Paradoxical worsening of hypoxemia in a patient treated by noninvasive positive pressure ventilation for obesity hypoventilation syndrome with concomitant obstructive sleep apnea: a case report

Abstract : AbstractBackgroundNoninvasive positive pressure ventilation is frequently prescribed to obese patients with obstructive sleep apnea syndrome and obesity hypoventilation syndrome. However, mechanical ventilation with a positive end-expiratory pressure can induce or worsen a right-to-left shunt through a patent foramen ovale associated with systemic hypoxemia. Thus, in obese patients treated with noninvasive positive pressure ventilation, a paradoxical worsening of hypoxemia may reveal the existence of a patent foramen ovale.Case presentationA 50-year-old African woman was referred to our sleep center for severe obstructive sleep apnea syndrome and obesity hypoventilation syndrome. Because she had alveolar hypoventilation and had failed previous obstructive sleep apnea syndrome therapy, noninvasive positive pressure ventilation was started. In May 2015, she had a normal residual apnea/hypopnea index calculated by the ventilator software with no hypoventilation. Six months later, severe hypoxemia without hypercapnia was noted. Contrast transthoracic echocardiography showed right-to-left shunt through a patent foramen ovale. This finding prompted a decrease in expiratory and inspiratory positive airway pressures, after which the ventilator software recorded a normal residual apnea/hypopnea index and the blood gas values improved.ConclusionNoninvasive positive pressure ventilation therapy for combined obstructive sleep apnea syndrome and obesity hypoventilation syndrome must be monitored by arterial blood gas measurements, both to reassess the hypercapnia and to look for worsening hypoxemia due to a patent foramen ovale.
Type de document :
Article dans une revue
Journal of Medical Case Reports, BioMed Central, 2016, 11 (1), pp.234. 〈10.1186/s13256-017-1393-1〉
Liste complète des métadonnées

Littérature citée [12 références]  Voir  Masquer  Télécharger

http://www.hal.inserm.fr/inserm-01577636
Contributeur : Bmc Bmc <>
Soumis le : dimanche 27 août 2017 - 05:20:12
Dernière modification le : mercredi 30 août 2017 - 01:08:30

Fichier

13256_2017_Article_1393.pdf
Publication financée par une institution

Identifiants

Collections

Citation

Carole De Picciotto, Coraline Duménil, Olivier Auzel, Violaine Giraud, Marcel Bonay. Paradoxical worsening of hypoxemia in a patient treated by noninvasive positive pressure ventilation for obesity hypoventilation syndrome with concomitant obstructive sleep apnea: a case report. Journal of Medical Case Reports, BioMed Central, 2016, 11 (1), pp.234. 〈10.1186/s13256-017-1393-1〉. 〈inserm-01577636〉

Partager

Métriques

Consultations de la notice

70

Téléchargements de fichiers

37