Vultur Mara Andreea, Grigorescu Bianca Liana, Huțanu Dragoș, Ianoși Edith Simona, Budin Corina Eugenia, Jimborean Gabriela
Pulmonology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania.
Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania.
Diagnostics (Basel). 2025 Aug 22;15(17):2120. doi: 10.3390/diagnostics15172120.
Obesity Hypoventilation Syndrome (OHS), also known as Pickwickian syndrome, is a complex disorder characterized by obesity (BMI > 30 kg/m), daytime hypercapnia (PaCO ≥ 45 mmHg), and sleep-disordered breathing, primarily affecting individuals with severe obesity. Its diagnosis requires the exclusion of other causes of alveolar hypoventilation and involves comprehensive assessments, including clinical history, physical examination, pulmonary function tests, arterial blood gases, and sleep studies. The pathophysiology of OHS involves mechanical constraints from excessive adipose tissue, diminished central respiratory drive often linked to leptin resistance, mitochondrial dysfunction, and oxidative stress, all contributing to impaired ventilation and systemic inflammation. The condition often coexists with obstructive sleep apnea (OSA), exacerbating nocturnal hypoxia and hypercapnia, which can lead to severe cardiopulmonary complications such as pulmonary hypertension and right-sided heart failure. Epidemiologically, the rising global prevalence of obesity correlates with an increased incidence of OHS, yet underdiagnosis remains a significant challenge, often resulting in critical presentations like acute hypercapnic respiratory failure. Management primarily centers on non-invasive ventilation modalities like CPAP and BiPAP, with an emphasis on individualized treatment plans, continuous monitoring, and addressing comorbidities such as hypertension and diabetes. Pharmacological interventions are still evolving, focusing on supportive care and metabolic regulation. Long-term adherence, psychological factors, and complications like ventilator failure or device intolerance highlight the need for ongoing multidisciplinary management. Overall, advancing our understanding of OHS's multifactorial mechanisms and optimizing tailored therapeutic strategies are crucial for improving patient outcomes and reducing mortality associated with this increasingly prevalent syndrome.
肥胖低通气综合征（OHS），也称为匹克威克综合征，是一种复杂的疾病，其特征为肥胖（BMI>30kg/m）、白天高碳酸血症（PaCO₂≥45mmHg）和睡眠呼吸障碍，主要影响重度肥胖个体。其诊断需要排除肺泡低通气的其他原因，包括临床病史、体格检查、肺功能测试、动脉血气分析和睡眠研究等全面评估。OHS的病理生理学涉及过多脂肪组织的机械性限制、常与瘦素抵抗相关的中枢呼吸驱动力减弱、线粒体功能障碍和氧化应激，所有这些都导致通气受损和全身炎症。该病症常与阻塞性睡眠呼吸暂停（OSA）并存，加剧夜间缺氧和高碳酸血症，可导致严重的心肺并发症，如肺动脉高压和右心衰竭。在流行病学方面，全球肥胖患病率的上升与OHS发病率的增加相关，但漏诊仍然是一项重大挑战，常常导致急性高碳酸血症呼吸衰竭等严重表现。治疗主要以CPAP和BiPAP等无创通气方式为中心，强调个体化治疗方案、持续监测以及处理高血压和糖尿病等合并症。药物干预仍在不断发展，重点是支持治疗和代谢调节。长期依从性、心理因素以及呼吸机故障或设备不耐受等并发症凸显了持续多学科管理的必要性。总体而言，加深我们对OHS多因素机制的理解并优化定制的治疗策略对于改善患者预后和降低与这种日益普遍的综合征相关的死亡率至关重要。
