Steep-related breathing disorders in obese patients presenting with acute respiratory failure

Introduction: The study was conducted to assess the clinical and polysomnographic characteristics of patients with steep-related breathing disorders who presented to the intensive care unit (ICU) with acute respiratory failure and the practicability of performing polysomnography for such patients. Material and methods: We analyzed clinical presentation, cause of admission to the ICU, ICU course and outcome of 11 subjects with acute respiratory failure who were diagnosed to have steep disordered breathing based on polysomnography between October 1999 and January 2003. Subjects were compared to 11 patients with obstructive steep apnea syndrome matched to each subject using body mass index, age and apnea hypopnea index measured at the time of diagnosis (matched comparison group). Repeated arterial blood gases and potysomnography were done for 8 subjects compliant to treatment 6-8 months after discharge from ICU. Results: The reason for ICU admission for all subjects was hypercapnic respiratory failure. pH and daytime PaO2 were significantly tower in studied subjects compared to the matched comparison group white awake daytime PaCO2 was significantly higher. Subjects had frequent episodes of hypoventilation. Follow up arterial blood gases and polysomnography 6-8 months after treatment (non-invasive ventilation) in compliant subjects showed significant improvement in all blood gases parameters. Conclusions: Early potysomnography (or portable cardio-respiratory monitoring) allows accurate diagnosis and institution of the appropriate ventilation method Further studies should assess the evolution of respiratory drive in patients with steep disordered breathing and hypercapnia under therapy (non-invasive ventilation). (c) 2004 Elsevier Ltd. All rights reserved.