Indian Journal of Sleep Medicine

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VOLUME 1 , ISSUE 1 ( January-March, 2006 ) > List of Articles


A difficult case of obstructive sleep apnea with obesity hypoventilation syndrome

D. Bhattacharya, S. Chakrabarti

Citation Information : Bhattacharya D, Chakrabarti S. A difficult case of obstructive sleep apnea with obesity hypoventilation syndrome. Indian Sleep Med 2006; 1 (1):58-64.

DOI: 10.5005/ijsm-1-1-58

License: NA

Published Online: 01-07-2011

Copyright Statement:  NA


A middle aged morbidly obese lady with symptoms of obstructive sleep apnea and obesity hypoventilation syndrome was admitted to our hospital emergency in circulatory and Type II respiratory failure. She was resuscitated and put on invasive mechanical ventilation. After extubation she was put on non invasive bilevel positive airway pressure ventilation. Despite two weeks on ventilatory support the patients blood gas did not show significant improvement. The patient was given a trial of oral medroxyprogesterone and aectazolomide with continuation of BiPAP support. By two weeks the patient could be discharged on nocturnal non invasive BiPAP ventilation

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  1. Achincloss JH, Cook E, Renzetti AD. Clinical and physiological aspects of a case of polycythemia and alveolar hypoventilation. J Clin Invest 1955; 34: 1537-45.
  2. Bedell GN, Wilson WR, Seebohm PM: Pulmonary function in obese persons. J Clin INvest 37: 1049-1060, 1958
  3. Alexander JK, Amad KH, Cole Vw: Observatons on some clilnical features of extreme obesity with particular reference to cardiorespiratory effect. Am J Med 32:512-524, 1962'(13-12)
  4. Sampson MG, Grassino A: Neurochemical properties in obese patients during carbon dioxide rebreathing Am J Med 75:81,1983'(14-57)
  5. Zwillich CW, Sutton FD, Pierson DI, et al: Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome. Am J Med 59:343, 1975'(14-71)
  6. Flemmons WW, Whitelaw WA, Brant R, Remmers JE, Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med 1994;150:1279-85.
  7. Sogol Nowbar, MD, Kristin M.Burkart, MD, Ralph Gonzales, MD, Andrew Fedorowicz, MD, Wendolyn S. Gozansky, MD, MPH, Jon C. Gaudio, MD, Matthew R.G. Taylor, MD, Clifford W. Zwillich, Obesity-Associated Hypoventilation in Hospitalized Patients: Prevalence, Effects, and Outcome - MD - Am J Med. 2004: 116:1-7'
  8. Sugerman HJ, Fairman RP, Sood RK, et al. Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 1992; 55(2):597S-601S’
  9. Kessler R, Chaouat A, Schinkewitch P, et al. The obesityhypoventilation syndrome revisited. A prospective study of 34 consecutive cases. Chest 2001: 120:369-76'.
  10. Barrera, I, Hillyer, P, Aneanio, G & Hechtel, J (1973): The distribution of ventilation, diffusion and blood flow in obese patients with normal and abnormal blood gases. Am Rev Respir Dis 108, 819-830'
  11. Bedell. G.N. Wilson W.R & Seebohm. P.M.(1958): Pulmonary function in obese patients J Clin Invest 37, 1049- 1060'
  12. Mac Gregor MI, BLock AJ, Ball WC Serious complications and sudden death in the Pickwickian Syndrome. Hopkins Med J. 1970: 126:279-295'
  13. Miller A, Granada M. In-hospital mortality in the PIckwickian syndrome. Am J Med. 1974; 56:144-150'
  14. Rochester DF, Enson Y. Current concepts in the pathogenesis of the obesity-hypoventilation syndrome. Am J Med. 1974;57:402-420'
  15. Rochester D. Obesity and pulmonary function. In: Alpert MA, alexander JK, editors. The heart and lung in obesity. Armonk, Ny: Futura Publishing Company. Inc; 1998. p.109- 131'
  16. Koenig SM, Suratt PM. Obesity and sleep-disordered breathing. In: Alpert MA, Alexander JK, editors. The heart and lung in obesity. Armonk, NY: Futura Publishing company, Inc; 1998. p.248-279'
  17. The report of an American Academy of Sleep Task Force. Sleep related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Sleep.1999;22:667-635.
  18. Piper AJ. Sullivan CE. Effects of short term NIPPV in the treatment of patients with severe obstructive sleep apnea and hypercapnia. Chest 1994; 105:434-440.
  19. Waldhorn RE. Nocturnal nasal intermittent positive pressure ventilation with bi-level positive airway pressure (BiPAP) in respiratory failure. Chest 1992; 101:516-521',
  20. Schafer H, Ewig S. Hasper E, et al. Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure. Respir Med 1998; 92:208-215'
  21. Pankow W, HIjjesh N, Schuttler F, et al. Influence of noninvasive positive pressure ventilation on inspiratory muscle activity in obese subjects. Eur Repir J 1997; 10:2847-2852'
  22. Luis a. Perez de Llano, MD; Rafael Golpe, MD; Montserrat Ortiz Piquer, MD; Alejandro Veres Racamonde, MD; Manuel Vazquez Caruncho, MD; Olga Caballero Muinelos, RN; and Cristina Alvarez Carro, RN'Short term and Long term effects of nasal intermittent positive pressure ventilation in patients with obesity – Hypoventilation syndrome’. CHEST 2005; 128:587-594.
  23. Skatrud, J.B.J.A.Dempsey, and D.J.Kaiser,. Ventilatory response to medroxyprogesterone acetate in normal subjects; time course and mechanism J.Appl. Physiol. 1978; 44:939-944'
  24. Zwillich, C.W.M.R. Natalino, F.D,.Sutton and J.V. Weil. Effects of progesterone on chemosensitivity in normal men. J.Lab. Clin. Med. 1978;92:262-269'.
  25. Strohl, K.P, N.J.Hensley, N.A.Saunders, S.M.Scharf, R.Brown, and R.H.Ingram. Progesterone administration and progressive sleep apnea J.A.M.A. 1981;245:1230-1232';
  26. Block, A.J., J.M.Wyme, P.G.Boysen, S.Lindsey, c. Martin, and B.Cantor,. Menopausd medroxyprogesterone and breathing during sleep. Am J.Med. 1981;70:506-510;
  27. Rajagopal, K.R., P.H.Abbrecht, and B.Jabbari.. Effects of medroxyprogesterone acetate in obstructive sleep apnea. Chest 1986;90:815-821.
  28. Cook, W.R., J.J.Benich and S.A.Wooten. Indies of severity of obstructive sleep apnea syndrome do not change during medroxyprogesterone acetate therapy. Chest 1989;96:262-266;
  29. Kimura, H., D.Tatsumi, F.Kunitomo. S.Okita, H.Tojima, S.Kouchiyama, S.Masuyama, T.shinozaki, Y.Honda and T.Kuriyama. Progesterone therapy for sleep apnea syndrome evaluated by occlusion pressure response to exogenous loading. Am. rev. Respir. Dis. 1989; 139:1198- 1206;
  30. Cistulli, P.A, D.J.Barnes, R.R.Grunstein, and C.E,.sullivan.. Effect of short term hormone replacement in the treatment of obstructive sleep apnoea in postmenopausal women. Thorax 1994;49;699-702'
  31. Frank D.Sutton. Jr. M.D.Clifford W.zwillich, M.D., C.Edward Creagh, M.D., David. J.Pierson, M.D. and John V.Weh, M.D., Denver, Colorade’. Progesterone for Outpatient Treatment of Pickwickian Syndrome. Annals of Internal Medicine 1975;83:476-479,
  32. White, D.P., C.W.Zwillich, C.K.Picket, N.J.Douglas, J.J.Findley, And J.V.Weil.. Central sleep apnea. Improvement with acetazolamide therapy. Arch. Intern. Med. 1982;142; 1816-1819
  33. DeBacker, W.A., J.Verbraecken, M.Willemen. W.Wittesaele, W.DeCook. and P.Van deHeyning.. Central apnea index decrease after prolonged treatment with acetazolamide. Am. J. Respir, Crit. Care Med. 1995; 151:87- 91
  34. David W. Hudge, and Sitthep Thanakitcharu. Pharmacologic Treatment of Sleep-disordered Breathing’ Am J Respir Crit Care Med. 1998; 158: 691-699.
  35. Nowbar S, Burkhart KM, Gonzales R, et al. Obesity associated hypoventilation in hospitalized patients: prevalence, impact, and outcome. Am J.Med.2004; 116:1- 7.
  36. Berg G, Delaiye K, Manfreda J, et al. The use of health-care resources in obesity hypoventilation syndrome. Chest. 2001;120: 377-383.
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