Management of Obesity Hypoventilation Syndrome

Introduction

Obesity hypoventilation syndrome (OHS) is a condition that occurs in people who are severely overweight or obese and is characterized by a combination of respiratory and metabolic abnormalities. This condition is caused by the accumulation of excess body fat, which can cause the respiratory system to become compromised and lead to chronic hypoventilation, or reduced breathing capacity. OHS can lead to a number of serious health complications, including pulmonary hypertension, heart failure, and even death if left untreated. The prevalence of OHS has been increasing in recent years due to the rise in obesity rates worldwide, making it an important public health concern. This article will discuss the causes, symptoms, diagnosis, and treatment of OHS, as well as the impact of obesity on respiratory function and overall health.

What Are the Causes of Obesity Hypoventilation Syndrome?

There is no specific cause for obesity hypoventilation syndrome. It occurs due to a combination of two to three causes. They are as follows:

• Body Mass Index (BMI) - The first and foremost cause is excess weight. A person having a body mass index (BMI) of more than 30 is considered to be obese.

• Brain Dysfunction - The Pickwickian syndrome occurs due to improper nerve signals in the brain. As a result, the brain fails to control the breathing muscles.

• Respiratory Failure - There is respiratory failure due to the excess weight covering the chest. The patient finds it difficult to inhale air with the help of the lungs.

• Oxygen Demand - The Pickwickian syndrome occurs if there is an oxygen deficiency in the vital organs like the lungs and brain. The metabolism of the body is interrupted due to long-term oxygen insufficiency.

What Are the Symptoms of Obesity Hypoventilation Syndrome?

The symptoms related to obesity hypoventilation syndrome are as follows:

• The patient feels that there is a scarcity of oxygen to breathe.

• There is a lack of energy, and the patient always feels sleepy due to the lack of oxygen supply to the brain and body tissues.

• The person makes an effort to complete one breathing cycle. It makes the patient exhausted even during the day.

• The color of the fingers or toes, or legs changes into a blue tint. This medical condition is also known as cyanosis.

• The person wakes up in the morning with a headache due to the excess amount of carbon dioxide level in the blood. They have constant low oxygen levels in the body. This condition is known as chronic hypoxia.

• In severe obesity hypoventilation syndrome cases, the patient loses interest in indulging in normal activities and feels upset due to extreme drowsiness. This results in depression along with suicidal thoughts.

• The blood pressure increases and causes vascular hypertension.

What Are the Complications of Obesity Hypoventilation Syndrome?

• Cardiac Failure - Severe obesity hypoventilation syndrome causes cardiac dysfunction and failure, particularly on the right side. This condition is known as cor pulmonale.

• Pulmonary Hypertension - There is increased pressure in the blood vessel of the lungs (pulmonary artery). It leads to pulmonary hypertension.

• Poor Sex Life - The person with Pickwickian syndrome loses interest in intimacy, and serious problems can occur in sex life.

• Obstructive Sleep Apnea - If the person is unable to breathe properly for a long period, especially during sleep, it results in obstructive sleep apnea.

How Is Obesity Hypoventilation Syndrome Diagnosed?

The tests that are used to investigate the oxygen and carbon dioxide level are as follows:

• Arterial Blood Gas - The blood from the artery is used to check the acidity level and gases like oxygen and carbon dioxide level. It is used to evaluate breathing conditions. The impaired acid or base balance reveals improper functioning of the lungs and the airways (bronchial tubes). It is also used to assess the body's metabolism.

• Pulmonary Function Test - It is used to inspect the abnormal functions of the lungs. The rate of air inhaled and exhaled is measured using a lung function test. It follows a forceful exhalation after a deep breath. It is used to estimate the oxygen level in the bloodstream. The obesity hypoventilation syndrome leads to scarring of the lungs due to inadequate breathing. Abnormal results indicate the weakness of the breathing muscles.

• Polysomnography - Since obesity hypoventilation syndrome affects sleep, polysomnography is used to record the sleep cycle. This test is conducted during the night. It is used to measure the time taken to fall asleep or to attain deep sleep. It also records the airflow in the lungs during sleep. The breathing effort during sleep is observed.

What Are the Various Treatment Methods for Obesity Hypoventilation Syndrome?

The person with obesity hypoventilation syndrome or Pickwickian syndrome requires supplemental oxygen to aid respiration. Those treatments are as follows:

• Mechanical Ventilation - The noninvasive techniques used to deliver oxygen with the help of specialized machines like continuous positive airway pressure (CPAP). The other technique used in mechanical ventilation involves bilevel-positive airway pressure (BiPAP). The patient wears a facemask either in a sitting or lying position and receives the air supply. Both these techniques are concerned with delivering oxygen. But the only difference is the change in pressure. Continuous positive airway pressure (CPAP) is used to supply air to the bronchial tubes (airways) present in the lungs. It prevents respiratory failure and saves the patient from lung collapse. In bilevel positive airway pressure (BiPAP), the air pressure is delivered from the tube connected to a machine during inhalation and exhalation.

• Hyperbaric Oxygen Therapy - In hyperbaric oxygen therapy, oxygen is provided to the lungs, blood, and body tissues. Hyperbaric oxygen is supplied twice more as the normal oxygen level. The oxygen is provided through the oral route or nasal route with the help of a facemask or catheter, respectively.

• Tracheostomy - For severe obesity hypoventilation syndrome patients, a tracheostomy is done to support breathing. It is used to open the airway and remove secretions around the lungs. It is inserted into the windpipe (trachea). While using tracheostomy, the patient with Pickwickian syndrome can breathe without any obstruction. It is done under general anesthesia.

Conclusion

Eat healthy foods to maintain an ideal body weight. Try to exercise for at least 20 minutes a day. It improves the respiratory mechanism. Contact the physician if there are any symptoms of hypoventilation syndrome. Untreated hypoventilation syndrome can affect the heart and blood vessels because there is an increased carbon dioxide level even during the day. It can eventually end in death.