Sleep-related hypoventilation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]

Overview

Sleep-related hypoventilation is characterized by decreased respiration episodes, correlated with high CO2 levels and low levels of hemoglobin oxygen saturation. The cause for this condition can be idiopathic, congenital or associated with another medical condition. Moreover, the severity is classified according to the levels of hypoxemia and hypercarbia.

Differential Diagnosis

• Lung diseases
• Skeletal malformations
• Neuromuscular disorders
• Sleep-related hypoxemia
• Obstructive sleep apnea hypopnea
• Central sleep apnea

Risk Factors

• Central nervous system depressants intake (e.g. benzodiazepines, opioid, alcohol)
• Hypothiroidism
• Neuromuscular or chest wall disorder
• Pulmonary disorder

Natural History, Complications and Prognosis

Prognosis

Poor prognostic factors include:

• Central nervous system depressants intake (e.g. benzodiazepines, opioid, alcohol)
• Hypothiroidism
• Neuromuscular or chest wall disorder

• Amyotrophic lateral sclerosis
• Spinal cord injury
• Diaphragmatic paralysis
• Myasthenia gravis
• Lambert-Eaton syndrome
• Toxic or metabolic myopathies
• Postpolio syndrome
• Charcot-Marie-Tooth syndrome

Diagnostic Criteria

DSM-V Diagnostic Criteria for Sleep-related Hypoventilation

“

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 hypoventilation: 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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