Dr Aidin Rawshani

Breathing problems in obesity and overweight


The reason that obese people often develop respiratory problems is still something of a mystery. Breathing disorders range from simple shortness of breath to a potentially life-threatening condition called obesity hypoventilation syndrome (OHS).

Obesity hypoventilation syndrome also called Pickwickian syndrome. This pathological condition affects only people with obesity or overweight. The higher the BMI increases the risk of developing respiratory problems. The syndrome leads to a decrease in oxygen in the blood while the gas carbon dioxide accumulates in the blood. Without treatment, it can lead to serious and even life-threatening health problems.

Diabetes and respiratory problems

Diabetes contributes to impaired lung function in several ways. Elevated blood sugar levels (HbA1c) affect the blood vessels in the lung tissue. Several people with diabetes also have reduced sensitivity to insulin (insulin resistance), which in turn negatively affects blood vessels and at the same time affects areas of the brain that control sleep and breathing.

Obesity Hypoventilation Syndrome (OHS)

It is so far unknown why obesity hypoventilation syndrome affects some people who have obesity and not others. Extra fat on the neck, chest or over the abdomen can make it difficult to breathe deeply and can produce hormones that affect the body’s breathing pattern. You may also have problems with how your brain controls your breathing. Most people who have obesity hypoventilation syndrome also have sleep apnea.

You can help prevent this condition by maintaining a healthy weight. If you have been diagnosed with obesity, your doctor may examine oxygen or carbon dioxide levels in your blood to exclude any effect on breathing.

If you have obesity hypoventilation syndrome, you may feel tired or sleepy during the day, experience headaches or shortness of breath. You or someone around you may notice that you often snore loudly, gasp or have difficulty breathing at night. Your symptoms may get worse over time. Complications of obesity hypoventilation syndrome include high blood pressure in small blood vessels that supply the lung tissue with blood, heart failure and elevated blood counts.

Symptoms in OHS

  • Poor Sleep quality
  • Sleep apnea
  • Fatigue feeling during the daytime
  • Depression
  • Headache

Diagnosing respiratory problems

To diagnose obesity hypoventilation syndrome, your doctor will perform a physical examination to measure your weight and height, calculate the body mass index (BMI), and measure the circumference of your waist and neck. Your doctor may perform other tests such as lung function tests, sleep studies, chest X-ray or measure various gases in the blood (arterial blood gas). Other blood tests can help exclude other causes or be used to plan your treatment. In several cases, ultrasound examination of the heart (echocardiography) is also performed during the simultaneous examination of OHS.

The definition of OHS

Obesity hypoventilation syndrome is defined as a combination of obesity (BMI above 30 kg/m2), falling oxygen levels in the blood (hypoxemia) during sleep and increased carbon dioxide levels in the blood (hypercapnia) during the day arising from slow or superficial breathing (hypoventilation). The disease has been known since the 1950s, originally as “Pickwickian syndrome”.


If you are diagnosed with obesity hypoventilation syndrome, your doctor may recommend healthy lifestyle changes, such as striving for a healthy weight and being physically active. You may also need a continuous positive airway pressure (CPAP) machine or other breathing devices to keep the airways open and increase the oxygen levels in the blood. Other treatments may include obesity surgery (obesity surgery) or medicines.

Preventing complications in OHS

To prevent complications, use your CPAP device as directed and proceed with healthy lifestyle changes. Tell your doctor about new signs and symptoms, such as swelling around the ankle, chest pain, dizziness or wheezing. Talk to your doctor if you are going to fly or need surgery, as these situations may increase the risk of serious complications.

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