Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hypoventilation Syndromes

  • Author: Jazeela Fayyaz, DO; Chief Editor: Ryland P Byrd, Jr, MD  more...
 
Updated: Feb 25, 2015
 

Background

Alveolar hypoventilation is caused by several disorders that are collectively referred as hypoventilation syndromes. Alveolar hypoventilation is defined as insufficient ventilation leading to hypercapnia, which is an increase in the partial pressure of carbon dioxide as measured by arterial blood gas analysis (PaCO2).[1] (See Etiology.)

Patients who hypoventilate may develop clinically significant hypoxemia, and the presence of hypoxemia along with hypercapnia aggravates the clinical manifestations seen with hypoventilation syndromes. Alveolar hypoventilation may be acute or chronic and may be caused by several mechanisms. (See Etiology and Presentation.)

The specific hypoventilation syndromes discussed in this article include the following (See Etiology, Presentation, Workup, Treatment, and Medication):

  • Central alveolar hypoventilation
  • Obesity hypoventilation syndrome (OHS)
  • Chest wall deformities
  • Neuromuscular disorders
  • Chronic obstructive pulmonary disease (COPD)

Central alveolar hypoventilation

The phrase "central alveolar hypoventilation" is used to describe patients with alveolar hypoventilation secondary to an underlying neurologic disease. Causes of central alveolar hypoventilation include drugs and central nervous system (CNS) diseases such as cerebrovascular accidents, trauma, and neoplasms.

Obesity hypoventilation syndrome

OHS is another well-known cause of hypoventilation. Abnormal central ventilatory drive and obesity contribute to the development of OHS. OHS is defined as a combination of obesity, a body mass index greater than or equal to 30kg/m2 with awake chronic hypercapnia (PaCO2 >45 mm Hg), and sleep-disordered breathing. Other disorders that may cause hypoventilation should be ruled out first. Approximately 90% of patients with OHS also have obstructive sleep apnea (OSA).[2] Hypoventilation is worse during rapid eye movement (REM) sleep than during non-REM sleep.

Chest wall deformities

Chest wall deformities such as kyphoscoliosis, fibrothorax, and those occurring postthoracoplasty are associated with alveolar hypoventilation leading to respiratory insufficiency and respiratory failure.

Neuromuscular disorders

Neuromuscular diseases that can cause alveolar hypoventilation include myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, and muscular dystrophy. Patients with neuromuscular disorders have rapid, shallow breathing secondary to severe muscle weakness or abnormal motor neuron function.

The central respiratory drive is maintained in patients with neuromuscular disorders. Thus, hypoventilation is secondary to respiratory muscle weakness. Patients with neuromuscular disorders have nocturnal desaturations that are most prevalent in the REM stage of sleep. The degree of nocturnal desaturation is correlated with the degree of diaphragm dysfunction. The nocturnal desaturations may precede the onset of daytime hypoventilation and gas exchange abnormalities.

Chronic obstructive pulmonary disease

Hypoventilation is not uncommon in patients with severe COPD. Alveolar hypoventilation in COPD usually does not occur unless the forced expiratory volume in 1 second (FEV1) is less than 1L or 35% of the predicted value. However, many patients with severe airflow obstruction do not develop hypoventilation. Therefore, other factors, such as abnormal control of ventilation, genetic predisposition, and respiratory muscle weakness, are likely to contribute.

Respiratory physiology

The respiratory control system tightly regulates ventilation. Alveolar ventilation (VA) is under the control of the central respiratory centers, which are located in the ventral aspects of the pons and medulla. The control of ventilation has metabolic and voluntary neural components. The metabolic component is spontaneous and receives chemical and neural stimuli from the chest wall and lung parenchyma and receives chemical stimuli from the blood levels of carbon dioxide and oxygen.

Metabolism rapidly generates a large quantity of volatile acid (carbon dioxide) and nonvolatile acid in the body. 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 (H2 CO3). The lungs excrete the volatile fraction via ventilation. Therefore, acid accumulation does not occur. PaCO2 is tightly maintained in a range of 39-41 mm Hg in normal states.

Ventilation is influenced and regulated by chemoreceptors for PaCO2, PaO2, and pH, located in the brainstem; by neural impulses from lung stretch receptors; and by impulses from the cerebral cortex. Failure of any of these mechanisms results in a state of hypoventilation and hypercapnia.

Hypoventilation and sleep

Hypoventilation and oxygen desaturation deteriorate during sleep secondary to a decrement in ventilatory response to hypoxia and increased PaCO2. In addition, diminished muscle tone develops during REM sleep, which further exacerbates hypoventilation secondary to insufficient respiratory effort.

Next

Etiology

The 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. Metabolic production of carbon dioxide occurs rapidly. Thus, a failure of ventilation promptly increases PaCO2.

Hypoventilation may be secondary to several mechanisms, including central respiratory drive depression, neuromuscular disorders, chest wall abnormalities, obesity hypoventilation, and COPD. The specific causes can be summarized as follows:

  • COPD - Emphysema, chronic bronchitis
  • Neuromuscular disorders [3] - Amyotrophic lateral sclerosis, muscular dystrophies (Duchenne and Becker dystrophies), diaphragm paralysis, Guillain-Barré syndrome, myasthenia gravis
  • Chest wall deformities - Kyphoscoliosis, fibrothorax, thoracoplasty
  • Central respiratory drive depression - Drugs (narcotics, benzodiazepines, barbiturates), neurologic disorders (encephalitis, brainstem disease, trauma, poliomyelitis, multiple sclerosis), primary alveolar hypoventilation
  • Obesity hypoventilation syndrome (OHS)
  • Carotid body resection and/or injury
  • Myxedema (severe hypothyroidism)

Gas exchange abnormalities

The alveoli are perfused by venous blood flow from the pulmonary capillary bed and participate in gas exchange. This gas exchange includes delivery of oxygen to the capillary bed and elimination of carbon dioxide from the bloodstream. The continued removal of carbon dioxide from the blood is dependent on adequate ventilation.

The relationship between ventilation and PaCO2 can be expressed as PaCO2 = (k)(VCO2)/VA, in which VCO2 is the metabolic production of carbon dioxide (ie, venous carbon dioxide production), k is a constant, and VA is alveolar ventilation. Therefore, in alveolar hypoventilation, PaCO2 increases as the VA decreases. Because the alveolus is a limited space, an increase in PaCO2 leads to a decrease in oxygen, with resultant hypoxemia.

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. Physiologic dead space occurs when an increase in ventilation to poorly perfused alveoli occurs. An increase in physiologic dead space results in a ventilation-perfusion mismatch, which, in classic presentation, occurs in patients with COPD.

The effect of physiologic dead space on alveolar hypoventilation can be expressed in the equation PaCO2 = (k)(VCO2)/VE(1 - VD/VT), in which VE (ie, expired volume) is the total expired ventilation and 1 - VD/VT measures the portion of ventilation directly involved in gas exchange. An increase in the physiologic dead space without an augmentation in ventilation leads to alveolar hypoventilation and an increased PaCO2.

Primary and central alveolar hypoventilation

Patients with primary alveolar hypoventilation can voluntarily hyperventilate and normalize their PaCO2. These patients are unable to centrally integrate chemoreceptor signals, although the peripheral chemoreceptors appear to function normally.

Congenital central hypoventilation syndrome

Hypoventilation may be caused by depression of the central respiratory drive. Congenital central hypoventilation syndrome (CCHS), previously known as Ondine curse, is defined as the failure of automatic control of breathing. It generally presents in newborns and, in 90% of the cases, is caused by a polyalanine repeat expansion mutation in the PHOX2B gene. Patients heterozygous for PHOX2B may have milder forms of the disease and live into adulthood.[4]

CCHS may occur in association with Hirschsprung disease. In addition, patients with CCHS are at increased risk for neuroblastoma and ganglioneuroma.[4]

These patients have absent or minimal ventilatory response to hypercapnia and hypoxemia during sleep and wakefulness. Since these individuals do not develop respiratory distress when challenged with hypercapnia or hypoxia, progressive hypercapnia and hypoxemia occurs during sleep. Ventilation in CCHS patients is more stable during rapid eye movement (REM) sleep than in non-REM sleep.[5]

The diagnosis is established after excluding another cause, either pulmonary, cardiac, metabolic, or neurologic, for central hypoventilation. Patients with CCHS require lifelong ventilatory support during sleep, and some may require 24-hour ventilatory support.

Obesity hypoventilation syndrome

Patients with OHS have a higher incidence of restrictive ventilatory defects when compared with patients who are obese but do not hypoventilate. Studies have shown that patients with obesity hypoventilation syndrome have total lung capacities that are 20% lower and maximal voluntary ventilation that is 40% lower than patients who are obese who do not have hypoventilation.[6]

Patients with OHS demonstrate an excessive work of breathing and an increase in carbon dioxide production. Inspiratory muscle strength and resting tidal volumes also are reported to be decreased in patients with obesity hypoventilation. Pulmonary compliance is lower in patients with OHS when compared with patients who are obese who do not have hypoventilation.

Obesity increases the work of breathing because of reductions in chest wall compliance and respiratory muscle strength. An excessive demand on the respiratory muscles leads to the perception of increased breathing effort and could unmask other associated respiratory and heart diseases.

Leptin deficiency or leptin resistance may also contribute to OHS, by reducing ventilatory responsiveness and leading to carbon dioxide retention.[7]

Despite the above-mentioned physiologic abnormalities, the most important factor in the development of hypoventilation in OHS is likely a defect in the central respiratory control system. These patients have been shown to have a decreased responsiveness to carbon dioxide rebreathing, hypoxia, or both.

Chest wall deformities

In patients with chest wall deformities, hypoventilation develops secondary to decreased chest wall compliance, with a resultant decreased tidal volume. Alveolar dead space is unchanged, but the VD/VT ratio is increased due to the reduced tidal volume.

The most common chest wall abnormality to cause hypoventilation is kyphoscoliosis. It is associated with a decrease in vital capacity and expiratory reserve volume, while the residual volume is only moderately reduced. These patients usually are asymptomatic until the late stages of disease, when the most severe deformity of the spine has occurred.

Neuromuscular disorders

Patients with neuromuscular disorders have a reduced vital capacity and expiratory reserve volume secondary to respiratory muscle weakness. The residual volume is maintained.

The reduction in vital capacity is greater than that which would be expected solely from the underlying respiratory muscle weakness, and these patients are likely to also have a significant reduction in lung and chest wall compliance, which further reduces vital capacity. The reduction in lung and chest wall compliance may be secondary to atelectasis and reduced tissue elasticity. In addition, the VD/VT ratio is increased due to the reduced tidal volume, and this further contributes to hypoventilation.

During sleep, ventilation decreases because of a lessening in respiratory center function. During REM sleep, atonia worsens, thus leading to more severe hypoventilation, particularly when diaphragmatic function is impaired. The effects of atonia are amplified by a low sensitivity of the respiratory centers. Nocturnal mechanical ventilation improves nocturnal hypoventilation and daytime arterial blood gases in these patients.

Chronic obstructive lung disease

Hypoventilation in patients with COPD is secondary to multiple mechanisms. As mentioned previously, these patients usually have severe obstruction, with an FEV1 of less than 1 L or 35% of the predicted value.

Patients with COPD who hypoventilate have a decreased chemical responsiveness to hypoxia and hypercapnia. This decreased chemical responsiveness also is observed in relatives of these patients who do not have COPD, leading researchers to believe that a genetic predisposition to alveolar hypoventilation exists.

These patients have a reduced tidal volume and a rapid, shallow breathing pattern, which leads to an increased VD/VT ratio. Patients also may have abnormal diaphragm function secondary to muscular fatigue and muscular mechanical disadvantage from hyperinflation.

Previous
Next

Epidemiology

Occurrence in the United States

The frequency of hypoventilation syndromes varies with the underlying cause of hypoventilation. The most common of these disorders is chronic obstructive lung disease, which affects more than 14 million people in the United States.

When the prevalence of hypoventilation was studied in 54 stable, hypercapnic COPD patients without concomitant sleep apnea or morbid obesity, it was found that 43% had sleep-related hypoventilation, which was more severe in REM sleep.

Currently, the prevalence of OHS ranges from 10-20%.[8] Data from the US Centers of Disease Control and Prevention (CDC) show that one third of the adult US population is obese. With an increase in the obesity rate, the prevalence of OHS will likely continue to increase.[9]

Sex-related demographics

Primary alveolar hypoventilation occurs more commonly in male patients than in female patients. COPD also occurs more commonly in men than in women; however, because of increased smoking in women, the incidence is increasing in females. OHS is another condition that occurs more commonly in males, with a 2:1 male-to-female ratio.[2]

Age-related demographics

Most patients with hypoventilation syndromes are older. COPD and obesity increase in prevalence with age. Primary alveolar hypoventilation occurs more commonly in early adulthood, but it also occasionally is diagnosed in infancy. Most patients with OHS are older than 50 years.[10]

Previous
Next

Prognosis

The prognosis of patients with hypoventilation syndromes is variable, being dependent on the underlying cause of hypoventilation and the severity of the underlying illness.

The morbidity and mortality rates of patients with hypoventilation syndromes depend on the specific etiology of the hypoventilation. Pulmonary hypertension is more common and more severe in patients with OHS than in those with only obstructive sleep apnea (OSA).

OHS patients have higher rates of ICU admission compared with patients with similar levels of obesity without hypoventilation.[2]

The morbidity and mortality rates of each of the above-mentioned disorders are increased secondary to the presence of respiratory failure and alveolar hypoventilation.

Some of the consequences of hypoventilation, such as cor pulmonale and pulmonary hypertension, may be irreversible.

Studies reported several decades ago showed significant increase in mortality in patients with OHS. This increased mortality is likely secondary to an increased risk of arrhythmias and cardiovascular complications.

Previous
 
 
Contributor Information and Disclosures
Author

Jazeela Fayyaz, DO Pulmonologist, Department of Pulmonology, Unity Hospital

Jazeela Fayyaz, DO is a member of the following medical societies: American College of Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

Ryland P Byrd, Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Acknowledgements

Ryland P Byrd Jr, MD Professor, Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, Program Director of Pulmonary Diseases and Critical Care Medicine Fellowship, East Tennessee State University, James H Quillen College of Medicine; Medical Director of Respiratory Therapy, James H Quillen Veterans Affairs Medical Center

Ryland P Byrd Jr, MD is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society

Disclosure: Nothing to disclose.

Jackie A Hayes, MD, FCCP Clinical Assistant Professor of Medicine, University of Texas Health Science Center at San Antonio; Chief, Pulmonary and Critical Care Medicine, Department of Medicine, Brooke Army Medical Center

Jackie A. Hayes, MD, FCCP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC, FACP, FCCP, DABSM is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. Piper AJ, Yee BJ. Hypoventilation syndromes. Compr Physiol. 2014 Oct 1. 4(4):1639-76. [Medline].

  2. Mokhlesi B, Tulaimat A. Recent advances in obesity hypoventilation syndrome. Chest. 2007 Oct. 132(4):1322-36. [Medline].

  3. Paschoal IA, Villalba Wde O, Pereira MC. Chronic respiratory failure in patients with neuromuscular diseases: diagnosis and treatment. J Bras Pneumol. 2007 Feb. 33(1):81-92. [Medline].

  4. Lesser DJ, Ward SL, Kun SS, Keens TG. Congenital hypoventilation syndromes. Semin Respir Crit Care Med. 2009 Jun. 30(3):339-47. [Medline].

  5. Eckert DJ, Jordan AS, Merchia P, Malhotra A. Central sleep apnea: Pathophysiology and treatment. Chest. 2007 Feb. 131(2):595-607. [Medline]. [Full Text].

  6. Balachandran JS, Masa JF, Mokhlesi B. Obesity Hypoventilation Syndrome Epidemiology and Diagnosis. Sleep Med Clin. 2014 Sep. 9(3):341-347. [Medline]. [Full Text].

  7. Piper AJ, Grunstein RR. Current perspectives on the obesity hypoventilation syndrome. Curr Opin Pulm Med. 2007 Nov. 13(6):490-6. [Medline].

  8. Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans AT. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007 Jun. 11(2):117-24. [Medline].

  9. Powers MA. The obesity hypoventilation syndrome. Respir Care. 2008 Dec. 53(12):1723-30. [Medline].

  10. Weitzenblum E, Kessler R, Canuet M, Chaouat A. [Obesity-hypoventilation syndrome]. Rev Mal Respir. 2008 Apr. 25(4):391-403. [Medline].

  11. Alawami M, Mustafa A, Whyte K, Alkhater M, Bhikoo Z, Pemberton J. Echocardiographic and Electrocardiographic findings in Patients with Obesity Hypoventilation Syndrome. Intern Med J. 2014 Nov 5. [Medline].

  12. [Guideline] Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005 Apr 1. 28(4):499-521. [Medline].

  13. Chen ML, Turkel SB, Jacobson JR, Keens TG. Alcohol use in congenital central hypoventilation syndrome. Pediatr Pulmonol. 2006 Mar. 41(3):283-5. [Medline].

  14. Ozsancak A, D'Ambrosio C, Hill NS. Nocturnal noninvasive ventilation. Chest. 2008 May. 133(5):1275-86. [Medline].

  15. [Guideline] Kushida CA, Littner MR, Hirshkowitz M, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006 Mar 1. 29(3):375-80. [Medline].

  16. [Guideline] Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. National Guidelines Clearinghouse. 2008.

  17. Combs D, Shetty S, Parthasarathy S. Advances in Positive Airway Pressure Treatment Modalities for Hypoventilation Syndromes. Sleep Med Clin. 2014 Sep. 9(3):315-325. [Medline]. [Full Text].

  18. Banerjee D, Yee BJ, Piper AJ, Zwillich CW, Grunstein RR. Obesity hypoventilation syndrome: hypoxemia during continuous positive airway pressure. Chest. 2007 Jun. 131(6):1678-84. [Medline].

  19. Wijesinghe M, Williams M, Perrin K, Weatherall M, Beasley R. The effect of supplemental oxygen on hypercapnia in subjects with obesity-associated hypoventilation: a randomized, crossover, clinical study. Chest. 2011 May. 139(5):1018-24. [Medline].

  20. Lyons HA, Huang CT. Therapeutic use of progesterone in alveolar hypoventilation associated with obesity. Am J Med. 1968 Jun. 44(6):881-8. [Medline].

  21. Morrison DA, Goldman AL. Oral progesterone treatment in chronic obstructive lung disease: failure of voluntary hyperventilation to predict response. Thorax. 1986 Aug. 41(8):616-9. [Medline]. [Full Text].

  22. Johnson W, DeMaria E. Surgical treatment of obesity. Curr Treat Options Gastroenterol. 2006 Apr. 9(2):167-74. [Medline].

  23. Taira T, Takeda N, Itoh K, Oikawa A, Hori T. Phrenic nerve stimulation for diaphragm pacing with a spinal cord stimulator: technical note. Surg Neurol. 2003 Feb. 59(2):128-32; discussion 132. [Medline].

  24. Chen ML, Tablizo MA, Kun S, Keens TG. Diaphragm pacers as a treatment for congenital central hypoventilation syndrome. Expert Rev Med Devices. 2005 Sep. 2(5):577-85. [Medline].

  25. Chakrabarti B, Angus RM. Ventilatory failure on acute take. Clin Med. 2005 Nov-Dec. 5(6):630-4. [Medline].

  26. Adnet F, Plaisance P, Borron SW, Levy A, Payen D. Prolonged severe hypercapnia complicating near fatal asthma in a 35-year-old woman. Intensive Care Med. 1998 Dec. 24(12):1335-8. [Medline].

  27. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999 Aug 1. 22(5):667-89. [Medline].

  28. BaHammam A, Syed S, Al-Mughairy A. Sleep-related breathing disorders in obese patients presenting with acute respiratory failure. Respir Med. 2005 Jun. 99(6):718-25. [Medline].

  29. Caruana-Montaldo B, Gleeson K, Zwillich CW. The control of breathing in clinical practice. Chest. 2000 Jan. 117(1):205-25. [Medline].

  30. Culebras A. Sleep disorders and neuromuscular disease. Semin Neurol. 2005 Mar. 25(1):33-8. [Medline].

  31. De Troyer A, Borenstein S, Cordier R. Analysis of lung volume restriction in patients with respiratory muscle weakness. Thorax. 1980 Aug. 35(8):603-10. [Medline]. [Full Text].

  32. Hoo GW, Hakimian N, Santiago SM. Hypercapnic respiratory failure in COPD patients: response to therapy. Chest. 2000 Jan. 117(1):169-77. [Medline].

  33. Kassirer JP, Madias NE. Respiratory acid-base disorders. Hosp Pract. 1980 Dec. 15(12):57-9, 65-71. [Medline].

  34. Kessler R, Chaouat A, Schinkewitch P, et al. The obesity-hypoventilation syndrome revisited: a prospective study of 34 consecutive cases. Chest. 2001 Aug. 120(2):369-76. [Medline].

  35. Krachman S, Criner GJ. Hypoventilation syndromes. Clin Chest Med. 1998 Mar. 19(1):139-55. [Medline].

  36. Langevin B, Petitjean T, Philit F, Robert D. Nocturnal hypoventilation in chronic respiratory failure (CRF) due to neuromuscular disease. Sleep. 2000 Jun 15. 23 Suppl 4:S204-8. [Medline].

  37. Masa JF, Celli BR, Riesco JA, et al. The obesity hypoventilation syndrome can be treated with noninvasive mechanical ventilation. Chest. 2001 Apr. 119(4):1102-7. [Medline].

  38. Nixon GM, Brouillette RT. Sleep and breathing in Prader-Willi syndrome. Pediatr Pulmonol. 2002 Sep. 34(3):209-17. [Medline].

  39. O'Donoghue FJ, Catcheside PG, Ellis EE, et al. Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors. Eur Respir J. 2003 Jun. 21(6):977-84. [Medline].

  40. Olson AL, Zwillich C. The obesity hypoventilation syndrome. Am J Med. 2005 Sep. 118(9):948-56. [Medline].

  41. Perez de Llano LA, Golpe R, Ortiz Piquer M, Veres Racamonde A, Vazquez Caruncho M, Caballero Muinelos O. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest. 2005 Aug. 128(2):587-94. [Medline].

  42. Perrin C, D'Ambrosio C, White A, Hill NS. Sleep in restrictive and neuromuscular respiratory disorders. Semin Respir Crit Care Med. 2005 Feb. 26(1):117-30. [Medline].

  43. Plant PK, Owen JL, Elliott MW. One year period prevalence study of respiratory acidosis in acute exacerbations of COPD: implications for the provision of non-invasive ventilation and oxygen administration. Thorax. 2000 Jul. 55(7):550-4. [Medline].

  44. Poulain M, Doucet M, Major GC, Drapeau V, Series F, Boulet LP. The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies. CMAJ. 2006 Apr 25. 174(9):1293-9. [Medline].

  45. Schlichtig R, Grogono AW, Severinghaus JW. Current status of acid-base quantitation in physiology and medicine. Anesth Clin North Am. 1998. 16 (1):211-33.

  46. Tuggey JM, Elliott MW. Titration of non-invasive positive pressure ventilation in chronic respiratory failure. Respir Med. 2006 Jul. 100(7):1262-9. [Medline].

  47. Ward S, Chatwin M, Heather S, Simonds AK. Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax. 2005 Dec. 60(12):1019-24. [Medline].

  48. Weitzenblum E, Chaouat A. Sleep and chronic obstructive pulmonary disease. Sleep Med Rev. 2004 Aug. 8(4):281-94. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.