Skip to main content

Abstract

Eucapnic obesity may be associated with an augmented chemosensitivity which represents a compensatory response to mass loading of the respiratory system. Yet, a small subset of obese subjects who develop daytime hypercapnia demonstrates a blunted respiratory drive. Although secondary to nocturnal hypoventilation and the subsequent development of daytime hypercapnia, this blunted chemosensitivity contributes to the establishment and maintenance of daytime hypercapnia.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Verbraecken J, McNicholas WT. Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation. Respir Res. 2013;14:132.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lin CK, Lin CC. Work of breathing and respiratory drive in obesity. Respirology. 2012;17:402–11.

    Article  PubMed  Google Scholar 

  3. Lopata M, Onal E. Mass loading, sleep apnea, and the pathogenesis of obesity hypoventilation. Am Rev Respir Dis. 1982;126:640–5.

    CAS  PubMed  Google Scholar 

  4. Sampson MG, Grassino AE. Load compensation in obese patients during quiet tidal breathing. J Appl Physiol. 1983;55:1269–76.

    CAS  PubMed  Google Scholar 

  5. Burki NK, Baker RW. Ventilatory regulation in eucapnic morbid obesity. Am Rev Respir Dis. 1984;129:538–43.

    CAS  PubMed  Google Scholar 

  6. Campo A, Frühbeck G, Zulueta JJ, Iriarte J, Seijo LM, Alcaide AB, Galdiz JB, Salvador J. Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients. Eur Respir J. 2007;30:223–31.

    Article  CAS  PubMed  Google Scholar 

  7. Steier J, Jolley CJ, Seymour J, Roughton M, Polkey MI, Moxham J. Neural respiratory drive in obesity. Thorax. 2009;64:719–25.

    Article  CAS  PubMed  Google Scholar 

  8. Chlif M, Keochkerian D, Choquet D, Vaidie A, Ahmaidi S. Effects of obesity on breathing pattern, ventilatory neural drive and mechanics. Respir Biol Neurobiol. 2009;168:198–202.

    Article  Google Scholar 

  9. Raurich JM, Rialp G, Ibáñez J, Llompart-Pou JA, Ayestarán I. Hypercapnic respiratory failure in obesity-hypoventilation syndrome: CO2 response and acetazolamide treatment effects. Respir Care. 2010;55:1442–8.

    PubMed  Google Scholar 

  10. de Lucas-Ramos P, de Miguel-Díez J, Santacruz-Siminiani A, González-Moro JM, Buendía-García MJ, Izquierdo-Alonso JL. Benefits at 1 year of nocturnal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Respir Med. 2004;98:961–7.

    Article  PubMed  Google Scholar 

  11. Lopata M, Pearle JL. Diaphragmatic EMG and occlusion pressure response to elastic loading during CO2 rebreathing in humans. J Appl Physiol Respir Environ Exerc Physiol. 1980;49:669–75.

    CAS  PubMed  Google Scholar 

  12. Shekleton M, Lopata M, Evanich MJ, Lourenço RV. Effect of elastic loading on mouth occlusion pressure during CO2 rebreathing in man. Am Rev Respir Dis. 1976;114:341–6.

    CAS  PubMed  Google Scholar 

  13. Hussain SN, Pardy RL, Dempsey JA. Mechanical impedance as determinant of inspiratory neural drive during exercise in humans. J Appl Physiol. 1985;59:365–75.

    CAS  PubMed  Google Scholar 

  14. Babb TG. Obesity: challenges to ventilatory control during exercise. A brief review. Respir Physiol Neurobiol. 2013;189:364–70.

    Article  PubMed  Google Scholar 

  15. DiMarco AF, Kelsen SG, Cherniack NS, Hough WH, Gothe B. Effects on breathing of selective restriction of movement of the rib cage and abdomen. J Appl Physiol. 1981;50:412–20.

    CAS  PubMed  Google Scholar 

  16. Sampson MG, Grassino K. Neuromechanical properties in obese patients during carbon dioxide rebreathing. Am J Med. 1983;75:81–90.

    Article  CAS  PubMed  Google Scholar 

  17. El Gamal H, Khayat A, Shikora S, Unterborn JN. Relationship of dyspnea to respiratory drive and pulmonary function tests in obese patients before and after weight loss. Chest. 2005;128:3870–4.

    Article  PubMed  Google Scholar 

  18. Benlloch E, Cordero P, Morales P, Soler JJ, Macián V. Ventilatory pattern at rest and response to hypercapnic stimulation in patients with obstructive sleep apnea syndrome. Respiration. 1995;62:4–9.

    Article  CAS  PubMed  Google Scholar 

  19. Verbraecken J, De Backer W, Willemen M, De Cock W, Wittesaele W, Heyning V d. Chronic CO2 drive in patients with obstructive sleep apnea and effect of CPAP. Respir Physiol. 1995;101:279–87.

    Article  CAS  PubMed  Google Scholar 

  20. Makinodan K, Yoshikawa M, Fukuoka A, Tamaki S, Koyama N, Yamauchi M, Tomoda K, Hamada K, Kimura H. Effect of serum leptin levels on hypercapnic ventilatory response in obstructive sleep apnea. Respiration. 2008;75:257–64.

    Article  CAS  PubMed  Google Scholar 

  21. Wang D, Grunstein RR, Teichtahl H. Association between ventilatory response to hypercapnia and obstructive sleep apnea-hypopnea index in asymptomatic subjects. Sleep Breath. 2007;11:103–8.

    Article  PubMed  Google Scholar 

  22. Hedner JA, Wilcox I, Laks L, Grunstein RR, Sullivan CE. A specific and potent pressor effect of hypoxia in patients with sleep apnea. Am Rev Respir Dis. 1992;146:1240–5.

    Article  CAS  PubMed  Google Scholar 

  23. Garay SM, Rapoport D, Sorkin B, Epstein H, Feinberg I, Goldring RM. Regulation of ventilation in the obstructive sleep apnea syndrome. Am Rev Respir Dis. 1981;124:451–7.

    CAS  PubMed  Google Scholar 

  24. Breskovic T, Valic Z, Lipp A, Heusser K, Ivancev V, Tank J, Dzamonja G, Jordan J, Shoemaker JK, Eterovic D, Dujic Z. Peripheral chemoreflex regulation of sympathetic vasomotor tone in apnea divers. Clin Auton Res. 2010;20:57–63.

    Article  PubMed  Google Scholar 

  25. Foster GE, Hanly PJ, Ostrowski M, Poulin MJ. Ventilatory and cerebrovascular responses to hypercapnia in patients with obstructive sleep apnoea: effect of CPAP therapy. Respir Physiol Neurobiol. 2009;165:73–81.

    Article  PubMed  Google Scholar 

  26. Narkiewicz K, van de Borne PJ, Pesek CA, Dyken ME, Montano N, Somers VK. Selective potentiation of peripheral chemoreflex sensitivity in obstructive sleep apnea. Circulation. 1999;99:1183–9.

    Article  CAS  PubMed  Google Scholar 

  27. Rajagopal KR, Abbrecht PH, Tellis CJ. Control of breathing in obstructive sleep apnea. Chest. 1984;85:174–80.

    Article  CAS  PubMed  Google Scholar 

  28. Jordan AS, Wellman A, Edwards JK, Schory K, Dover L, MacDonald M, Patel SR, Fogel RB, Malhotra A, White DP. Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea. J Appl Physiol. 2005;99:2020–7.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wellman A, Jordan AS, Malhotra A, Fogel RB, Katz ES, Schory K, Edwards JK, White DP. Ventilatory control and airway anatomy in obstructive sleep apnea. Am J Respir Crit Care Med. 2004;170:1225–32.

    Article  PubMed  Google Scholar 

  30. White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005;172:1363–70.

    Article  PubMed  Google Scholar 

  31. Kronenberg RS, Gabel RA, Severinghaus JW. Normal chemoreceptor function in obesity before and after ileal bypass surgery to force weight reduction. Am J Med. 1975;59:349–53.

    Article  CAS  PubMed  Google Scholar 

  32. Nishibayashi Y, Kimura H, Maruyama R, Ohyabu Y, Masuyama H, Honda Y. Differences in ventilatory responses to hypoxia and hypercapnia between normal and judo athletes with moderate obesity. Eur J Appl Physiol. 1987;56:144–50.

    Article  CAS  Google Scholar 

  33. Ge RL, Stone JA, Levine BD, Babb TG. Exaggerated respiratory chemosensitivity and association with SaO2 level at 3568 m in obesity. Respir Physiol Neurobiol. 2005;146:47–54.

    Article  CAS  PubMed  Google Scholar 

  34. Kunitomo F, Kimura H, Tatsumi K, Kuriyama T, Watanabe S, Honda Y. Sex differences in awake ventilatory drive and abnormal breathing during sleep in eucapnic obesity. Chest. 1988;93:968–76.

    Article  CAS  PubMed  Google Scholar 

  35. Chapman KR, Himal HS, Rebuck AS. Ventilatory responses to hypercapnia and hypoxia in patients with eucapnic morbid obesity before and after weight loss. Clin Sci. 1990;78:541–5.

    Article  CAS  PubMed  Google Scholar 

  36. Narkiewicz K, Kato M, Pesek CA, Somers VK. Human obesity is characterized by a selective potentiation of central chemoreflex sensitivity. Hypertension. 1999;33:1153–8.

    Article  CAS  PubMed  Google Scholar 

  37. Buyse B, Markou N, Cauberghs M, van Klaveren R, Muls E, Demedts M. Effect of obesity and/or sleep apnea on chemosensitivity: differences between men and women. Respir Physiol Neurobiol. 2003;134:13–22.

    Article  PubMed  Google Scholar 

  38. Regensteiner JG, Woodard WD, Hagerman DD, Weil JV, Pickett CK, Bender PR, Moore LG. Combined effects of female hormones and metabolic rate on ventilatory drives in women. J Appl Physiol (1985). 1989;66:808–13.

    CAS  Google Scholar 

  39. Sin DD, Jones RL, Man GC. Hypercapnic ventilatory response in patients with and without obstructive sleep apnea: do age, gender, obesity, and daytime PaCO(2) matter? Chest. 2000;117:454–9.

    Article  CAS  PubMed  Google Scholar 

  40. Yuan H, et al. Ventilatory responses to hypercapnia during wakefulness and sleep in obese adolescents with and without obstructive sleep apnea syndrome. Sleep. 2012;35:1257–67.

    PubMed  PubMed Central  Google Scholar 

  41. Gold AR, Schwartz AR, Wise RA, Smith PL. Pulmonary function and respiratory chemosensitivity in moderately obese patients with sleep apnea. Chest. 1993;103:1325–9.

    Article  CAS  PubMed  Google Scholar 

  42. Leech J, Onal E, Aronson R, Lopata M. Voluntary hyperventilation in obesity hypoventilation. Chest. 1991;100:1334–8.

    Article  CAS  PubMed  Google Scholar 

  43. Zwillich CW, Sutton FD, Pierson DJ, Greagh EM, Weil JV. Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome. Am J Med. 1975;59:343–8.

    Article  CAS  PubMed  Google Scholar 

  44. Lourenco RV. Diaphragm activity in obesity. J Clin Invest. 1969;48:1609–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Jahavery S, Colangelo G, Corser B, Zahedpour MR. Familial respiratory chemosensitivity does not predict hypercapnia of patients with sleep apnea-hypopnea syndrome. Am Rev Respir Dis. 1992;145:837–40.

    Article  Google Scholar 

  46. Jokic R, Zintel T, Sridhar G, Gallagher CG, Fitzpatrick MF. Ventilatory responses to hypercapnia and hypoxia in relatives of patients with the obesity hypoventilation syndrome. Thorax. 2000;55:940–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Lin CC. Effect of nasal CPAP on ventilatory drive in normocapnic and hypercapnic patients with obstructive sleep apnoea syndrome. Eur Respir J. 1994;7:2005–10.

    CAS  PubMed  Google Scholar 

  48. Han F, Chen E, Wei H, He Q, Ding D, Strohl KP. Treatment effects on carbon dioxide retention in patients with obstructive sleep apnea-hypopnea syndrome. Chest. 2001;119:1814–9.

    Article  CAS  PubMed  Google Scholar 

  49. Chouri-Pontarollo N, Borel JC, Tamisier R, Wuyam B, Levy P, Pépin JL. Impaired objective daytime vigilance in obesity-hypoventilation syndrome: impact of noninvasive ventilation. Chest. 2007;131:148–55.

    Article  PubMed  Google Scholar 

  50. Javaheri S, Simbarti LA. Respiratory determinants of diurnal hypercapnia in obesity hypoventilation syndrome. Ann Am Thorac Soc. 2014;11:945–50.

    Article  PubMed  Google Scholar 

  51. Berger KI, Ayappa I, Sorkin IB, Norman RG, Rapoport DM, Goldring RM. Postevent ventilation as a function of CO(2) load during respiratory events in obstructive sleep apnea. J Appl Physiol. 2002;93:917–24.

    Article  PubMed  Google Scholar 

  52. Ayappa A, Berger KI, Norman RG, Oppenheimer BW, Rapoport DM, Goldring RM. Hypercapnia and ventilatory periodicity in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2002;166:1112–5.

    Article  PubMed  Google Scholar 

  53. Javaheri S, Kazemi H. Metabolic alkalosis and hypoventilation in humans. Am Rev Respir Dis. 1987;136:1011–6.

    Article  CAS  PubMed  Google Scholar 

  54. Javaheri S, Colangelo G, Lacey W, Gartside PS. Chronic hypercapnia in obstructive sleep apnea-hypopnea syndrome. Sleep. 1994;17:416–23.

    Article  CAS  PubMed  Google Scholar 

  55. Norman RG, Goldring RM, Clain JM, Oppenheimer BW, Charney AN, Rapoport DM, Berger KI. Transition from acute to chronic hypercapnia in patients with periodic breathing: predictions from a computer model. J Appl Physiol. 2006;100:1733–41.

    Article  CAS  PubMed  Google Scholar 

  56. Piper AJ, Grunstein RR. Big breathing: the complex interaction of obesity, hypoventilation, weight loss, and respiratory function. J Appl Physiol. 2010;108:199–205.

    Article  PubMed  Google Scholar 

  57. Weil JV, Byrne-Quinn E, Sodal IE, Filley GF, Grover RF. Acquired attenuation of chemoreceptor function in chronically hypoxic man at high altitude. J Clin Invest. 1971;50:186–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Hlavac MC, Catcheside PG, McDonald R, Eckert DJ, Windler S, McEvoy RD. Hypoxia impairs the arousal response to external resistive loading and airway occlusion during sleep. Sleep. 2006;29:624–31.

    PubMed  Google Scholar 

  59. Hollier CA, Harmer AR, Maxwell LJ, Menadue C, Willson GN, Unger G, Flunt D, Black DA, Piper AJ. Moderate concentrations of supplemental oxygen worsen hypercapnia in obesity hypoventilation syndrome: a randomised crossover study. Thorax. 2014;69:346–53.

    Article  PubMed  Google Scholar 

  60. Sutton FD Jr, Zwillich CW, Creagh CE, Pierson DJ, Weil JV. Progesterone for outpatient treatment of Pickwickian syndrome. Ann Intern Med. 1975;83:476–9.

    Article  PubMed  Google Scholar 

  61. Skatroud JB, Dempsey JA. Relative effectiveness of acetazolamide versus medroxyprogesterone acetate in correction of chronic carbon dioxide retention. Am Rev Respir Dis. 1983;127:405–12.

    Article  Google Scholar 

  62. Tojima H, Kunitomo F, Kimura H, Tatsumi K, Kuriyama T, Honda Y. Effects of acetazolamide in patients with the sleep apnoea syndrome. Thorax. 1988;43:113–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Whyte KF, Gould GA, Airlie MA, Shapiro CM, Douglas NJ. Role of protriptyline and acetazolamide in the sleep apnea/hypopnea syndrome. Sleep. 1988;11:463–72.

    Article  CAS  PubMed  Google Scholar 

  64. Bassi M, Furuya WI, Zoccal DB, et al. Control of respiratory and cardiovascular functions by leptin. Life Sci. 2015;125:25–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Phipps PR, Starritt E, Caterson I, Grunstein RR. Association of serum leptin with hypoventilation in human obesity. Thorax. 2002;57:75–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Shimura R, Tatsumi K, Nakamura A, Kasahara Y, Tanabe N, Takiguchi Y, Kuriyama T. Fat accumulation, leptin, and hypercapnia in obstructive sleep apnea-hypopnea syndrome. Chest. 2005;127:543–9.

    Article  CAS  PubMed  Google Scholar 

  67. Yee BJ, Cheung J, Phipps P, Banerjee D, Piper AJ, Grunstein RR. Treatment of obesity hypoventilation syndrome and serum leptin. Respiration. 2006;73:209–12.

    Article  CAS  PubMed  Google Scholar 

  68. Caro JF, Kolaczynski JW, Nyce MR, Ohannesian JP, Opentanova I, Goldman WH, Lynn RB, Zhang PL, Sinha MK, Considine RV. Decreased cerebrospinal-fluid/serum leptin ratio in obesity: a possible mechanism for leptin resistance. Lancet. 1996;348:159–61.

    Article  CAS  PubMed  Google Scholar 

  69. Redolfi S, Corda L, La Piana G, Spandrio S, Prometti P, Tantucci C. Long-term non-invasive ventilation increases chemosensitivity and leptin in obesity-hypoventilation syndrome. Respir Med. 2007;101:1191–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nikolaos Markou M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Markou, N., Stefanatou, H., Kanakaki, M. (2018). Control of Ventilation in Obesity. In: Esquinas, A., Lemyze, M. (eds) Mechanical Ventilation in the Critically Ill Obese Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-49253-7_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-49253-7_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-49252-0

  • Online ISBN: 978-3-319-49253-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics