38 CLINICAL
Obesity hypoventilation syndrome
Toni Jenkins , an independent bariatric nurse consultant and obesity nurse specialist , discusses how to help obese patients with hypoventilation syndrome
O besity hypoventilation syndrome is a condition in which people with obesity fail to breathe properly , resulting in low oxygen and high carbon dioxide levels in the blood . It is commonly associated with obstructive sleep apnoea hypopnoea syndrome ( OSAHS ), where the upper airway narrows or closes during sleep when muscles relax , causing under breathing ( hypopnoea ) or temporary cessation of breathing ( apnoea ).
The person fully or partially awakes to stop these episodes , leading to disrupted sleep and potentially excessive sleepiness . 1 OSAHS can have a major impact on safety for the patient and those around them .
Practice nurses may be the first clinicians to identify the syndrome by spotting subtle signs during a routine consultation for other reasons . A prompt diagnosis and early management can be vital , with initial issues being physical , psychological or social .
Signs and symptoms of OSAHS The patient may report , or exhibit , any of the following :
‘ Nodding off ’. They may appear drowsy during the consultation or have been asleep in the waiting room . When this happens both adults and children can sometimes be assumed to be slow or inattentive . Clumsiness , including stumbling , bruising and injuries Poor concentration span Depression It is essential to do a full sleep assessment to see if the patient falls into a high-risk category ( or may simply have had bad nights or be caring for a small baby or a new puppy !)
Sometimes the patient ’ s partner may comment on signs and symptoms they have observed 1 including : Snoring Apnoea Nocturia ( waking from sleep to urinate ) Choking during sleep Cognitive dysfunction or memory impairment : ‘ They have a memory like a sieve ’ The patient may additionally complain about : Feeling tired despite sleep Waking with a headache Feeling shattered , exhausted and experiencing tired all the time syndrome ( TATT ) Insomnia or repeated sleep interruptions Some of these symptoms may be related to conditions such as depression , prostate issues and dementia . However , if three or more of the above are present , a patient should be deemed at risk and considered for sleep studies .
Many practice nurses are familiar with obstructive sleep apnoea ( OSA ) and it is easy to assume a patient has OSA . Some patients will self-diagnose and may even purchase a continuous positive airway pressure ( CPAP ) machine . This will help OSA but not OSAHS .
Should we refer or can we help in the community ? Practice nurses ’ experience equips them to discuss appropriate lifestyle changes with people living with OSAHS , including support and advice regarding : Weight management Smoking cessation Reduction in alcohol intake Improving sleep hygiene Ultimately , referral may be needed as the consequences can include : Death from complications associated with hypoventilation apnoea Driving or burning accidents caused by falling asleep High risk during general anaesthesia Poor Covid-19 outcomes
When to refer to sleep services During the Covid-19 pandemic , many services have been reduced or even suspended altogether . Sleep studies always have significant waiting lists and the pandemic has added to this . However , nurses should not be discouraged from referring , especially patients with a history of the following : 1 Obesity or overweight ( especially in pregnancy ) Hypertension that doesn ’ t respond to drug treatment Type 2 diabetes Cardiac arrhythmia Cerebrovascular accident or transient ischaemic attack Chronic heart failure Moderate or severe asthma Polycystic ovary syndrome Down ’ s syndrome ( adults with Down ’ s are predisposed to OSAHS )
Non-arteritic anterior ischaemic optic neuropathy ( sudden unilateral loss of vision due to decreased blood flow to the optic nerve ).
Patients may have to wait and their expectations need to be managed . Patients can be prioritised for urgent referral , but will still require support while they wait .
Toni Jenkins is an independent bariatric nurse consultant and obesity nurse specialist at accredited healthcare training provider ECG Training
Resources and further information
Obesity UK . obesityuk . org . uk
Britsh Obesity and Metabolic Surgery Society . bomss . org
Reference 1 NICE . Obstructive sleep apnoea / hypopnoea syndrome and obesity hypoventilation syndrome in over 16s . 2021 . nice . org . uk / ng202
Online
Go online for the full article with references nursinginpractice . com Winter 2021