• Sogol Nowbar, Kristin M Burkart, Ralph Gonzales, Andrew Fedorowicz, Wendolyn S Gozansky, Jon C Gaudio, Matthew R G Taylor, and Clifford W Zwillich.
• University of Colorado Health Sciences Center, Denver, Colorado, USA.
• Am. J. Med. 2004 Jan 1; 116 (1): 171-7.

BackgroundSevere 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.MethodsConsecutive admissions to internal medicine services were screened over a 6-month period. In all eligible subjects with severe obesity (body mass index > or =35 kg/m2), 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.ResultsOf 4,332 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 [PaCO2], 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 PaCO2, 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].ConclusionHypoventilation frequently complicates severe obesity among hospitalized adults and is associated with excess morbidity and mortality.

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