Obesity hypoventilation syndrome (Pickwickian syndrome) is a condition that affects some obese patients. They experience poor breathing that may be the result of a problem in the brain. This ultimately results in less oxygen and higher carbon dioxide levels in the blood. Patients with this disease mainly suffer from lack of sleep and shortness of breath, although other symptoms are also manifested. The patient must receive appropriate respiratory support, otherwise potentially life-threatening complications may arise.
- Causes of obesity hypoventilation syndrome
- Symptoms
- Lack of sleep
- Too low oxygen level in blood
- Diagnosis and examinations
- Therapy
- Complications of condition in obese patients
- Heart
- Sleep
- Prevention
Causes of obesity hypoventilation syndrome
The exact cause of obesity hypoventilation syndrome is not known as of October 2020. Researchers suspect that obesity hypoventilation syndrome is the result of a problem in the brain, namely a defect in the control of breathing. Excess weight against the chest wall also makes it harder for the muscles to take deep breaths and to breathe fast enough. As a result, the blood contains too much carbon dioxide and too little oxygen.
Symptoms
Due to the lack of sleep, patients may suffer from headaches / Source: Geralt, Pixabay
Lack of sleep
The main symptoms of obesity hypoventilation syndrome are due to lack of sleep and include:
- a depression
- poor sleep quality
- headache
- sleep apnea
- daytime sleepiness
- fatigue
Too low oxygen level in blood
Symptoms of too low oxygen levels in the blood (chronic hypoxia) are also sometimes manifested. The patient then suffers from shortness of breath or fatigue after very little effort.
Diagnosis and examinations
Physical examination Patients with obesity hypoventilation syndrome are usually very overweight. The physical examination reveals the following possible signs:
- a bluish color in the lips, fingers, toes or skin (cyanosis)
- reddish skin
- signs of excessive sleepiness
- signs of right-sided heart failure (cor pulmonale), such as swollen legs or feet, shortness of breath or fatigue after little exertion
A blood test is necessary / Source: Frolicsomepl, PixabayDiagnostic examination The doctor uses additional tests to diagnose and confirm obesity hypoventilation syndrome:
- a blood test
- an X-ray or CT scan of the chest to rule out other possible causes
- a lung function test (spirometry)
- a sleep study (polysomnography)
- an echocardiography (examination of the heart using sound waves)
Differential diagnosis The symptoms of obesity hypoventilation syndrome are reminiscent of the signs of sleep apnea. Patients with obstructive sleep apnea syndrome, in contrast to patients with obesity hypoventilation syndrome, have high levels of carbon dioxide in the blood when they are awake.
Therapy
The treatment of obesity hypoventilation syndrome consists of respiratory assistance using special machines (mechanical ventilation). Options include:
- non-invasive mechanical ventilation such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) through a mask that fits tightly over the nose or nose and mouth (mainly for sleep)
- oxygen therapy
- breathing assistance through an opening in the neck (tracheostomy) for severe cases
Other treatments focus on weight loss, which may reverse the symptoms of obesity hypoventilation syndrome
Complications of condition in obese patients
Heart
Left untreated, obesity hypoventilation syndrome leads to serious heart and blood vessel problems such as:
- high blood pressure (hypertension)
- high blood pressure in the lungs (pulmonary hypertension)
- right-sided heart failure (cor pulmonale)
Sleep
Obesity hypoventilation syndrome may also cause complications due to sleep deprivation, such as:
- depression, agitation, irritability
- an increased risk of accidents or errors at work
- problems with intimacy and sex
Prevention
It is important that people maintain a healthy weight so that they do not become obese. After all, obesity is associated with numerous complications.