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    Obesity hypoventilation syndrome (OHS)

    Pickwickian syndrome

    Obesity hypoventilation syndrome (OHS) is a condition in obese people in which poor breathing leads to lower oxygen and higher carbon dioxide levels in the blood.

    Causes

    The exact cause of OHS is unknown. The condition 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. This 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 OHS are often tired due to sleep loss, poor sleep quality, and chronic low blood oxygen levels (hypoxia).

    Most patients with the syndrome have a form of sleep apnea. Obesity is the main risk factor.

    See also: Respiratory acidosis

    Symptoms

    The main symptoms of OHS are due to lack of sleep and include:

    • Daytime sleepiness
    • Depression
    • Headaches

    Symptoms of low blood oxygen level (chronic hypoxia) can also occur, such as shortness of breath or feeling tired after very little effort.

    Exams and Tests

    People with OHS are usually very overweight. A physical exam may reveal:

    • Bluish color in the lips, fingers, toes, or skin (cyanosis)
    • Reddish colored skin
    • Signs of right-sided heart failure (cor pulmonale), such as swollen legs or feet, shortness of breath, or feeling tired after little effort

    Tests used to help diagnose and confirm OHS include:

    • Arterial blood gas
    • Chest x-ray or CT scan to rule out other possible causes
    • Lungfunction tests (pulmonary function tests)
    • Sleep study (polysomnography)

    Doctors can tell OHS from obstructive sleep apnea because patients with OHS have high carbon dioxide levels in the blood when awake.

    Treatment

    The treatment involves breathing assistance using special machines (mechanical ventilation). Options include:

    • Noninvasive mechanical ventilation (BiPAP or other modes) through a mask that fits tightly over the nose or nose and mouth (mainly for sleep)
    • Breathing help through an opening in the neck (tracheostomy)
    • Oxygen

    Other treatments are aimed at weight loss, which can reverse OHS.

    Support Groups

    Support groups can help patients with OHS, or their family members, adjust to the lifestyle changes needed for treatment to be successful. Also, support groups can offer information about new treatments.

    Outlook (Prognosis)

    Untreated, it can lead to serious heart and blood vessel problems, severe disability, or death. Chronic sleeping problems may also increase the chance of having a motor vehicle accident.

    Possible Complications

    Complications of OHS have to do with a lack of sleep, such as:

    • Depression, agitation, irritability
    • Increased risk for accidents or mistakes at work
    • Sexual dysfunction

    OHS can also cause heart problems, such as:

    • Hypertension
    • Right-sided heart failure (cor pulmonale)
    • Pulmonary hypertension (high blood pressure in the lungs)

    When to Contact a Medical Professional

    Call your health care provider if you are very tired during the day, or have any other symptoms that suggest OHS.

    Prevention

    Maintain a healthy weight and avoid obesity.

    References

    Malhotra A. Disorders of ventilatory control. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 86.

    Tzelepis GE, McCool FD. The lungs and chest wall diseases. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 88.

    Duffin J, Phillipson EA. Hypoventilation and hyperventilation syndromes In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa:Saunders Elsevier; 2010:chap 78.

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          Tests for Obesity hypoventilation syndrome (OHS)

            Review Date: 8/30/2012

            Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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