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 overcome the syndrome is to cut obese! OHS is distinct from other sleep related breathing disorders although overlap may exist.
Causes: Most patients with syndrome having a form of sleep apnea. IT is believed to result from both a defect in brain’s control over breathing, and excessive weight (due to obesity) against chest wall, which makes it hard for person to take a deep breath. As a result, 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 characterised 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 main risk factor.
- Decreased exercise tolerance and chest pain occur
- Depressed central ventilator control
- Excessive daytime sleepiness or interrupted sleep
- Falling asleep during the day
- Heart murmur due to blood leaking through tricuspid valve, hepatomegaly (an enlarged liver), ascites and leg edema
- Hypertension and headaches can happen that worsen condition in morning
- Increased risk for accidents or mistakes at work
- 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
- Neuro hormonal effect
- Obstructive sleep apnea, condition characterized with snoring, brief episodes at night
- 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
- Symptoms of low blood oxygen level (chronic hypoxia) can also occur, such as shortness of breath or feeling tired after very little effort
- Tightens the small blood vessels in lungs to create an ideal distribution of blood through 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 lungs
Exams and Tests: People with OHS are usually very overweight. A physical exam reveals:
- A short, thick neck and small airway passage in the mouth
- Lips, fingers, toes, or skin cyanotic, bluish color
- Reddish complexion
- Sign of excessive sleepiness
- Signs of right-side heart failure, such as swollen legs or feet, shortness of breath, or feeling tired after little effort
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 are 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 reduced quality life, which often associate condition as asthma, diabetes, and heart failure.
Possible Complications: Complications of OHS have to do with a lack of sleep, such as:
Right heart failure
Increased risk for accidents
Depression, agitation, irritability
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