Article information
Abstract
Obesity, well known as a cardiovascular risk factor, can also lead to significant respiratory complications. The respiratory changes associated with obesity extend from a simple change in respiratory function, with no effect on gas exchange, to the more serious condition of hypercapnic respiratory failure, characteristic of obesity hypoventilation syndrome. More recently, it has been reported that there is an increased prevalence of asthma which is probably multifactorial in origin, but in which inflammation may play an important role. Hypoventilation in the obese subject is the result of complex interactions that involve changes in the ventilatory mechanics and anomalies in breathing control. Two other conditions (COPD and sleep apneahypopnea syndrome [SAHS], often present in obese patients, can trigger or aggravate it. The prevalence of hypoventilation in the obese is under-estimated and the diagnosis is usually established during an exacerbation, or when the patient is studied due to suspicion of SAHS. Ventilatory management of these patients, ventilatory management of these patients includes either CPAP or NIV. The choice of one or another will depend on the underlying clinical condition and whether or not there is another comorbidity. Both NIV and CPAP have demonstrated their effectiveness, not only in the control of gas exchange, but also in improving the quality of life and survival of these patients
Keywords:
Obesity
Obesity-hypoventilation syndrome
Non-invasive ventilation
Continuous positive airway pressure
Respiratory failure
Resumen
La obesidad, bien conocida como factor de riesgo cardiovascular, puede asimismo comportar una importante afectación respiratoria. Las alteraciones respiratorias relacionadas con la obesidad abarcan desde la simple alteración de la función ventilatoria, sin consecuencias sobre el intercambio gaseoso, hasta la situación más grave, la insuficiencia respiratoria hipercápnica característica del síndrome de obesidad hipoventilación. Más recientemente se ha señalado la presencia de un incremento de prevalencia de asma de probable etiología multifactorial pero en el que puede desempeñar un papel importante la inflamación. La hipoventilación en el sujeto obeso es el resultado de complejas interacciones que implican a las alteraciones de la mecánica ventilatoria y a anomalías del control ventilatorio. Otras dos entidades (enfermedad pulmonar obstructiva crónica y síndrome de apnea hipopnea del sueño [SAHS]), frecuentemente presentes en los pacientes obesos, pueden potenciarla o agravarla. La prevalencia de hipoventilación en el obeso se encuentra subestimada y es frecuente que el diagnóstico sólo se establezca con motivo de una exacerbación o cuando el paciente es estudiado por sospecha de SAHS. El manejo ventilatorio de estos pacientes, mediante CPAP o ventilación no invasiva (VNI), dependerá de la situación clínica subyacente y de la presencia o no de otra comorbilidad. Tanto la VNI como la CPAP han mostrado su eficacia no sólo en el control de las alteraciones gasométricas, sino también en la mejora de la calidad de vida y en la supervivencia de los pacientes
Palabras clave:
Obesidad
Síndrome obesidad-hipoventilación
Ventilación no invasiva
Presión positiva continua en la vía respiratoria
Insuficiencia respiratoria
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