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Defining obesity hypoventilation syndrome

Neeraj M. Shah, Sonia Shrimanker, Georgios Kaltsakas
Breathe 2021 17: 210089; DOI: 10.1183/20734735.0089-2021
Neeraj M. Shah
1Lane Fox Respiratory Service, St Thomas’ Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK
2Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK
3Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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  • ORCID record for Neeraj M. Shah
Sonia Shrimanker
1Lane Fox Respiratory Service, St Thomas’ Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK
2Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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Georgios Kaltsakas
1Lane Fox Respiratory Service, St Thomas’ Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK
2Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK
3Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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  • For correspondence: georgios.kaltsakas@gstt.nhs.uk
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    Figure 1

    Evolution of the identification and definition of OHS. AASM: American Academy of Sleep Medicine.

Tables

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  • Table 1

    Staging of hypoventilation in obesity

    0At riskBMI >30 kg·m−2No hypercapnia
    1Obesity-associated sleep hypoventilationBMI >30 kg·m−2Intermittent nocturnal hypercapnia; serum bicarbonate <27 mmol·L−1
    2Obesity-associated sleep hypoventilationBMI >30 kg·m−2Intermittent nocturnal hypercapnia; serum daytime bicarbonate ≥27 mmol·L−1
    3Obesity hypoventilationBMI >30 kg·m−2Sustained daytime hypercapnia (PaCO2 >45 mmHg)
    4Obesity hypoventilation syndromeBMI >30 kg·m−2Sustained daytime hypercapnia with cardiometabolic abnormalities

    Reproduced and modified from [20] with permission.

    • Table 2

      Proposed classification system for obesity hypoventilation syndrome

      MildModerateSevere
      PaCO2 (mmHg)46–6060–80>80
      PaO2 (mmHg)>7060–70<60
      BMI (kg·m−2)30–4040–50>50
      Apnoea/hypopnoea index (events·h−1)<55–15>15
      ComorbiditiesNoNoYes

      Reproduced from [21] with permission.

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      Vol 17 Issue 3 Table of Contents
      Breathe: 17 (3)
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      Defining obesity hypoventilation syndrome
      Neeraj M. Shah, Sonia Shrimanker, Georgios Kaltsakas
      Breathe Sep 2021, 17 (3) 210089; DOI: 10.1183/20734735.0089-2021

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      Defining obesity hypoventilation syndrome
      Neeraj M. Shah, Sonia Shrimanker, Georgios Kaltsakas
      Breathe Sep 2021, 17 (3) 210089; DOI: 10.1183/20734735.0089-2021
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      • Article
        • Abstract
        • Abstract
        • Introduction
        • The problem with OHS
        • Historical descriptions of OHS
        • Current definitions
        • Serum bicarbonate
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        • Summary
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      • Management of difficult-to-treat asthma in adolescence and young adults
      • Respiratory complications of obesity
      • Diagnosis and management of PH in infants with BPD
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