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Screening of Sleep Breathing Disorders in Morbid Obesity
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A3970 - Screening of Sleep Breathing Disorders in Morbid Obesity
Author Block: E. Perger1, J. Aron-Wisnewsky2, C. Philippe1, I. Arnulf1, J. Oppert2, S. Redolfi3; 1Service de Pathologies du Sommeil, Groupe Hospitalier Pitié-Salpêtrière, Paris, France, 2Service de Nutrition, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris, France, 3Service de Pathologies du Sommeil, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris, France.
Rationale: Sleep breathing disorders (SDB) are common in morbid obesity (body mass index, BMI ≥40 kg/m2), particularly obstructive sleep apnea (OSA). The association of obesity, OSA and diurnal hypoventilation defines the obesity-hypoventilation syndrome (OHS). OSA and OHS are associated with systemic inflammation, endothelial dysfunction, insulin resistance, increased cardiovascular and metabolic diseases, leading to increased morbidity and mortality compared to obese subjects without SDB. Therefore, the early diagnosis and optimal treatment are necessary to avoid cardiometabolic consequences. We aimed at identifying the best diagnostic approach of SDB among subjects with morbid obesity.
Methods: Patients hospitalized for more than 24h at the Nutrition Service of the Pitié-Salpêtrière Hospital due to obesity underwent systematized ventilatory polygraphy (VP) and arterial blood gases (ABG) as part of standard evaluation. All patients affected by morbid obesity with an oxygen desaturation index (ODI) >30/h at the VP without diurnal hypoventilation (PaCO2 ≤45 mmHg at the ABG) underwent a polysomnography (PSG) including a transcutaneous monitoring of the carbone dioxide (PtcCO2) at the Sleep Disorders Unit of the same hospital.
Results: Between Mai and October 2017, 19 patients were evaluated at the Sleep Disorder Service (5 males, age mean ± standard deviation 48 ± 13 years, BMI 47 ± 44 kg/m2, PV apnea-hypopnea index AHI 44 ± 24/h, ODI 56 ± 24/h ). The PSG confirmed the presence of severe OSA (AHI>30) in only 10 patients (53%; hence 47% false positive) whereas 6 patients (32%, not diagnosed) had nocturnal hypoventilation (defined as PtcCO2 increase more than 55mmHg for >10 minutes or more than 10mmHg compared to the awake PtcCO2).
Conclusions: The assessment of SDB with PV is insufficient as a screening of SDB among morbidly obese subjects, as it yields a high prevalence of false positive diagnosis of OSA and of misdiagnosis of nocturnal hypoventilation, which may evolve in OHS. A more exhaustive examination including PSG with PtcCO2 monitoring is needed for a correct diagnosis. These first results need to be confirmed on larger populations.
Author Block: E. Perger1, J. Aron-Wisnewsky2, C. Philippe1, I. Arnulf1, J. Oppert2, S. Redolfi3; 1Service de Pathologies du Sommeil, Groupe Hospitalier Pitié-Salpêtrière, Paris, France, 2Service de Nutrition, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris, France, 3Service de Pathologies du Sommeil, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris, France.
Rationale: Sleep breathing disorders (SDB) are common in morbid obesity (body mass index, BMI ≥40 kg/m2), particularly obstructive sleep apnea (OSA). The association of obesity, OSA and diurnal hypoventilation defines the obesity-hypoventilation syndrome (OHS). OSA and OHS are associated with systemic inflammation, endothelial dysfunction, insulin resistance, increased cardiovascular and metabolic diseases, leading to increased morbidity and mortality compared to obese subjects without SDB. Therefore, the early diagnosis and optimal treatment are necessary to avoid cardiometabolic consequences. We aimed at identifying the best diagnostic approach of SDB among subjects with morbid obesity.
Methods: Patients hospitalized for more than 24h at the Nutrition Service of the Pitié-Salpêtrière Hospital due to obesity underwent systematized ventilatory polygraphy (VP) and arterial blood gases (ABG) as part of standard evaluation. All patients affected by morbid obesity with an oxygen desaturation index (ODI) >30/h at the VP without diurnal hypoventilation (PaCO2 ≤45 mmHg at the ABG) underwent a polysomnography (PSG) including a transcutaneous monitoring of the carbone dioxide (PtcCO2) at the Sleep Disorders Unit of the same hospital.
Results: Between Mai and October 2017, 19 patients were evaluated at the Sleep Disorder Service (5 males, age mean ± standard deviation 48 ± 13 years, BMI 47 ± 44 kg/m2, PV apnea-hypopnea index AHI 44 ± 24/h, ODI 56 ± 24/h ). The PSG confirmed the presence of severe OSA (AHI>30) in only 10 patients (53%; hence 47% false positive) whereas 6 patients (32%, not diagnosed) had nocturnal hypoventilation (defined as PtcCO2 increase more than 55mmHg for >10 minutes or more than 10mmHg compared to the awake PtcCO2).
Conclusions: The assessment of SDB with PV is insufficient as a screening of SDB among morbidly obese subjects, as it yields a high prevalence of false positive diagnosis of OSA and of misdiagnosis of nocturnal hypoventilation, which may evolve in OHS. A more exhaustive examination including PSG with PtcCO2 monitoring is needed for a correct diagnosis. These first results need to be confirmed on larger populations.
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