Epidemiology and pathogenesis of obesity hypoventilation syndrome
- Amanda Piper, PhD
Amanda Piper, PhD
- Associate Professor
- Faculty of Medicine, University of Sydney
- Brendon Yee, MBChB, PhD
Brendon Yee, MBChB, PhD
- Associate Professor, University of Sydney
- Royal Prince Alfred Hospital Sydney, Woolcock Institute of Research
Obesity Hypoventilation Syndrome (OHS; "Pickwickian syndrome") is defined as the presence of awake alveolar hypoventilation (arterial carbon dioxide tension [PaCO2] >45 mmHg) in an obese individual (body mass index ≥30 kg/m2) which cannot be attributed to other conditions associated with alveolar hypoventilation (eg, neuromuscular disorders) [1-3].
The pathogenesis of OHS is reviewed here. Clinical manifestations, diagnosis, and treatment are discussed separately. (See "Clinical manifestations and diagnosis of obesity hypoventilation syndrome" and "Treatment and prognosis of the obesity hypoventilation syndrome" and "Noninvasive positive airway pressure therapy of the obesity hypoventilation syndrome".)
Prevalence estimates for OHS are inaccurate and vary significantly due to differences in disease definition, population studied, and methods of sample acquisition.
●General population – Estimates based on rates of obesity and obstructive sleep apnea (OSA) in the community suggest 0.15 to 0.3 percent of the adult population in the United States are likely to have OHS .
●Obese population – The prevalence of OHS increases as body mass index (BMI) rises [4,5]. In several retrospective studies among patients with OSA, the prevalence of OHS in those with a BMI of 30 to 35 kg/m2 is 8 to 12 percent, higher among those with a BMI ≥40 kg/m2 (18 to 31 percent) and those with a BMI ≥50 kg/m2 (50 percent) [1,5-9].
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- Sleep disordered breathing
- - Reduced nocturnal carbon dioxide clearance
- - Nocturnal hypoxemia
- Impaired pulmonary mechanics
- - Abnormal spirometry
- - Ventilation/perfusion mismatching
- - Reduced respiratory muscle strength
- Impaired ventilatory control
- - Reduced neural drive
- - Reduced ventilatory responsiveness
- - Leptin resistance
- Carbon dioxide overproduction
- SUMMARY AND RECOMMENDATIONS