Rabec Claudio, Janssens Jean-Paul, Murphy Patrick B
Division of Pulmonary Diseases, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
Hôpital de La Tour, Centre Cardio-respiratoire, Geneva, Switzerland.
Eur Respir Rev. 2025 May 14;34(176). doi: 10.1183/16000617.0190-2024. Print 2025 Apr.
Obesity can have profound adverse effects on the respiratory system, including an impact on pulmonary function, respiratory mechanics, respiratory muscle strength and endurance, gas exchange, control of breathing, and exercise capacity. Lung mechanics are modified by increased pleural pressure resulting from increased abdominal mass and subsequent peripheral airway occlusion and worsening of lung compliance due to reduced functional residual capacity without impairment of chest wall compliance. Arterial blood gases are frequently altered in these subjects and these abnormalities are directly proportional to body mass index. Mechanisms that may account for gas exchange abnormalities are multiple: ventilation/perfusion inequality (responsible for isolated hypoxaemia) and alveolar hypoventilation (responsible for so-called "obesity hypoventilation syndrome" (OHS)). Hypoventilation in obese patients results from a diversity of mechanisms, among which the two most frequently raised are mechanical limitation and blunted ventilatory drive. OHS is frequently underappreciated and diagnosis is frequently made during a first acute exacerbation. Obstructive sleep apnoea is a condition frequently associated with obesity and must be systematically screened for in this population because of its impact on morbidity and therapeutic management. Ventilatory management of these patients will depend on the patient's underlying situation, clinical presentation and physiology, including sleep study results; it may include continuous positive airway pressure or non-invasive ventilation. The goal of this narrative review is to provide a physiological-based overview of the impact of obesity on the respiratory system with a special focus on ventilatory management of patients with obesity-related respiratory disturbances.
肥胖会对呼吸系统产生深远的不利影响，包括对肺功能、呼吸力学、呼吸肌力量和耐力、气体交换、呼吸控制及运动能力的影响。肺力学因腹部质量增加导致胸膜压力升高、外周气道阻塞以及功能残气量减少致使肺顺应性恶化（而胸壁顺应性未受损）而发生改变。这些受试者的动脉血气经常发生变化，且这些异常与体重指数成正比。可能导致气体交换异常的机制有多种：通气/灌注不均（导致单纯性低氧血症）和肺泡通气不足（导致所谓的“肥胖低通气综合征”（OHS））。肥胖患者的通气不足由多种机制引起，其中最常提及的两种是机械性限制和通气驱动减弱。OHS常常未得到充分认识，诊断往往在首次急性加重期作出。阻塞性睡眠呼吸暂停是一种常与肥胖相关的病症，鉴于其对发病率和治疗管理的影响，必须对该人群进行系统筛查。这些患者的通气管理将取决于患者的基础状况、临床表现和生理学情况，包括睡眠研究结果；可能包括持续气道正压通气或无创通气。本叙述性综述的目的是基于生理学概述肥胖对呼吸系统的影响，特别关注肥胖相关呼吸障碍患者的通气管理。
