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Hi, the average man is not going to be able to understand this stuff! Perhaps someone should tone it down from it being a reference text for nuerologists, to something the average human being can understand?? -- 211.28.125.210 07:47, 23 April 2007 (UTC)
PMID 17934118 is a very recent review. Unfortunately this is not available free, and I am therefore working from Olson et al in updating this article. JFW | T@lk 10:24, 20 January 2008 (UTC)
Having access to Mokhlesi's 2007 review, as well as another paper from his hand ( doi: 10.1513/pats.200708-122MG) I am now expanding this article and will hopefully get it up to GA status.
My worklist for each section:
Anyone interested in helping is welcome, as usual. JFW | T@lk 09:24, 23 November 2008 (UTC)
In "mechanism" I'm citing PMID 17901754, but I've only seen the abstract of that review. I've requested the fulltext on WP:WRE to see if the article needs supplementing. Likewise, I need to review Harrison's to see if there is any discrepancy there with our current content.
Images would be nice, but apart from the CPAP machine I'd need to draw some sort of diagram to make this look pretty.
Once this is done, off to GAC it is. JFW | T@lk 16:43, 23 November 2008 (UTC)
Mokhlesi notes: "The optimal management of patients with OHS remains uncertain." However the Wikipedia article states (in the section "Positive airways pressure"): "Positive airway pressure ... is the treatment of choice for obesity hypoventilation syndrome". This is misleading. Weight loss is the initial strategy, in combination with a sleep study to assess the degree of OSA. The majority of patients with OHS also have some degree of OSA, hence a CPAP trial is performed. A proportion of patients do not respond adequately to weight loss and CPAP alone (CO2 remains high), so bilevel ventilation is trialled. Axl ¤ [Talk] 10:03, 1 December 2008 (UTC)
There is some confusion about the significance of morning headaches in sleep-disordered breathing syndromes. Many texts and papers include morning headache as an unusual feature of OSA. This is because morning headache is actually a feature of carbon dioxide retention. McNicholas notes in "Breathing Disorders in Sleep" p. 80: "Carbon dioxide retention is uncommon in pure OSA without some accompanying problem that promotes CO2 retention, such as chronic obstructive pulmonary disease (COPD), morbid obesity, alcoholism, or chronic intoxication with benzodiazepines." [1] (Emphasis mine.) However patients with OSA, CO2 retention and morbid obesity actually have the overlap with OHS. Strumpf in " The Management of Chronic Hypoventilation" notes: "Their earliest symptoms are related to the nocturnal exaggeration of CO2 retention that disrupts normal sleep patterns and causes fretful sleeping, nightmares, enuresis, and morning headaches." [2] Axl ¤ [Talk] 11:17, 3 December 2008 (UTC)
Axl, I only realised later that you had changed the headache bit. Should teach me not to edit Wikipedia after a long day at work. Thanks for fixing all that. I was indeed taught that OSA was linked with morning headaches, by a general physician and subsequently by a respiratory physician running a sleep clinic. Oddly, Harrison's OSA chapter (16th ed, page 1574) doesn't mention headaches, but it is listed as a feature of hypoventilation. So I can only agree with you that I might have been misinformed. Does the McNicholas source make any mention of papilloedema, so we could replace the old BMJ source? JFW | T@lk 09:00, 4 December 2008 (UTC)
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I have looked through a couple more respiratory physiology & sleep textbooks, and I didn't find any mention of papilloedema. The BMJ article is a case report, and references other case reports. Given the rarity of this clinical feature in this setting, I think that it is better to remove papilloedema from the Wikipedia article. Axl ¤ [Talk] 10:41, 4 December 2008 (UTC)
From "Mechanism", paragraph 1: "Firstly, people with obesity need to expend much more energy (about fivefold, or fifteen percent of overall energy consumption) to breathe effectively, as adipose tissue restricts the normal movement of the chest muscles, the diaphragm moves less effectively, the chest wall is less compliant, respiratory muscles are fatigued more easily, and airflow in and out of the lung is impaired." (Emphasis mine.) This long sentence should be simplified. Also, I am unsure where these figures come from. In the ironically named "Handbook of Obesity" (it stretches the meaning of the word "Handbook", all puns intended), p. 726 "Work of breathing can be increased two- to three-fold even in obese eucapnic patients." [1] Axl ¤ [Talk] 09:45, 5 December 2008 (UTC)
From the unoriginally named textbook "Obesity", p. 569 "The mechanical work of breathing is increased by 30% in simple obesity and by three times normal in OHS." [2] This is referenced to the Journal of Clinical Investigation: "Total respiratory work in kilogram-meters per 1 L breath (respiratory rate, 20) measured from tank respirator data averaged 0.073 in the normal subjects, 0.095 in the obese normal subjects, and 0.212 in the O.H. patients." [3]
Axl ¤ [Talk] 10:02, 5 December 2008 (UTC)
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Stop press! Just found another review in Thorax this year. It's actually part of a larger series on obesity and the lung (part 1 epidemiology PMID 18587034, part 2 sleep disordered breathing PMID 18663071, part 3 intensive care PMID 18820119, part 4 asthma PMID 18984817, part 5 COPD PMID 19020276). I will track down the paper and integrate any useful content into the article. JFW | T@lk 11:07, 5 December 2008 (UTC)
I'm starting a review of this article. Looie496 ( talk) 20:07, 14 December 2008 (UTC)
A couple of quick hits. First, the lead needs to be made readable to non-physicians. This article isn't going to be read by doctors, it is going to be read by patients and their friends and relatives, and maybe by high-school or college students. The technical information should be there, but the article should start by explaining the condition in a more user-friendly way. Second, it would be nice to include a picture of Joe the fat boy -- there are lots of public domain editions of Pickwick Papers floating around so this ought to be possible. More to come… Looie496 ( talk) 20:17, 14 December 2008 (UTC)
After a pretty careful reading, I think this is fundamentally a very good article and it won't take all that much to solve the problems. Sourcing looks good, and consistency with MEDMOS is very good in most respects. I see two more issues. First, there are a few cases of unnecessarily medicalized terminology, e.g., "some present to hospital" in Treatment. Second, in Prognosis, there ought to be some information about how likely treatment is to resolve the condition. Looie496 ( talk) 20:37, 14 December 2008 (UTC)
Good enough -- I'm going to pass the article. I still think a picture of "Joe" would be nice, but in looking around I couldn't find a really good one, and there is a danger of offending people if it is not handled carefully. Looie496 ( talk) 17:52, 19 December 2008 (UTC)
Dear all, My English is not good enough to write for the English version of wikipedia and I am already active on the Dutch version of wikipedia. I wanted to point out a new article from the New England Journal of Medicine that states that the CPAP doesn't prevent cardiovascular events. "CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea" I Hope someone can address this correctly in the article and in the article of sleep apnea. Yours Doctodoc ( talk) 12:19, 23 September 2016 (UTC)
doi:10.1177/0885066616663179 - critically ill patients with OHS. JFW | T@lk 10:58, 21 July 2017 (UTC)
doi:10.1164/rccm.201905-1071ST JFW | T@lk 21:22, 22 August 2019 (UTC)
https://www.nice.org.uk/guidance/ng202 JFW | T@lk 20:31, 4 December 2021 (UTC)