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Obesity-Hypoventilation Syndrome (OHS) (Diagnostic testing (OSA (evidence…
Obesity-Hypoventilation Syndrome (OHS)
Etiology
OSA- Obstructive sleep apnea
Occurs in some over weight people with a BMI >30 kg/m2
Pathophysiology
Fatty tissue restricts chest-wall movement
Reduces lung volumes
Decreases thoracic and lung compliance
Increases work of breathing
Decreased response to hypercapnia
Diagnostic testing
Definitive diagnosis requires excluding any coexisting pulmonary neuromuscular, neurologic, or hormonal condition that may be causing ventilatory impairment such as COPD, kyphoscoliosis, central sleep apnea and hypothyroidism
BMI > 30 kg/m2 :red_flag:
ABG to verify hypercapnia
OSA (evidence of snorting, witnessed apneas, daytime sleepiness, morning headaches) :red_flag:
Recommend polysomnography exam for any patient with OSA symptoms
Objective measurement of dyspnea - using Borg Scale
Spirometry and lung volume measurements: confirm presence and assess the magnitude of pulmonary restriction
Decreased TLC, IC, FRC, FVC but normal FEV1/FVC
MIP/MEP: to confirm abnormal respiratory mechanics and respiratory muscle weakness or impairment
CBC: assess for polycythemia
Thyroid screen: to identify hypothyroidism
Differential Diagnosis
BMI > 30 kg/m2 :red_flag:
OSA :red_flag:
Definitive diagnosis requires excluding any coexisting pulmonary neuromuscular, neuologic, or hormonal condition that may be causing ventilatory impairment such as COPD, kyphoscoliosis, central sleep apnea and hypothyroidism
Respiratory Management
Acute-on-chronic hypercampic respiratory failure
Assess ABG: pH <7.25
Obtunded
Hemodynamic instability
IMPLEMENT ABC's and consider intubation and MV
Assess ABG: pH >7.25
Conscious
Otherwise stable
RECOMMEND: NIV (bi-pap)
Stable but symptomatic patients
RECOMMEND: CPAP (pressures of 12-14 cmH20)
If patient remains hypercapnia RECOMMEND: Bipap
Long-term management: recommend weight loss program using diet and medications or possible bariatric surgery
Clinical Signs and Symptoms
Obtunded
Hemodynamic instability
Daytime sleepiness
Morning headaches
Fatigue
Exertional dyspnea
Apneas