Presentation on theme: "Obesity Hypoventilation Syndrome. Pickwickian Syndrome Obstructive sleep apnea was called the Pickwickian syndrome in the past because Joe the Fat Boy."— Presentation transcript:
Obesity Hypoventilation Syndrome
Pickwickian Syndrome Obstructive sleep apnea was called the Pickwickian syndrome in the past because Joe the Fat Boy who was described by Charles Dickens in the Pickwick papers had typical features with snoring, obesity, sleepiness and “dropsy”.
OHS: Definition - Obesity (BMI 30 kg/m 2 ) - Hypercapnia (Pa CO 2 45 mmHg) - Sleep-disordered breathing Thomas Nast, The Pickwick Papers
Mechanism of OSAS The upper airway dilating muscles,like all striated muscles-normally relax during sleep. In OSAS, the dilating muscles can no longer successfully oppose negative pressure in the airway during inspiration. Apneas and hypopneas are caused by the airway being sucked and closed on inspiration during sleep.
NORMALSNORINGSLEEP APNEA Anatomy of OSA
Symptoms of OSA,OHS Night time Snoring Witnessed apnoea Frequent nocturnal awakenings Waking up choking or gasping for air Unrefreshed sleep Restless sleep nocturia Dry mouth decreased libido
Symptoms of OSA,OHS Daytime Early morning headaches Fatigue Daytime sleepiness Poor memory, concentration or motivation Unproductive at work Falling asleep during driving Depression
Symptoms of Sleep Apnea Syndrome
Features of Excessive Sleepiness Motor vehicle crashes Work related accidents Impaired school or work performance Marital problems Memory and concentration difficulties Depression Impaired quality of life
OHS,OSA & Cardiovascular Diseases Uncontrolled HTN- 83% have OSAH; activation of sympathetic drive. Acute coronary syndrome % has OSA Cardiac arrhythmias mostly Af Heart Failure Sudden cardiac death Stroke
OSA,OHS and DM Patients from the sleep clinic with AHI>10 are much more likely to have impaired glucose tolerance and diabetes (Meslier et al Eur Respir J 2003)
Diagnosis A good sleep history Assessment of obesity, oral cavity Assessment of possible predisposing causes: HTN, hypothyroidism, acromegaly and Polysomnography: gold standard tool
Apnea-Hypopnea Index Apnoea-hypopnoea index (AHI)= number of apnea/hypopnea per hour of sleep AHI<5 Normal AHI 5-15 Mild OSA AHI Moderate OSA AHI >30 Severe OSA
OHS: Treatment PAP (CPAP or BiPAP) –No standard protocol for titration Oxygen therapy Surgery –Tracheostomy –Weight reduction Pharmacotherapy –Medroxyprogesterone –Acetazolamide
Behavioral Treatments 1.Attain an ideal body weight 2.Sleep on the side 3.Avoid sedative medication before sleep 4.Avoid being sleep deprived 5.Avoid alcohol before sleep 6.Elevate the head of the bed 7.Promptly treat colds and allergies 8.Avoid large meals before bedtime 9.Stop smoking
Body Position Raise HOB Avoid supine position Strategies- Tennis ball in pajamas Backpacks
CPAP Therapy Works as a pneumatic Splint 1 st choice of treatment in moderate to severe OSAHS Success rate % Long term compliance 60-70% Retitrate pressure if needed
Oral Appliances □ Not yet available in Iran □ Appropriate first-line treatment for Mild OSA, primary snoring, upper airway resistance syndrome ( UARS ) □ Not as effective as CPAP, 52% OSA have AHI<10% □ Young, non-obese □ Second line therapy for moderate-severe OSA □ Patient’s choice - Not tolerating / refuse to use CPAP, or are not surgical candidates MAD TRD
Medical Treatments 1.Weight loss 2.Pharmacological 3.Oxygen therapy 4.Nasopharynegeal intubation 5.Nasal CPAP 6.BiLevel CPAP 7.Automatic CPAP 8.Oral Appliances 9.Atrial Pacing
Oxygen Therapy Improves oxygen saturation during sleep May prolong apneic episodes Reduces cardiac arrythmias Useful additive treatment with CPAP Rarely reduces apneic episodes Can improve daytime sleepiness May cause CO2 retention
Conclusion With the increasing problem of obesity, the impact of undetected OHS & OSAS as a public health burden cannot be undermined among our population, It merits appropriate preventive and treatment strategies.
references Mokhlesi, B., Tulaimat, A. (2007), “Recent Advances in Obesity Hypoventilation Syndrome”, Chest 132 (4), Weinberger, S.E., Drazen, J.M., “Disturbances in Respiratory Function”, in Kasper et al (eds), Harrison’s Principles of Internal Medicine (16th Edition), New York: McGraw-Hill, pp Guyton, A.C., Hall, J.E. (2000), Textbook of Medical Physiology (10th edition), Philadelphia: W.B. Saunders.