Obesity hypoventilation syndrome: symptoms, causes and treatment.

Summary of the characteristics of this disease associated with overweight and respiratory problems.

Obesity hypoventilation syndrome is a medical condition associated, as the name suggests, with advanced overweight.. The person who suffers from it has difficulty breathing during the day, causing sleeping problems at night.

It is a disease that affects many people with obesity, so a key aspect to prevent and treat it is weight loss through exercise and a good diet, although surgery and the use of air masks may also be necessary.

Below we will talk more in depth about this respiratory disease, its main symptoms, what examinations and physical tests are done to diagnose it and how it is treated.

What is obesity hypoventilation syndrome?

Obesity hypoventilation syndrome is a respiratory disease that can occur in obese people. a respiratory disease that people with obesity may present. Because of their overweight, they cannot breathe adequately during the day or at night, and their health and mood are affected.and their health and mood are affected.

During the day, their poor breathing causes their blood oxygen levels to be low and carbon dioxide levels to be high, which is known as diurnal hypoventilation.

At night they are also unable to breathe well, which means they do not enjoy a restful sleep or rest properly. What's more, their breathing difficulties are further aggravated because they may suffer from obstructive sleep apnea. This causes them to stop breathing for short periods of time, leaving the brain unable to get the oxygen it needs to function properly.

Obesity hypoventilation syndrome has also been called Pickwick syndrome has also been referred to as Pickwick's syndrome. The reason for this is rather curious, and is related to the famous British writer and novelist Charles Dickens, who describes in his essay The Posthumous Papers of the Pickwick Club symptoms very similar to those associated with the syndrome.

Symptoms

As mentioned above, obesity hypoventilation syndrome is a condition associated with obesity that causes breathing problems both day and night. Among the main symptoms are abnormal levels of oxygen and carbon dioxide in the blood, being lower and higher, respectively.. This medical condition is called chronic hypoxia.

As people suffering from this syndrome cannot sleep adequately, having a poor quality sleep at night when waking up they suffer from daytime sleepiness. This causes them to have a great lack of energy and to feel tired when making the slightest effort. They may also suffer from headaches associated with irregular blood gas levels and poor rest.

When sleeping, their breathing may be interrupted momentarily, and they may snore loudly.. These two symptoms are not detected by the patient himself, but by the people who live with him, such as his partner or roommates. Although it does not necessarily have to affect the patient's social life, loud snoring can make it difficult for others to sleep, causing a problem in the coexistence of the domestic unit.

But not everything has to do with breathing. By not being able to sleep well for a long period of time, the patient's mood is affected, and problems such as depression, irritation and agitation may arise. As he suffers from drowsiness, he is more prone to accidents, both at work and at home. This can also affect the patient's sex life since he/she has less desire to have sex and prefers to sleep, although he/she knows that he/she will not be able to rest completely.

Causes of obesity hypoventilation.

Not all the causes of obesity hypoventilation syndrome are known, although as the name suggests, obesity plays a very important role in the severity and development of this medical condition.

It may be a combination of several health problemsThese include the brain's inability to correctly manage breathing, excess body fat that produces hormones that alter the breathing rate, and the extra weight against the chest wall, making it difficult for the breathing muscles to work.

Diagnosis

In order to properly diagnose this medical condition, a series of tests and physical examinations are necessary. In addition, he will be asked about medical problems that he and his immediate environment have noticed, such as tiredness, snoring and apnea during sleep.

The first thing to be done is to assess the patient's physical condition, starting with his or her body mass indexstarting with the patient's body mass index (BMI). If the patient has a BMI over 30 it will mean that he/she is obese.

In addition to this, other physical signs other physical signs that are associated with hypoventilation due to obesity, among which areamong which we have:

• Cyanosis: bluish discoloration of the lips, fingers, toes or skin.
• Reddish skin color.
• Hypertension: high blood pressure
• Pulmonary hypertension: high Blood Pressure in the lungs.
• Cor pulmonale: right-sided heart failure.
• Swelling in legs or feet.
• Shortness of breath.
• Feeling tired after minimal exertion.
• Signs of excessive drowsiness.

In order to diagnose this medical condition it is necessary to evaluate blood gas levels, specifically oxygen and carbon dioxide. For this purpose, arterial blood gas arterial blood gas analysis is usually done by taking blood samples from the patient, usually taken from his wrist, usually from his wrist.usually taken from the patient's wrist, and checking their blood gas levels. A pulse oximeter, a sensor placed on the finger of the hand that measures the amount of oxygen in the blood, can also be used, although it is not as accurate a technique as an arterial blood sample.

A chest x-ray or CT scan of the same area is necessary to rule out other possible physical causes for the patient's breathing problems. An echocardiogram is also usually performed in which an ultrasound of the heart is made to see how this organ behaves.

Finally, one of the tests that cannot be missed to diagnose hypoventilation syndrome due to obesity is polysomnography, i.e., a sleep study.. It is a technique that allows to know if the patient suffers from sleep apnea, the severity of the same and guide the most appropriate treatment for the case.

Treatment

In the treatment for the syndrome of hypoventilation by obesity a weight loss program is usually applied together with therapy focused on the respiratory disease..

Sometimes, the simple fact of losing a little weight makes the person improve significantly, snoring less and having a more restful sleep, besides being able to breathe better during the day and, in many cases, correcting the obstructive sleep apnea. In other cases, surgery is necessary to perform a gastric by-pass in which the size of the stomach is reduced and the patient eats less.

In order to make the patient lose weight, what is usually done is to give him/her a program in which a menu with restricted calories is presented, in addition to presenting him/her with foods that satisfy his/her nutritional needs but losing weight. Many diets focus on proteins and vegetables, as these are the two types of foods that are most important for weight loss.Many diets focus on protein and vegetables, since it is these two types of foods that contribute to a fuller stomach with less caloric intake. In addition, protein helps to build muscle, altering the patient's body composition and reducing the production of hormones associated with fat.

To help the patient control his cravings for food, it is recommended that he has a good sleep hygiene, going to bed between 10 and 12 o'clock at night. Although it is true that their sleep quality is poor, going to bed at a good time will reduce the chances of feeling tired the next day. People who wake up in a bad mood and exhausted tend to counteract their tiredness by overeating, something that would be very counterproductive in the treatment of this syndrome.

To treat respiratory distress, air masks, i.e. a pressure support, are often used.The use of air masks, i.e. a positive airway pressure support, is often used to treat respiratory distress. These masks administer constant air at a certain pressure, allowing the patient to inhale and exhale in a healthy way. Al poder respirar mejor por las noches, tiene un mejor descanso y sus niveles de oxígeno y dióxido de carbono en sangre se normalizan.

Referencias bibliográficas:

• Vidya Krishnan MD, MHS y Pedro Genta MD (2014) Síndrome de hipoventilación por obesidad.Am J Respir Crit Care Med, Vol. 189, P15-P16.
• Malhotra A, Powell F (2020). Disorders of ventilatory control. En: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier:chap 80.
• Mokhlesi B (2017). Obesity-hypoventilation syndrome. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier;:chap 120.
• Mokhlesi B, Masa JF, Brozek JL, et al (2019). Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med.;200(3):e6-e24. PMID: 31368798 www.ncbi.nlm.nih.gov/pubmed/31368798.