What is Obesity Hypoventilation Syndrome: Causes, Symptoms, Treatment, Prognosis, Diagnosis

What is Obesity Hypoventilation Syndrome?

Obesity hypoventilation syndrome is a condition in which some obese people feel difficulty in breathing which leads to a decrease in oxygen and an increase in carbon dioxide levels in the body. It is a global concern as it is one of the complications of morbid obesity. About .15% to .13% of the obese adult population and 8% or people undergoing bariatric surgery are found suffering from obesity hypoventilation syndrome.(1)

Cause of Obesity Hypoventilation Syndrome

Though the exact cause of Obesity hypoventilation syndrome is not known completely it can be due to a defect in the brain’s control over breathing. Also, it is believed that excess weight around the chest makes obese people put in extra effort to breathe effectively. This leads to an increase in carbon dioxide levels and dips in the oxygen level in the body.

Signs and Symptoms of Obesity Hypoventilation Syndrome

  • Obstructive Sleep Apnoea: Most of the people with obesity hypoventilation syndrome suffer from sleep apnoea which is characterized by snoring and disturbed night sleep because of episodes of cessation of breathing.
  • Day Time Sleepiness: Disturbed sleep at night leads to drowsiness in the daytime. This can lead to poor concentration and lack of energy the following day.
  • Excessive Drowsiness: If the patient is not able to get sound sleep, drowsiness is felt all the time. Drowsiness can also be a result of raised carbon dioxide levels in the body.
  • Headache
  • Tiredness
  • A rise in blood pressure levels
  • Shortness of breath
  • Feeling tired after a minimal activity due to the low blood oxygen level
  • Ascites and edema are the results of low oxygen levels in the body which affects the right side of the heart. As a result, the heart is not able to pump blood to the body through the lungs. This leads to an accumulation of fluid in the limbs and abdominal cavity.
  • Low oxygen level also leads to pain in the chest
  • Depression

The symptoms might worsen over time and if not treated might complicate to pulmonary hypertension, right heart failure, and secondary erythrocytosis.

Examination and Investigation to Diagnose Obesity Hypoventilation Syndrome

Patients with obesity hypoventilation syndrome are examined and checked for the presence of the following features,

  • Cyanosis: It is bluish discoloration on lips, fingertips, body, and toes.
  • Edema: Swelling in the limbs
  • Shortness of breath
  • Reddish skin
  • Tiredness after slightest effort
  • Signs of excessive sleepiness
  • If obesity hypoventilation syndrome is suspected the following tests are performed to come to confirmation.
  • Body mass index
  • Arterial blood gas: This test helps to demonstrate the increase in the level of carbon dioxide and is measured by taking the sample of blood from the radial artery.
  • Polysomnography: It is a sleep study and is done by admitting a patient to the hospital and carrying out various tests while the patient is sleeping. The various test includes electroencephalography, electrocardiography, pulse oximetry.
  • Ultrasound of the heart or the echocardiogram
  • CT scan and a chest X-Ray are also performed.

Treatment of Obesity Hypoventilation Syndrome

Obesity hypoventilation syndrome is associated with a high rate of morbidity and mortality. The treatment targets the underlying pathophysiology. The goal is to normalize the arterial carbon dioxide, reduce oxyhemoglobin desaturation, and improve the symptoms.(3)

  1. Weight loss: It is considered a most important treatment as losing weight can reverse the condition of obesity hypoventilation syndrome or can improve it to a great extent. Exercise, certain weight loss medication, and even bariatric surgery are recommended to the patient.
  2. Positive airway pressure: It is given through a mask on the nose or both on nose and mouth during sleep, initially in the form of continuous positive airway pressure (CPAP). It relieves the patient from obstructive sleep apnoea features and reduces carbon dioxide levels.
  3. Oxygen therapy: It is a treatment of providing the patient with extra oxygen.(2)
  4. Tracheostomy: This helps relieve the airway obstruction during sleep, improving the alveolar ventilation and waking PaCO2.

Prognosis of Obesity Hypoventilation Syndrome

Obesity hypoventilation syndrome reduces the quality of life and if untreated can lead to severe heart problem, disability, and even death.

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