• The Obesity Hypoventilation Syndrome
• The physiologic interaction between sleep apnea and cardiovascular dysfunction
• Mechanisms leading to alveolar hypoventilation
• Therapy of sleep-disordered breathing: compliance and outcome

• Zwillich CW. Is untreated sleep apnea a contributing factor for chronic hypertension? JAMA, April 12, 283(14), 2000.

• Nowbar S, Burkart K, Zwillich CW. Hypoventilation among obese inpatients: A common and under-diagnosed problem. (Submitted)

• Burkart K, Nowbar S, Zwillich CW. The obesity hypoventilation syndrome: High death rates following hospital discharge. (Submitted)

Obesity is epidemic in the US population where 58 percent of men and 54 percent of women are overweight. We now recognize that obesity can have a profound impact on breathing where individuals with obstructive sleep apnea suffer the direct effect of excess body weight on their ability to breath during sleep. Significant weight reduction may be curative for such individuals who can suffer from hypertension, daytime sleepiness, and an increased risk for heart attacks because of their frequent apneic episodes.

Severe obesity with body weight 1.5 to 2 times normal is present in about seven percent of hospitalized patients on Internal Medicine wards. One third of these individuals have severe respiratory failure which is life threatening. This illness called the obesity hypoventilation syndrome appears to result from the effects of mechanical loading of extreme obesity on breathing coupled with the patients’ inability to reflexly increase their respiratory drive. Our recent studies have demonstrated that 25 percent of such individuals die within 18 months of hospital discharge. Fortunately, new forms of therapy have emerged which may play a pivotal role in improving this otherwise dismal outcome. Future studies are aimed at determining if non-invasive masked ventilation applied at home while asleep may improve the alarming outcome in this illness.

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