OSA results in multiple episodes of interrupted breathing (apnea and hypopnea) during sleep, which leads to alveolar hypoventilation. The continued removal of carbon dioxide from the blood is dependent on adequate ventilation.VA also can be reduced when an increase in physiologic dead-space ratio (ie, the dead-space gas volume-to-tidal gas volume [VD/VT] ratio) occurs. [Guideline] Global Initiative for Chronic Obstructive Lung Disease (GOLD).
Other disorders that may cause hypoventilation should be ruled out …
Patients also may have abnormal diaphragm function secondary to muscular fatigue and muscular mechanical disadvantage from hyperinflation.The frequency of hypoventilation syndromes varies with the underlying cause of hypoventilation. Banerjee D, Yee BJ, Piper AJ, Zwillich CW, Grunstein RR.
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The degree of nocturnal desaturation is correlated with the degree of diaphragm dysfunction.
Practice parameters for the indications for polysomnography and related procedures: an update for 2005.
David Lacomis, in Office Practice of Neurology (Second Edition), 2003.
These include obesity-hypoventilation syndrome, restrictive thoracic disorders, central sleep apnoea syndromes, and COPD. I have read and accept the Wiley Online Library Terms and Conditions of UseWho was the first to use the term Pickwickian in connection with sleepy patients? 2011 May.
ALVEOLAR HYPOVENTILATION. Lyons HA, Huang CT. Nocturnal mechanical ventilation improves nocturnal hypoventilation and daytime arterial blood gases in these patients.Hypoventilation in patients with COPD is secondary to multiple mechanisms. http://www.medscape.com/viewarticle/937151
Central sleep apnea: Pathophysiology and treatment. These patients usually are asymptomatic until the late stages of disease, when the most severe deformity of the spine has occurred.Patients with neuromuscular disorders have a reduced vital capacity and expiratory reserve volume secondary to respiratory muscle weakness. These patients have been shown to have a decreased responsiveness to carbon dioxide rebreathing, hypoxia, or both.In patients with chest wall deformities, hypoventilation develops secondary to decreased chest wall compliance, with a resultant decreased tidal volume. If you log out, you will be required to enter your username and password the next time you visit.
Ventilatory failure on acute take. The obesity hypoventilation syndrome (OHS) has become widely recognized as a major cause of acute and chronic ventilatory failure in the last two decades. 139(5):1018-24.
This gas exchange includes delivery of oxygen to the capillary bed and elimination of carbon dioxide from the bloodstream.
Features of the syndrome were described as early as the 19th century,The OHS is a common indication for home non‐invasive positive pressure ventilation (NIV) therapyThe OHS is managed by weight reduction and positive airways pressure therapy. 2001
Metabolic production of carbon dioxide occurs rapidly. The generation of respiratory impulses can be impaired in congenital disorders, such as central congenital alveolar hypoventilation, in alterations of the brain stem or complex diseases like obesity hypoventilation. Many patients with OHS are prescribed home NIV because therapy is initiated during an episode of acute ventilatory failure, hypercapnia is severe or continuous positive airways pressure (CPAP) therapy is regarded inadequate on the basis of monitoring over a single night. The metabolism of fats and carbohydrates leads to the formation of a large amount of carbon dioxide, which combines with water to form carbonic acid (HVentilation is influenced and regulated by chemoreceptors for PaCOHypoventilation and oxygen desaturation deteriorate during sleep secondary to a decrement in ventilatory response to hypoxia and increased PaCOThe respiratory system serves a dual purpose: delivering oxygen to the pulmonary capillary bed from the environment and eliminating carbon dioxide from the bloodstream by removing it from the pulmonary capillary bed.