Obesity Hypoventilation Syndrome

From Physiologic Principles to Clinical Practice

1st Edition - July 22, 2020
Imprint: Academic Press
Editor: Aiman Tulaimat
Language: English
Paperback ISBN:
9 7 8 - 0 - 1 2 - 8 1 5 2 9 0 - 4
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 1 5 2 9 1 - 1

Obesity Hypoventilation Syndrome: From Physiologic Principles to Clinical Practice summarizes the current state of knowledge regarding the epidemiology, physiology and treatment… Read more

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Obesity Hypoventilation Syndrome: From Physiologic Principles to Clinical Practice summarizes the current state of knowledge regarding the epidemiology, physiology and treatment of obesity hypoventilation syndrome (OHS). Currently, the identification and management of OHS is suboptimal, especially in the acute setting, hence the misdiagnosis or mislabeling of the problem has a significant impact on patient outcomes. This volume brings together all aspects of assessment and management into a main resource for understanding the complex physiological and clinical consequences of this condition.

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
Preface
Part I: Historical and social introduction
Chapter 1: Obesity: A social and public policy perspective
Abstract
The obesity epidemic
Disparities in obesity and related conditions
Overview of social ecological model
Individual-level influences on obesity
Interpersonal-level influences
Organizational-level influences
Community-level influences
Society-level influences
Chapter 2: History of obesity hypoventilation
Abstract
Respiration and the ancient Greeks
Ancient Greek accounts of hypoventilation
Chemists and clinicians: Ne’er the two shall meet
Partial pressures, polio, and polysomnography
Part II: The burden of obesity on respiratory
Chapter 3: Effect of obesity on the respiratory system
Abstract
Introduction
Respiratory patterns
Respiratory system compliance
Oxygenation, ventilation, perfusion, and gas exchange
Chapter 4: The burden of obesity hypoventilation syndrome
Abstract
Prevalence and risk factors
Prevalence of OHS among patients on home mechanical ventilation
Prevalence of OHS among patients with acute hypercapnic respiratory failure
Social and health care consequences of OHS
Effect of OHS on the quality of life and health status
Mortality
Part III: Pathophysiology of obesity hypoventilation syndrome
Chapter 5: Neural control of breathing in sleep
Abstract
Introduction
Mechanisms controlling breathing
Changes in breathing during sleep
Mechanism of central apnea generation
Clinical relevance
Chapter 6: Pathogenesis of sleep apnea
Abstract
Conflict of interest
Introduction
Importance of sleep apnea phenotypes to understand sleep apnea pathophysiology
Physiologic determinants in obese and nonobese patients with OSA
Phenotypic traits in patients with severe OSA
Chapter 7: The pathophysiology of obesity hypoventilation syndrome
Abstract
Introduction
The origins
Mechanics and work of breathing
Respiratory muscles
Gas exchange and control of ventilation
Fat distribution
Renal response
Polycythemia
Leptin
Orexin
Effect of treatment
Chapter 8: Evolution of obesity hypoventilation syndrome
Abstract
Introduction
Respiratory adaptation
Acute hypercapnia during sleep
Respiratory-renal interactions
Evolution to chronic hypercapnia during wakefulness
Impact of obesity and coexisting respiratory disease
Goals of therapy
Hazards of medical therapy
Chapter 9: Cardiovascular, neurological, and inflammatory complications of obesity hypoventilation syndrome
Abstract
Introduction
Cardiovascular consequences of OHS
Neurological complications of OHS
Inflammatory complications of OHS
Part IV: Clinical assessment of a patient with obesity hypoventilation
Chapter 10: Assessment of patients with obesity hypoventilation syndrome
Abstract
A historical example
Diagnosing OHS
Evaluation of respiratory function
Polysomnography
Comorbidities in patients with OHS
Central nervous system manifestation
Hepatic manifestation
Chapter 11: Detection of hypoventilation
Abstract
Phenotypes of sleep-disordered breathing in obese patients
Symptoms
Carbon dioxide
Bicarbonate levels
Pulse oximetry
Parameters measured by positive airway pressure devices
Measuring response to treatment
Chapter 12: Diagnosis of sleep-disordered breathing
Abstract
Polysomnography and sleep stage scoring: A brief historical introduction
Definitions
Assessment of a patient suspected of having SDB
Diagnosing SDB during hospitalization
Part V: Management of obesity hypoventilation
Chapter 13: Positive airway pressure I: Equipment
Abstract
Introduction
What are the key technical components of PAP equipment?
OHS phenotypes and therapy choices
What treatment options are best for OHS patients?
Practical considerations for equipment reimbursement in the United States
Chapter 14: Positive airway pressure II: Settings and outcomes
Abstract
Introduction
Matching mechanism to therapy
PAP therapy for OHS—What choice do we have?
Managing chronic stable OHS
Bilevel positive airway pressure therapy
CPAP vs BPAP therapy—Are two pressures better than one?
Oxygen therapy
Obesity hypoventilation without obstructive sleep apnea
Managing acute presentations of OHS with PAP therapy
Conclusions
Chapter 15: The effects of weight loss, tracheostomy, and medication on obesity hypoventilation syndrome
Abstract
The effects of weight loss on breathing, sleep-disordered breathing, and OHS
Tracheostomy in sleep apnea and OHS
Medications and OHS
Chapter 16: Weight loss: Lifestyle interventions and pharmacotherapy
Abstract
Introduction
Clinical assessment of the patient
Motivating patients to adopt weight loss behaviors
How to achieve weight loss through lifestyle intervention
Pharmacotherapy
Medications that cause weight gain
Weight maintenance
Chapter 17: Surgical weight loss
Abstract
Patient selection
Procedure selection
Weight loss effects
Postoperative complications
Early postoperative management
Chapter 18: Tracheostomy in morbidly obese patients
Abstract
Patient selection
Effect of OHS on surgical management
Perioperative management
Upper airway surgery for patients with severe OSA and OHS
Surgical technique
Chapter 19: Obesity hypoventilation in the intensive care unit
Abstract
Introduction
Pathophysiology of ventilatory failure
The characteristics of patients with OHS in acute hypercapnic respiratory failure
Differential diagnosis and comorbidities
Treatment with noninvasive ventilation
Treatment with invasive mechanical ventilation
Other issues in intensive care related to the morbidly obese
Long-term outcomes
Conclusions
Chapter 20: Perioperative considerations and management in patients with obesity hypoventilation syndrome
Abstract
Introduction
Pathophysiology
Preoperative assessment
Intraoperative considerations
Postoperative considerations
Index

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