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Obesity-Associated hypoventilation in hospitalized patients: prevalence, effects, and outcome

2003; Elsevier BV; Volume: 116; Issue: 1 Linguagem: Inglês

10.1016/j.amjmed.2003.08.022

1555-7162

Sogol Nowbar, Kristin M. Burkart, Ralph Gonzales, Andrew Fedorowicz, Wendolyn S. Gozansky, Jon C Gaudio, Matthew R.G. Taylor, Clifford W. Zwillich,

Respiratory Support and Mechanisms

Abstract Background Severe obesity is associated with hypoventilation, a disorder that may adversely affect morbidity and mortality. We sought to determine the prevalence and effects of obesity-associated hypoventilation in hospitalized patients. Methods Consecutive admissions to internal medicine services were screened over a 6-month period. In all eligible subjects with severe obesity (body mass index ≥35 kg/m 2 ), we administered a sleep questionnaire, and performed neuropsychological, arterial blood gas, and pulmonary function testing. Hospital course and mortality at 18 months was also determined. Results Of 4332 admissions, 6% (n = 277) of patients were severely obese, of whom 150 were enrolled, 75 refused to participate, and 52 met the exclusion criteria. Hypoventilation (mean [± SD] arterial partial pressure of carbon dioxide [PaCO 2 ], 52 ± 7 mm Hg) was present in 31% (n = 47) of subjects who did not have other reasons for hypercapnia. Decreased objective attention/concentration and increased subjective sleepiness were present in patients with obesity-associated hypoventilation compared with in severely obese hospitalized patients without hypoventilation (simple obesity group; mean PaCO 2 , 37 ± 6 mm Hg). There were higher rates of intensive care ( P = 0.08), long-term care at discharge ( P = 0.01), and mechanical ventilation ( P = 0.01) among subjects with obesity-associated hypoventilation. Therapy for hypoventilation at discharge was initiated in only 6 (13%) of the patients with obesity-associated hypoventilation. At 18 months following hospital discharge, mortality was 23% in the obesity-associated hypoventilation group as compared with 9% in the simple obesity group (hazard ratio=4.0; 95% confidence interval: 1.5 to 10.4]. Conclusion Hypoventilation frequently complicates severe obesity among hospitalized adults and is associated with excess morbidity and mortality.