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Pulmonary Disease


Answer 4
  1. Polysomnography. An observed polysomnogram should be ordered to establish the severity of OSA syndrome and the degree of oxygen desaturation. In addition, results of polysomnography can be used to immediately and effectively titrate the positive airway pressure (PAP) to resolve obstructive events and correct the hypoxemia. Approximately half of patients with OHS require oxygen therapy in addition to PAP therapy upon initiation of treatment. Although continuous PAP alone may suffice in about half of cases, BiPAP and, in a significant number of cases, supplemental oxygen may be necessary.7 Supplemental oxygen and furosemide are reasonable options; however, oxygen alone will not alleviate the hypoventilation and obstructive apneas. Furosemide may improve the edema but it will not resolve in the setting of hypoventilation syndrome. There is no role of cardiac catheterization in the absence of ischemia. BiPAP at 10/5 cm H2O may not suffice if started empirically, as the degree of OSA contributing to hypoventilation is unknown and the amount of positive end-expiratory pressure needed to resolve the obstructive component of the disease can only be determined through accurately measuring respiratory effect, airflow, and oxygen saturations, all components of the polysomnogram.

    REFERENCE
    7. Mokhlesi B, Tulaimat A. Recent advances in obesity hypoventilation syndrome. Chest 2007;132:1322–36.

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