the weight loss through exercise and a good diet, although surgery and the use of face masks may also be necessary air.

Below we will talk more in depth about this respiratory disease, its main symptoms, what examinations and physical tests are done to diagnose it, and how it is treated.

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What is obesity hypoventilation syndrome?

Obesity hypoventilation syndrome is a respiratory disease that people with obesity can have. Because of their overweight, they cannot breathe properly during the day or at night, seeing their health and state of mind affected.

During the day, their poor breathing makes their blood oxygen levels low and carbon dioxide high, this being known as diurnal hypoventilation.

At night they also cannot breathe well, which causes them not to enjoy a good night's sleep or get a good rest. What's more, their breathing difficulties are further aggravated because they may suffer from obstructive sleep apnea. This causes them to stop breathing for a short time, causing the brain to not be able to have the oxygen it needs to function properly.

Hypoventilation syndrome due to obesity it has also been called Pickwick syndrome. The reason for this is quite curious, and it relates to the famous British writer and novelist Charles Dickens, who describes in his essay The Posthumous Papers of the Pickwick Club symptoms very similar to those related to the syndrome.

Symptoms

As we have mentioned, obesity hypoventilation syndrome is a condition associated with obesity that causes respiratory problems both day and night. Among the main symptoms we have the abnormal levels of oxygen and carbon dioxide in the blood, being lower and higher, respectively. This medical condition is called chronic hypoxia.

As people who suffer from this syndrome cannot sleep properly, having a poor quality sleep at night when they wake up they suffer from daytime sleepiness. This causes them to have a great lack of energy and that they feel tired when exerting the slightest effort. They may also suffer from headaches associated with irregular blood gas levels and poor sleep.

While sleeping it can interrupt your breathing momentarily; in addition, they can make very loud snoring. These two symptoms are not detected by the patient himself, but by the people who live with him, such as his partner or his roommates. Although it does not necessarily have to affect the social life of the patient, the fact of snoring very Strong can make it difficult for others to sleep, causing a problem in the coexistence of the unit domestic.

But not everything has to do with breathing. By not being able to sleep well for a long time, the patient's mood is affected, and problems such as depression, irritation and agitation may occur. As he suffers from drowsiness, he is more prone to accidents, both at work and at home. This can also affect the sexual life of the patient since he has less desire to have intercourse and prefers to sleep, although he knows that he will not be able to rest completely.

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Causes of obesity hypoventilation

Not all causes of obesity hypoventilation syndrome are known, although as its own The name indicates obesity plays a very important role in the severity and development of this condition. medical.

It can be a combination of several health problemsincluding the inability of the brain to properly handle breathing, excess body fat that produces hormones that alter the respiratory rate and the extra weight against the chest wall, making it difficult for the muscles of the chest to work. breathing.

Diagnosis

In order to properly diagnose this medical condition, it is necessary to perform a series of tests and physical exams. In addition, he will be asked about medical problems that he and those closest to him have noticed, such as tiredness, snoring, and sleep apnea.

The first thing to do is to evaluate the physical condition of the patient, starting with your body mass index (BMI). If the patient has a BMI greater than 30 it will mean that he suffers from obesity.

In addition to this, they will look at each other other physical signs associated with obesity hypoventilation, among which we have:

• Cyanosis: bluish discoloration of the lips, fingers and toes, or the skin.
• Reddish skin.
• Hypertension: high blood pressure
• Pulmonary hypertension - high blood pressure in the lungs
• Cor pulmonale: Right heart failure
• Swelling in the legs or feet.
• Difficulty breathing.
• Feeling tired after minimal effort.
• Signs of excessive sleepiness.

In order to diagnose this medical condition, it is necessary to evaluate the levels of gases in the blood, specifically oxygen and carbon dioxide. For this an arterial blood gas is usually done, taking blood samples from the patient, usually taken from your wrist, and checking your gas levels. You can also use a pulse oximeter, a sensor placed on the finger of the hand that measures the amount of oxygen in the blood, although it is not as accurate a technique as a blood sample arterial.

A chest X-ray or CT scan of the same area is necessary to rule out other possible physical causes that explain the patient's breathing problems. An echocardiogram is also usually performed in which an ultrasound of the heart is done to see how this organ behaves.

Finally, one of the tests that cannot be missed to diagnose obesity hypoventilation syndrome is polysomnography, that is, a sleep study. It is a technique that allows knowing if the patient suffers from sleep apnea, its severity and orienting the most appropriate treatment for the case.

Treatment

In the treatment of obesity hypoventilation syndrome a weight loss program is usually applied accompanied by therapy focused on the respiratory disease.

Sometimes the simple act of losing a little weight makes the person improve significantly, snoring less and having a more restful sleep, in addition to being able to breathe better during the day and, in many cases, correcting the obstructive apnea of ​​the dream. In other cases, surgical intervention is necessary by doing a gastric bypass in which the size of the stomach is reduced and the patient eats less.

To get the patient to lose weight, what is usually done is to give him a program in which he is presented with a menu with restricted calories, in addition to presenting you with foods that meet your nutritional needs but losing weight. Many diets focus on protein and vegetables, since it is these two types of foods that contribute to a fuller stomach with less caloric intake. In addition, proteins help build muscle, altering the patient's body composition and reducing the production of hormones associated with fats.

To help the patient control his cravings to eat, it is recommended that he have good sleep hygiene, going to sleep between 10 and 12 at night. Although it is true that your quality of sleep is poor, going to bed at a good time will reduce the chances of feeling tired the next day. People who wake up in a bad mood and exhausted tend to counteract their fatigue by eating too much, something that would be very counterproductive in the treatment of this syndrome.

Air masks are often used to treat respiratory deficits., that is, a positive pressure support in the airway. These masks deliver constant air at a certain pressure, allowing the patient to breathe in and out in a healthy way. By being able to breathe better at night, you have better rest and your blood oxygen and carbon dioxide levels return to normal.

Bibliographic references:

• Vidya Krishnan MD, MHS and Pedro Genta MD (2014) Obesity hypoventilation syndrome. Am J Respir Crit Care Med, Vol. 189, P15-P16.
• Malhotra A, Powell F (2020). Disorders of ventilatory control. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier: chap 80.
• Mokhlesi B (2017). Obesity-hypoventilation syndrome. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier;: chap 120.
• Mokhlesi B, Masa JF, Brozek JL, et al (2019). Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med.; 200 (3): e6-e24. PMID: 31368798 www.ncbi.nlm.nih.gov/pubmed/31368798.