Shallow breathing during the day that worsens at bedtime may require medical attention if you fall under the characteristics of obesity hypoventilation syndrome, or OHS. This breathing disorder can lead to life-threatening conditions if symptoms are left unattended. We will closely look at obesity hypoventilation syndrome symptoms and possible treatment, as it has a close link to other breathing disorders.
Referred to as Pickwickian syndrome or hypercapnic sleep apnea, it is a disease prevalent among obese people. Obesity hypoventilation syndrome is when your oxygen is at very low levels while the carbon dioxide in your blood is high, or over the acceptable level. Consequently, this results in labored breathing and can present at night as another disorder called obstructive sleep apnea. More than 90% of those with obesity hypoventilation syndrome have obstructive sleep apnea.
We distinguish obesity hypoventilation syndrome with three factors. The first characteristic is obesity, where the patient’s Body Mass Index measures higher than 30. Second on the list is daytime hypoventilation or hypercapnia, where the blood has levels of carbon dioxide higher than normal. The third factor to take into account is sleep-disordered breathing, which is hypoventilation during REM sleep. When this happens, there is an increased risk of their breathing stopping completely, such as with obstructive sleep apnea.
Obesity Hypoventilation Syndrome Causes and Symptoms
Although research has yet to determine the exact cause of this disease, obesity is the most likely primary cause of obesity hypoventilation syndrome. Other factors linked to its origin include a possible malfunction of the brain in relation to breathing control. Also, the excessive weight pressing on the chest wall forces the muscles to work harder for air, and this causes the carbon dioxide levels to increase.
These varying factors can cause obesity hypoventilation syndrome symptoms that range from a mild to severe form.
These may include:
- Shallow breathing
- Daytime sleepiness
- Poor nighttime sleep
- Sleep apnea
- Poor memory
- Concentration issues
- Loss of interest
- Mood swings
Diagnosing Obesity Hypoventilation Syndrome
As there are many other conditions that present similar symptoms, it can be difficult to diagnose obesity hypoventilation syndrome. The doctor will check the face and abdominal fat deposits in clinically obese patients, as well as look for any signs of a hump in the spine, leg swelling, nasal polyps, drug or alcohol abuse, or improper use of prescription medications.
Obesity hypoventilation syndrome diagnosis goes beyond measuring a person’s weight. There are other visible signs to watch for such as redness of the skin, the bluish hue of lips, fingers, and toes, swollen feet or hands, fatigue, and any labored breathing.
The laboratory and imaging tests that can help pinpoint the diagnosis include an arterial blood gas test, chest X-ray, a computerized tomography scan, lung function tests, and a possible sleep study.
1. Arterial Blood Gas Test
This form of blood test is conducted to diagnose any daytime hypercapnia by measuring the carbon dioxide levels. Obesity hypoventilation syndrome shows when mercury levels are higher than 45 millimeters.
2. Chest Radiograph
A chest X-ray will detect any heart failure signs and chest wall deformities.
The results of this test will highlight any damage to the heart ventricles or arrhythmias.
4. Pulmonary Function Test
This lung test can help see if there is any blockage of the airway passage or any lung capacity reduction.
5. Sleep Study
The doctor many have you do an overnight polysomnography, where you sleep in a specialized sleep lab, hooked up to monitors for the night. A nocturnal pulse oximetry test, another common test to diagnose obstructive sleep apnea, is also conducted at this time to measure your oxygen levels and heart rate.
Treating Obesity Hypoventilation Syndrome
Obesity hypoventilation syndrome treatment focuses on improving your breathing ability and weight loss. Treatment may also include medication and therapy.
1. Breathing Support
Treatment will first focus on a breathing support management plan to get breathing under control and give the patient a comfortable state of mind and body with the use of mechanical devices. One is positive airway pressure treatment, and the other is a ventilator.
Positive airway pressure treatment is used to help balance the oxygen and carbon dioxide levels in the bloodstream. It keeps the airway passages open by using air pressure. By allowing a sufficient amount of oxygen to flow, it can alleviate any daytime sleepiness. For more serious cases, you may require a continuous positive airway pressure treatment, which alters the air pressure as you breathe.
Ventilator treatment is used if you require hospital care. The machine forces oxygen into the lungs while it removes excess carbon dioxide. You will have an easier flow of breathing, and oxygen can be added if required.
Additional therapy using oxygen may be required but is rarely used in modern days, as it can suppress breathing ability. During breathing treatment, your doctor will advise you not to drink alcohol and take any medication that could hinder your breathing ability.
2. Weight Loss
Once your breathing is under control, the focus will then turn to weight loss. However, this is not an overnight expectation, and it goes further than just cutting out junk food and fats. As with all weight loss programs, the best and healthiest results come from lifestyle changes which include following a diet plan outlined by a professional nutritionist or dietician and a regular exercise routine.
Since there is no set ideal weight for successful treatment of obesity hypoventilation syndrome, you will be monitored over the months while you lose weight. For those people in medical need of weight loss, your doctor may recommend medication or surgery to help lose the weight. These are options only for those patients with severe sleep apnea and whose Body Mass Index is higher than 35. Also, they must not have any other major health conditions that could increase the risk of a complicated surgery.
Depending on the severity of the condition and any risk of life-threatening symptoms, the doctor may prescribe certain medications for treating obesity hypoventilation syndrome. This can involve changing existing medications that may hinder your treatment, or may include a prescription for obesity hypoventilation syndrome. Know what can counteract all medications you may be taking as substances such as narcotics, alcohol, and sedatives can have negative effects.
Dealing with obesity hypoventilation syndrome can be a living nightmare, especially if you have the added condition of obstructive sleep apnea. It is important to note any accompanying symptoms to your labored breathing, as there are closely linked conditions that present the same symptoms. A medical diagnosis is the key to knowing what the best treatment is for you.
Since breathing problems have a link to obesity, the tough job of losing the pounds needs to be forefront in your mind. Surround yourself with a good support system of family, friends, and a knowledgeable medical team.
“How Is Obesity Hypoventilation Syndrome Treated?” National Heart, Lung and Blood Institute; https://www.nhlbi.nih.gov/health/health-topics/topics/ohs/treatment, last accessed May 3, 2017.
Havens, Kristen, “What is Obesity Hypoventilation Syndrome? (Diagnosis and Treatment)” Sound Sleep Health, March 3, 2017; https://www.soundsleephealth.com/blog/what-is-obesity-hypoventilation-syndrome-diagnosis-and-treatment, last accessed May 3, 2017.
“Obesity Hypoventilation Syndrome (OHS),” Medline Plus; https://medlineplus.gov/ency/article/000085.htm, last accessed May 3, 2017.