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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The role of sleep-disordered breathing (SDB) in the development of persistent daytime pulmonary hypertension (PH) and cor pulmonale is controversial and has not been extensively studied. In this review we discuss the physiological changes that occur during SDB in the cardiovascular system, as well as review the most recent literature examining the relationship between SDB and PH/cor pulmonale. The literature suggests that much of the PH and right heart dysfunction seen in SDB is related to concurrent obesity and underlying lung disease, although it does appear that isolated SDB (in the form of obstructive sleep apnea) may be responsible for a small but significant degree of PH. The clinical consequences of this, however, remain unclear.
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PMID:Cardiovascular abnormalities in sleep-disordered breathing. 1608 52

The obesity hypoventilation syndrome, which is defined as a combination of obesity and chronic hypoventilation, utimately results in pulmonary hypertension, cor pulmonale, and probable early mortality. Since the classical description of this syndrome nearly fifty years ago, research has led to a better understanding of the pathophysiologic mechanisms involved in this disease process, and to the development of effective treatment options. However, recent data indicate the obesity hypoventilation syndrome is under-recognized, and under-treated. Because obesity has become a national epidemic, it is critical that physicians are able to recognize and treat obesity-associated diseases. This article reviews current definitions of the obesity hypoventilation syndrome, clinical presentation and diagnosis, present understanding of the pathophysiology, and treatment options.
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PMID:The obesity hypoventilation syndrome. 1720 68

Patients with obstructive sleep apnea provide significant challenges to the perioperative team. This disorder is often undiagnosed and coexists with other disease processes such as hypertension, congestive heart failure, and cor pulmonale. The prevalence of obesity in American society suggests that an increasing number of patients with sleep apnea will present for surgery. During the perioperative period, life-threatening problems can occur during anesthetic induction and emergence. The pathophysiology of obstructive sleep apnea is reviewed here along with the anesthesia implications of this disease process. Members of the perioperative team need to be aware of the implications of sleep apnea so that surgical outcomes can be optimized.
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PMID:The perioperative implications of obstructive sleep apnea. 1703 13

Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent episodes of upper airway obstruction that result in recurrent arousals and episodic oxyhemoglobin desaturations during sleep. Significant clinical consequences of the disorder cover a wide spectrum, including daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, and cor pulmonale. The major risk factors for the disorder include obesity, male gender, and age. Current understanding of the pathophysiologic basis of the disorder suggests that a balance of anatomically imposed mechanical loads and compensatory neuromuscular responses are important in maintaining upper airway patency during sleep. OSA develops in the presence of both elevated mechanical loads on the upper airway and defects in compensatory neuromuscular responses. A sleep history and physical examination is important in identification of patients and appropriate referral for polysomnography. Understanding nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic approaches. Knowledge of common patterns of OSA may help to identify patients and guide therapy.
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PMID:Adult obstructive sleep apnea: pathophysiology and diagnosis. 1762 94

Changes and impairments of the chest wall are associated with skeletal or neuromuscular system illnesses. However, they can lead to significant pulmonary function impairment with the development of respiratory failure and chronic cor pulmonale. These are: kyphoscoliosis, ankylotic spondylitis, sternum deformities, and obesity. Kyphoscoliosis, i.e. curvature of the spinal column in postero-anteral (kyphosis) and lateral (scoliosis) direction is most common. Severe deformity leads to the development of restrictive ventilatory insufficiency, ventilation--perfusion mismatching, diffusion abnormalities and the appearence of hypoxemic respiratory failure, i.e. hypoxamic-hypercapnic failure in the terminal phase of the disease. Associated diseases of the pulmonary parenchyma lead to more rapid progression of respiratory failure. Diagnosis is based on clinical and radiographic findings, pulmonary function tests. Therapy is oxygen and treatment of complications.
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PMID:[Respiratory failure caused by chest wall changes]. 1797 62

The complex nature of interactions between the pulmonary and cardiovascular systems is becoming increasingly appreciated. Pulmonary vascular abnormalities are frequently present in patients with respiratory disorders, including chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, sarcoidosis, neuromuscular or chest wall disorders, and disorders of ventilatory control including sleep apnea syndromes and obesity hypoventilation syndrome. Pulmonary hypertension, classified as group III in the World Health Organization classification scheme for pulmonary hypertension, may result in severe right ventricular dysfunction caused by lung disease, also known as cor pulmonale. The development of cor pulmonale is generally associated with poorer prognosis and increased death. Systemic manifestations of lung disease, particularly obstructive disorders, are also particularly relevant because they are associated with increased cardiac death and impaired health status. This article will discuss the most common pulmonary diseases and disorders of ventilatory control that cause pulmonary vascular abnormalities and cor pulmonale, with particular concentration on how treatment of these diseases may affect the heart. In addition, the complex nature of cardiac and lung disease will also be explored, particularly with respect to the relationship between chronic obstructive pulmonary disease, systemic inflammation, atherosclerosis, and cardiovascular death, which is currently a very active focus of research.
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PMID:Pulmonary diseases and the heart. 1808 41

Both obesity and sleep apnea are prevalent health conditions that frequently coaggregate. Obesity-associated inflammation may influence asthma control; the relation of sleep apnea to asthma or allergic rhinitis may be bidirectional. Both obesity and sleep apnea are associated with augmented levels of inflammation and oxidative stress, and it is biologically plausible that the proinflammatory effects of one disorder influence the expression of the other disorder. This article elucidates mechanistic associations among obesity, sleep apnea, and systemic inflammation; highlights interrelationships between these factors with cardiopulmonary disease; and identifies specific areas for future research directions.
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PMID:Sleep apnea: a proinflammatory disorder that coaggregates with obesity. 1846 82

Hypoventilation can present as the primary manifestation or as a part of the clinical spectrum in a variety of diseases. It often goes unrecognized by clinicians and health care providers, especially if the presentation is subacute. If untreated, it is associated with increased morbidity and mortality. Some of the consequences of hypoventilation (e.g., cor pulmonale and pulmonary hypertension) may be irreversible. It becomes imperative that conditions commonly associated with hypoventilation (e.g., obesity hypoventilation syndrome, muscular dystrophy, and rigid chest wall diseases) be carefully evaluated and appropriate treatment implemented to prevent these complications. The ability to ventilate patients without invasive procedures is now available. These noninvasive therapies can be successfully implemented and are tolerated well by patients. The noninvasive positive pressure ventilation not only improves nocturnal hypoventilation during sleep but may improve muscle strength during the daytime. This review provides an overview of the treatment of hypoventilation in various diseases with emphasis on noninvasive positive pressure therapy. Treatment needs to be individualized to a given patient and the primary pathology. Success is impacted by the experience of the respiratory team caring for the patient.
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PMID:Therapy of hypoventilation. 1945 85

The term "cor pulmonale" is still popular but there is presently no consensual definition and it seems more appropriate to define the condition by the presence of pulmonary hypertension (PH) resulting from diseases affecting the structure and/or the function of the lungs: PH results in right ventricular enlargement and may lead with time to right heart failure (RHF). Chronic obstructive pulmonary disease (COPD) is the first cause of cor pulmonale, far before idiopathic pulmonary fibrosis and obesity-hypoventilation syndrome. In chronic respiratory disease (CRD) PH is "pre-capillary," due to an increase of pulmonary vascular resistance (PVR). The first cause of increased PVR is chronic long-standing alveolar hypoxia which induces pulmonary vascular remodeling. The main characteristic of PH in CRD and particularly in COPD is its mild to moderate degree, resting pulmonary artery mean pressure (PAP) in a stable state of the disease usually ranging between 20 and 35 mmHg. However, PH may worsen during exercise, sleep, and exacerbations of the disease. These acute increases in afterload can favor the development of RHF. A minority (<5%) of COPD patients exhibit severe or "disproportionate" PH (PAP >40 mmHg), the mechanism of which is not well understood. At present long-term oxygen therapy (LTOT) is the logical treatment of PH since alveolar hypoxia is considered to be the major determinant of the elevation of PAP and PVR. LTOT stabilizes or at least attenuates and sometimes reverses the progression of PH, but PAP seldom returns to normal. Vasodilators (prostacyclin, endothelin receptor antagonists, sildenafil, nitric oxide) could be considered in patients with severe PH but controlled studies in this field are presently lacking.
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PMID:Cor pulmonale. 1964 33

Influenza is a seasonal viral infection associated with significant morbidity and mortality. In 2009, a novel H1N1 influenza A virus emerged and has been classified as a pandemic. In contrast to seasonal influenza, severe disease from pandemic H1N1 seems concentrated in older children and young adults, with almost no cases reported in patients older than 60 yrs. Although patients with underlying cardiopulmonary disease remain at risk, most complications have occurred among previously healthy individuals, with obesity and respiratory disease as the strongest risk factors. Pulmonary complications are common. Primary influenza pneumonia occurs most commonly in adults and may progress rapidly to acute lung injury requiring mechanical ventilation. Secondary bacterial infection is more common in children. Staphylococcus aureus, including methicillin-resistant strains, is an important cause of secondary bacterial pneumonia with a high mortality rate. Treatment of pneumonia should include empirical coverage for this pathogen. Neuromuscular and cardiac complications are unusual but may occur.
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PMID:Complications of seasonal and pandemic influenza. 1993 13


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