Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]
Overview
Differential Diagnosis
Epidemiology and Demographics
Prevalence
The prevalence of sleep-related hypoventilation is unknown of the overall population.[1]
Risk Factors
- Central nervous system depressants intake (e.g. benzodiazepines, opioid, alcohol)
- Hypothiroidism
- Neuromuscular or chest wall disorder
- Pulmonary disorder[1]
Natural History, Complications and Prognosis
Prognosis
Poor prognostic criteria include:
- Central nervous system depressants intake (e.g. benzodiazepines, opioid, alcohol)
- Hypothiroidism
- Neuromuscular or chest wall disorder
Diagnostic Criteria
DSM-V Diagnostic Criteria for Paranoid Personality Disorder[1]
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- A. Polysomnograpy demonstrates episodes of decreased respiration associated with elevated CO2 levels.
(Note: In the absence of objective measurement of CO2, persistent low levels of hemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.)
- B. The disturbance is not better explained by another current sleep disorder.
Specify whether:
- Idiopathic hiypoventilation: This subtype is not attributable to any readily identified condition.
- Congenital central alveolar hypoventilation: This subtype is a rare congenital disorder in which the individual typically presents in the perinatal period with shallow breathing, or cyanosis and apnea during sleep.
- Comorbid sleep-related hypoventilation: This subtype occurs as a consequence of a medical condition, such as a pulmonary disorder (e.g., interstitial lung disease, chronic obstructive pulmonary disease) or a neuromuscular or chest wall disorder (e.g., muscular dystrophies, postpolio syndrome, cervical spinal cord injury, kyphoscoliosis), or medications (e.g., benzodiazepines, opiates). It also occurs with obesity (obesity hypoventilation disorder), where it reflects a combination of increased work of breathing due to reduced chest wall compliance and ventilation-perfusion mismatch and variably reduced ventilatory drive. Such individuals usually are characterized by body mass index of greater than 30 and hypercapnia during wakefulness (with a PCO2 of greater than 45), without other evidence of hypoventilation.
Specify current severity:
- Severity is graded according to the degree of hypoxemia and hypercarbia present during sleep and evidence of end organ impairment due to these abnormalities (e.g., right sided heart failure). The presence of blood gas abnormalities during wakefulness is an indicator of greater severity.
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References
- ↑ 1.0 1.1 1.2 1.3 1.4 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
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