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J Clin Sleep Med. 2013 Sep 15;9(9):879-84. doi: 10.5664/jcsm.2986.

Diagnostic predictors of obesity-hypoventilation syndrome in patients suspected of having sleep disordered breathing.

Author information

1
Sleep and Ventilation Unit, Department of Respiratory Medicine, North Middlesex University Hospital, London, UK. vladimirmacavei@gmail.com

Abstract

INTRODUCTION:

Obesity-hypoventilation syndrome (OHS) is associated with significant morbidity and mortality and requires measurement of arterial pCO2 for diagnosis.

OBJECTIVE:

To determine diagnostic predictors of OHS among obese patients with suspected obstructive sleep apnea/hypopnea syndrome (OSAHS).

METHODS:

Retrospective analysis of data on 525 sleep clinic patients (mean age 51.4 ± 12.7 years; 65.7% males; mean BMI 34.5 ± 8.1). All patients had sleep studies, and arterialized capillary blood gases (CBG) were measured in obese subjects (BMI > 30 kg/m2).

RESULTS:

Of 525 patients, 65.5% were obese, 37.2% were morbidly obese (BMI > 40 kg/m2); 52.3% had confirmed OSAHS. Hypercapnia (pCO2 > 6 kPa or 45 mm Hg) was present in 20.6% obese and 22.1% OSAHS patients. Analysis of OHS predictors showed significant correlations between pCO2 and BMI, FEV1, FVC, AHI, mean and minimum nocturnal SpO2, sleep time with SpO2 < 90%, pO2, and calculated HCO3 from the CBG. PO2 and HCO3 were independent predictors of OHS, explaining 27.7% of pCO2 variance (p < 0.0001). A calculated HCO3 cutoff > 27 mmol/L had 85.7% sensitivity and 89.5% specificity for diagnosis of OHS, with 68.1% positive and 95.9% negative predictive value.

CONCLUSION:

We confirmed a high prevalence of OHS in obese OSAHS patients (22.1%) and high calculated HCO3 level (> 27 mmol/L) to be a sensitive and specific predictor for the diagnosis of OHS.

KEYWORDS:

Obstructive sleep apnea; obesity hypoventilation syndrome

PMID:
23997700
PMCID:
PMC3746715
DOI:
10.5664/jcsm.2986
[Indexed for MEDLINE]
Free PMC Article

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