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Obesity/Hypoventilation Syndrome (Clinical Signs & Symptoms…
Obesity/Hypoventilation Syndrome
Etiology
Obesity
Slow metabolism
Unhealthy foods
Leptin deficiency/resistance
Insulin resistance
Pathophysiology
Fatty tissues accumulate and makes the body gain weight
Excessive fats compress the lungs, therefore limits the expansion of the thoracic wall
Decreases muscle strength
Increasing carbon dioxide production due to caloric intake
Clinical Signs & Symptoms
Breathlessness when waking up
Headache in the morning
Daytime Sleepiness
Tiredness
Poor sleep quality
Loud snoring
Diagnostic Tests
BMI of > 30 kg/m2
ABG (while sleeping) PCO2 > 45, PO2 < 70
Chest x-ray showing excessive body fat with small lungs
Epsworth Sleepiness Scale of 10 or higher
Spirometry with decreased TLC, IC, FRC, and FVC, but normal FEV1/FVC
Normal blood toxic levels for blood/urine tests
Differential Diagnosis
hypothyroidism
COPD
Drug overdose
ARDS
Central Sleep Apnea
Respiratory Management
Consider Intubation if patient is unstable to protect the airway
Use high levels of PEEP as base in order to match the intrathoracic pressure
Initiate CPAP (CPAP of 12-14), if patient remains hypercapneic, initiate NPPV