OBESITY hypoventilation syndrome (OHS) also known as Pickwickian syndrome a condition that occurs in severely obese people who fail to breathe rapidly enough, where poor breathing leads to lower blood oxygen levels and higher blood carbon dioxide levels in blood. Many during sleep having obstructive sleep apnea, awake at night that leads to continual sleepiness in daytime. The disease puts an extra strain on heart, which gradually leads to symptoms heart failure, or such as leg swelling and various other complications. The effective way to over come the syndrome is to cut obese! OHS is distinct from other sleep related breathing disorders although overlap may exist.
Causes: Most patients with the syndrome having a form of sleep apnea. IT 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 such are often tired due to sleep loss; poor sleep quality, and chronic hypoxia. Hypoventilation occurs when level of alveolar ventilation is insufficient to meet metabolic needs that is characterized by rise in arterial carbon dioxide CO2 tension, normally measured from arterial blood gases. To maintain adequate ventilation relies on capacity of respiratory muscles, load that is placed on these muscles and adequacy of central drive to breathe.
Excess (morbid) obesity is the main risk factor.
~Excessive daytime sleepiness or interrupted sleep
~Obstructive sleep apnea, condition characterized with snoring, brief episodes at night
~Falling asleep during the day
~Increased risk for accidents or mistakes at work
~Hypertension and headaches can happen that worsen condition in morning
~Symptoms of low blood oxygen level (chronic hypoxia) can also occur, such as shortness of breath or feeling tired after very little effort
~Low oxygen level leads to excessive strain on heart as fluid may accumulate in legs in the form of edema, swelling and in abdominal cavity in the form of ascites
~Decreased exercise tolerance and chest pain occur
~Depressed central ventilator control
~Tightens the small blood vessels in lungs to create an ideal distribution of blood through the lungs that causes to increase pressure on pulmonary artery hypertension, which in turn extra strain on right ventricle, part of the heart that pumps blood to the lungs
~OHS elevated blood levels of carbon dioxide that causes drowsiness CO2 narcosis may worsen sleepiness. High carbon dioxide can also cause headaches, which further tend to worsen in morning
~Neuro hormonal effect
~Heart murmur due to blood leaking through tricuspid valve, hepatomegaly (an enlarged liver), ascites and leg edema
Exams and Tests: People with OHS are usually very overweight. A physical exam reveals:
- ~Lips, fingers, toes, or skin cyanotic, bluish color
- ~Signs of right-side heart failure, 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
- ~Sign of excessive sleepiness
Tests to confirm OHS include: •Sleep study •Lungs (pulmonary) function tests •Arterial blood gas •Chest x-ray or CT to rule out other possible causes
Treatment: It involves breathing help using special machines (mechanical ventilation). Options include: Non-invasive mechanical ventilation 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)
Other treatments aimed at weight loss, which can reverse OHS.
Prognosis: Untreated, it can lead to serious heart and blood vessel problems, severe disability, or death. It is further associated with a reduced quality life, which often associate the condition such as asthma, diabetes, and heart failure.
Possible Complications: Complications of OHS have to do with a lack of sleep, such as:
Increased risk for accidents
Depression, agitation, irritability
Right heart failure
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