Obesity hypoventilation syndrome (OHS)

Answer 1

Definition

Obesity hypoventilation syndrome (OHS) is a condition that occurs in obese people, in which poor breathing leads to lower oxygen levels and higher carbon dioxide levels in the blood.

Alternative Names

Pickwickian syndrome

Causes, incidence, and risk factors

The exact cause of OHS in unknown. Most (but not all) patients with the syndrome have a form of sleep apnea.

OHS is believed to result from both a defect in the brain's control over breathing, and excessive weight (due to obesity) against the chest wall, which makes it hard for a person to take a deep breath. As a result, the blood has too much carbon dioxide and not enough oxygen. People with OHS are often tired due to sleep loss, poor sleep quality, and chronic hypoxia.

Excess (morbid) obesity is the main risk factor.

See also: Respiratory acidosis

Symptoms

The main symptoms of OHS are due to lack of sleep and include:

• Excessive daytime sleepiness
• Falling asleep during the day
• Increased risk for accidents or mistakes at work
• Depression

Symptoms of low blood oxygen level (chronic hypoxia) can also occur, such as shortness of breath or feeling tired after very little effort.

Signs and tests

People with OHS are usually very overweight. Symptoms of OHS include:

• Bluish color in the lips, fingers, toes, or skin (cyanosis)
• Signs of right-side heart failure (cor pulmonale), such as swollen legs or feet, shortness of breath, or feeling tired after little effort
• Reddish complexion
• A short, thick neck and small airway passage in the mouth

Tests to confirm OHS include:

• Sleep study
• Lung (pulmonary) function
• Arterial blood gas

Doctors can tell OHS from obstructive sleep apnea by high carbon dioxide levels in the blood when a person is awake.

Treatment

The treatment involves breathing assistance using special machines (mechanical ventilation). Options include:

• Non-invasive mechanical ventilation (BiPAP or other modes) through a mask that fits tightly over the nose or nose and mouth (mainly for sleep)
• Mechanical ventilation through an incision in the neck (tracheostomy)
• Oxygen

Other treatments are aimed at weight loss, which can reverse OHS.

Support Groups

Support groups can help patients with OHS, or their family members, adjust to the lifestyle changes needed for treatment to be successful. Also, support groups can offer information about new treatments.

Expectations (prognosis)

Untreated, it can lead to serious heart and blood vessel problems, severe disability, or death. Chronic sleeping problems may also increase the chance of having a motor vehicle accident.

Complications

Complications of OHS have to do with a lack of sleep, such as:

• Increased risk for accidents
• Depression, agitation, irritability
• Sexual dysfunction

OHS can also include heart problems, such as:

• Hypertension
• Right heart failure (cor pulmonale)

Calling your health care provider

Call your health care provider if you are very tired during the day, or have any other symptoms that suggest OHS.

Prevention

Maintain a healthy weight and avoid obesity.

References

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: W.B. Saunders Company; 2000:2326-2328.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby, Inc; 2004:221-223.

Answer 2

Definition

Obesity hypoventilation syndrome (OHS) is a condition in obese people in which poor breathing leads to lower oxygen and higher carbon dioxide levels in the blood.

Alternative Names

Pickwickian syndrome

Causes, incidence, and risk factors

The exact cause of OHS is unknown. The condition is believed to result from both a defect in the brain's control over breathing, and excessive weight (due to obesity) against the chest wall. This makes it hard for a person to take a deep breath. As a result, the blood has too much carbon dioxide and not enough oxygen. People with OHS are often tired due to sleep loss, poor sleep quality, and chronic low blood oxygen levels (hypoxia).

Most patients with the syndrome have a form of sleep apnea. Obesity is the main risk factor.

See also: Respiratory acidosis

Symptoms

The main symptoms of OHS are due to lack of sleep and include:

• Daytime sleepiness
• Depression
• Headaches

Symptoms of low blood oxygen level (chronic hypoxia) can also occur, such as shortness of breath or feeling tired after very little effort.

Signs and tests

People with OHS are usually very overweight. A physical exam may reveal:

• Bluish color in the lips, fingers, toes, or skin (cyanosis)
• Signs of right-sided heart failure (cor pulmonale), such as swollen legs or feet, shortness of breath, or feeling tired after little effort
• Reddish complexion

Tests used to help diagnose and confirm OHS include:

• Arterial blood gas
• Chest x-ray to rule out other possible causes
• Lung (pulmonary) function
• Sleep study

Doctors can tell OHS from obstructive sleep apnea because patients with OHS have high carbon dioxide levels in the blood when awake.

Treatment

The treatment involves breathing assistance using special machines (mechanical ventilation). Options include:

• Noninvasive mechanical ventilation (BiPAP or other modes) through a mask that fits tightly over the nose or nose and mouth (mainly for sleep)
• Breathing help (tube) through an opening in the neck (tracheostomy)
• Oxygen

Other treatments are aimed at weight loss, which can reverse OHS.

Support Groups

Support groups can help patients with OHS, or their family members, adjust to the lifestyle changes needed for treatment to be successful. Also, support groups can offer information about new treatments.

Expectations (prognosis)

Untreated, it can lead to serious heart and blood vessel problems, severe disability, or death. Chronic sleeping problems may also increase the chance of having a motor vehicle accident.

Complications

Complications of OHS have to do with a lack of sleep, such as:

• Increased risk for accidents or mistakes at work
• Depression, agitation, irritability
• Sexual dysfunction

OHS can also include heart problems, such as:

• Hypertension
• Right-sided heart failure (cor pulmonale)

Calling your health care provider

Call your health care provider if you are very tired during the day, or have any other symptoms that suggest OHS.

Prevention

Maintain a healthy weight and avoid obesity.

References

Malhotra A. Disorders of ventilatory control. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 86.

Tzelepis GE, McCool FD. The lungs and chest wall diseases. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 88.

Reviewed By

Review Date: 08/05/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.