eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity: Follow-up

Author: Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Coauthor(s): Gila Hertz, PhD, ABSM, Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook
Contributor Information and Disclosures

Updated: Nov 25, 2008

Follow-up

Further Inpatient Care

  • Obesity has been linked to metabolic syndrome, with a prevalence that increases with advancing degrees of obesity. This high prevalence warrants consideration in children who are obese, both inpatient and follow-up care.
  • Cardiovascular risk factors, including evaluation of blood pressure, should be assessed.

Further Outpatient Care

Patients receiving noninvasive nocturnal ventilatory support should be monitored for the following:

  • Compliance
  • Need for changes in pressure support
  • Need for changes in mask size
  • Complications and adverse effects of treatment
  • Recurrence or progression of symptoms

Inpatient & Outpatient Medications

  • Medications may be required for the treatment of comorbidities of obesity, which include hypertension, dyslipidemia, and metabolic syndrome.
  • An increased incidence of asthma has been seen in children who are obese. Management guidelines for asthma are outlined in the United States Department of Health and Human Services National Asthma Education and Prevention Program Expert Panel Report and 2007 Update.8

Deterrence/Prevention

  • Childhood and adolescent obesity are both associated with an increased incidence of adult obesity.
  • Good nutrition is a deterrent.
  • Physical activity is a deterrent.

Complications

  • In children with apnea, an increased risk of postoperative complications following relief of upper airway obstruction is observed when the patient history includes young age (<2-3 y), morbid obesity, hypotonia, cor pulmonale, or severe obstructive sleep apnea (OSA). In such patients, strongly consider cardiorespiratory monitoring in a pediatric recovery or special care unit. Postoperative pulmonary edema may be observed.

Prognosis

  • Sustained weight loss is difficult. The cardiovascular consequences of obesity include dysrhythmias, right ventricular hypertrophy, and congestive heart failure. Children with obesity have an increased incidence of asthma, and exercise tolerance may be limited. Results of pulmonary function testing in children with obesity vary.

Patient Education

  • Education about pediatric sleep disorders is limited in US medical schools. Attempts are underway to improve awareness of sleep disorders and their impact on the health of children with obesity.
  • For excellent patient education resources, visit eMedicine's Sleep Disorders Center. Also, see eMedicine's patient education article Disorders That Disrupt Sleep (Parasomnias).
  • The introduction of continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation for children with OSA may benefit from the gradual introduction of ventilatory support beginning with lower that effective pressures initially and working up to effective pressure. Behavioral modification techniques have been helpful, particularly in young children and in children with developmental delay.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose
  • Failure to diagnose comorbid conditions (eg, thyroid disease, diabetes)
  • Failure to evaluate and diagnose potential complications (eg, cor pulmonale, systemic hypertension)
  • Failure to appropriately treat
  • Failure to anticipate risks (eg, increased risk of postoperative complications following an adenotonsillectomy for obstructive sleep apnea [OSA] in children with morbid obesity)

Special Concerns

  • Rhodes data show decreased academic performance. Consider this diagnosis when evaluating a child who has obesity and a learning disability.
 


More on Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity

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Differential Diagnoses & Workup: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
Treatment & Medication: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
Follow-up: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
Multimedia: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
References
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References

  1. Shields M. Overweight and obesity among children and youth. Health Rep. Aug 2006;17(3):27-42. [Medline].

  2. Eneli I, Dele Davis H. Epidemiology of Childhood Obesity. In: Dele Davis H. Obesity in Childhood & Adolescence. Vol 1. Westport, CT: Praeger Perspectives; 2008:3-19.

  3. Rosen CL. Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol. Jun 1999;27(6):403-9. [Medline].

  4. Mallory GB Jr, Fiser DH, Jackson R. Sleep-associated breathing disorders in morbidly obese children and adolescents. J Pediatr. Dec 1989;115(6):892-7. [Medline].

  5. Fung KP, Lau SP, Chow OK, Lee J, Wong TW. Effects of overweight on lung function. Arch Dis Child. May 1990;65(5):512-5. [Medline].

  6. Biring MS, Lewis MI, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. Nov 1999;318(5):293-7. [Medline].

  7. Inselma LS, Milanese A, Deurloo A. Effect of obesity on pulmonary function in children. Pediatr Pulmonol. Aug 1993;16(2):130-7. [Medline].

  8. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol. Nov 2007;120(5 Suppl):S94-138. [Medline].

  9. Coleman J. Disordered breathing during sleep in newborns, infants, and children. Symptoms, diagnosis, and treatment. Otolaryngol Clin North Am. Apr 1999;32(2):211-22. [Medline].

  10. Erler T, Paditz E. Obstructive sleep apnea syndrome in children: a state-of-the-art review. Treat Respir Med. 2004;3(2):107-22. [Medline].

  11. Goble M. Medical and Psychological Complications of Obesity. In: Dele Davis H (ed). Obesity in Childhood & Adolescence. Westport, CT: Praeger Perspectives; 2008:229-257.

  12. Han F, Chen E, Wei H, He Q, Ding D, Strohl KP. Treatment effects on carbon dioxide retention in patients with obstructive sleep apnea-hypopnea syndrome. Chest. Jun 2001;119(6):1814-9. [Medline].

  13. Hudgel DW, Thanakitcharu S. Pharmacologic treatment of sleep-disordered breathing. Am J Respir Crit Care Med. Sep 1998;158(3):691-9. [Medline].

  14. Levy P, Pepin JL, Arnaud C, et al. Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives. Eur Respir J. Oct 2008;32(4):1082-95. [Medline].

  15. Marcus CL, Curtis S, Koerner CB, et al. Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol. Mar 1996;21(3):176-83. [Medline].

  16. Marcus CL, Gozal D, Arens R, et al. Ventilatory responses during wakefulness in children with obstructive sleep apnea. Am J Respir Crit Care Med. Mar 1994;149(3 Pt 1):715-21. [Medline].

  17. Perkin RM, Downey R 3rd, Macquarrie J. Sleep-disordered breathing in infants and children. Respir Care Clin N Am. Sep 1999;5(3):395-426, viii. [Medline].

  18. Rhodes SK, Shimoda KC, Waid LR, et al. Neurocognitive deficits in morbidly obese children with obstructive sleep apnea. J Pediatr. Nov 1995;127(5):741-4. [Medline].

  19. Schonfeld-Warden N, Warden CH. Pediatric obesity. An overview of etiology and treatment. Pediatr Clin North Am. Apr 1997;44(2):339-61. [Medline].

  20. Silvestri JM, Weese-Mayer DE, Bass MT, et al. Polysomnography in obese children with a history of sleep-associated breathing disorders. Pediatr Pulmonol. Aug 1993;16(2):124-9. [Medline].

  21. Strauss R. Childhood obesity. Curr Probl Pediatr. Jan 1999;29(1):1-29. [Medline].

  22. Tantisira KG, Litonjua AA, Weiss ST, et al. Association of body mass with pulmonary function in the Childhood Asthma Management Program (CAMP). Thorax. Dec 2003;58(12):1036-41. [Medline].

  23. Zwillich CW, Sutton FD, Pierson DJ, et al. Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome. Am J Med. Sep 1975;59(3):343-8. [Medline].

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Further Reading

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Keywords

obesity, hypoventilation syndrome, Pickwick syndrome, pickwickian syndrome, obstructive sleep apnea/hypoventilation, OSA/H, obstructive sleep apnea, hypoventilation, sleep-disordered breathing, hypercarbia, excessive daytime sleepiness, hyperactivity, cor pulmonale, failure to thrive, mental retardation, tonsillar hypertrophy, diabetes, hypertension, gallstones, hypercholesterolemia, reactive airways, poor exercise tolerance, increased work of breathing, increased oxygen consumption, right-sided heart failure, upper respiratory infections, snoring, parasomnias, chronic mouth breathing, asthma, short stature, developmental delay, macroglossia, retrognathia, micrognathia, high-arched palate, thoracic kyphosis, pectus excavatum, scoliosis, abdominal obesity, ankle edema, congestive heart failure

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Contributor Information and Disclosures

Author

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Coauthor(s)

Gila Hertz, PhD, ABSM, Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook
Gila Hertz, PhD, ABSM is a member of the following medical societies: American Academy of Sleep Medicine and American Psychological Association
Disclosure: Nothing to disclose.

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis Center
Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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