Sánchez-Medina A, Sánchez-Medina MM

Language: Spanish
References: 28
Page: 604-611
PDF size: 111.08 Kb.

ABSTRACT

Introduction: Obesity is a disease that is closely associated with deleterious respiratory effects such as the Obesity Hypoventilation Syndrome which conventionally includes awake hypercapnia. There are studies addressing the detection of daytime hypercapnia with the patient either in sitting or standing position. However, there are no studies in obese subjects with a normal daytime PaCO₂ in whom the detection of hypercapnia is made in the supine position. It is feasible that the physiopathological changes that occur in obese patients when they adopt the supine position lead to increased PaCO₂ levels or hypercapnia. Objective: To determine the levels of PaCO₂ in obese patients with a normal daytime PaCO₂ in the supine position using arterial blood gas test. Methods: Fifty patients with BMI › 30 Kg/m², with a normal daytime PaCO₂ were included. Daytime arterial blood gas test was performed first with the patient in a standing position along with pulmonary function test. A second arterial blood gas test was made 15 minutes after the patient adopted the supine position. Polisomnography was performed. Results: Mean BMI was 40 kg/m². PaCO2 levels in the standing position were less, statistically significant, than the PaCO₂ levels in the supine position, 30.7 ± 2.5 mmHg vs 35.6 ± 6.7 mmH, p ‹ 0.001. Conclusions: We can achieve an early detection of Obesity hipoventilation syndrome in obese patients with a normal daytime PaCO2 by performing the arterial blood gas test in the supine position before these patients develop severe complications.

REFERENCES

1. Franco S. Obesity and the Economics of Prevention Fit not Fat Organization for the Economic Cooperation and Development (O2CD publishing).

2. Levitzky MG. Fisiología pulmonar. 3a ed. México: Editorial Uteha; 1993. pp. 231-2.

3. Krimsky WR, Leiter JC. Physiology of breathing and respiratory control during sleep. Semin Respir Crit Care Med. 2005;26:5-11.

4. Luce M, Culver B. Respiratory muscle function in health and disease. Chest. 1982;81:82-9.

5. Berger K, Ayappa I, Chatr-amontri B, et al. Obesity hypoventilation syndrome as spectrum of respiratory disturbances during sleep. Chest. 2001;120:1231-8.

6. Akashiba T, Kawahara S, Kosaka N, et al. Determinants of chronic hypercapnia in Japanese men with obstructive sleep apnea syndrome. Chest. 2002;12:415-21.

7. Rochester DF. Obesity and abdominal distention. En: Roussos C. (editor). The Thorax. New York: Dekker; 1995. pp. 1915-50.

8. Krieger J, Sforza E, Apprill M, Lampert E, Weitzenblum E, Ratomaharo J. Pulmonary hypertension, hypoxemia, and hypercapnia in obstructive sleep apnea patients. Chest. 1989;96:729-37.

9. Sahebjami H, Gartiside P. Pulmonary function in obese subjects with a normal VEF1/CVF ratio. Chest. 1996;110:1425-9.

10. Resta O, Foschino M, Carpagnano G, et al. Diurnal PaCO2 tension in obese women: relationship with sleep disordered breathing. Int J Obes Relat Metab Disord. 2003;27:1453-8.

11. Rodríguez-Rosín R, García A, Burgos F, et al. Gasometría arterial. Arch Bronconeumol. 1998;34:142-53.

12. American Thoracic Society Statement. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis. 191;144:1202-18.

13. Olson E, Moore W, Morgenthaler T, et al. Obstructive sleep apnea-hypopnea syndrome. Mayo Clin Proc. 2003;78:1545-52.

14. Norman G, Streiner D. Bioestadística. Barcelona: Harcourt; 2000. pp. 145-56.

15. Leech JA, Onal E, Baer P, et al. Determinants of hypercapnia in occlusive sleep apnea syndrome. Chest. 1987;92:807-13.

16. Marcus E, Buist S, Curb JD, et al. Correlates of FEV1 and prevalence of pulmonary conditions in Japanese-American men. Am Rev Respir Dis. 1988;138:1398-404.

17. Zerah F, Harf A, Perlemuter L, Lorino H, Lorino AM, Atlan G. Effects of obesity on respiratory resistance. Chest. 1993;103:1470-6.

18. Dixon J, Schachter L, O´brien P. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes (Lond). 2005;29:1048-54.

19. Shelton K, Woodson H, Gay S, Suratt PM. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993;148:462-6.

20. Ogretmenoglu O, Emre A, Taskin O, Onerci TM, Sahin A. Body fat composition: a predictive factor for obstructive sleep apnea. Laryngoscope. 2005;115:1493-8.

21. Friedman M, Vidyasagar R, Bliznikas D, Joseph N. Does severity of obstructive sleep apnea/hipopnea syndrome predict uvulopalatopharyngoplasty outcome? Laryngoscope. 2005;115:2109-13.

22. Shelton K, Woodson H, Gay S, Suratt PM. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993;148:462-6.

23. Horner RL, Mohiaddin RH, Lowell DG, et al. Sites and sizes of fats deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls. Eur Respir J. 1989;2: 613-22.

24. Schwartz AR, Gold AR, Schubert N, et al. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis. 1991;144:494-8.

25. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217-39.

26. Resta O, Barabaro MPF, Brindicci C, Nocerino MC, Caratozzolo G, Carbonara M. Hypercapnia in overlap syndrome: possible determinant factors. Sleep Breath. 2002;6:11-7.

27. Kessler R, Chaouat A, Schinkewitch P, et al. The obesity hypoventilation syndrome revisited: a prospective study of 34 consecutive cases. Chest. 2001;120:369-76.

28. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle aged adults. N Engl J Med. 1993;328:1230-5.