Highlights & Basics
- Hypoventilation syndrome comprises disorders associated with alveolar hypoventilation (an elevation in PaCO₂ to levels >45 mmHg). Hypoxemia is also present in most cases, especially during sleep (PaO₂ <60 mmHg).
- Alveolar hypoventilation can occur with obesity hypoventilation syndrome, restrictive thoracic disorders, central sleep apnea syndromes, and COPD.
- Symptoms are often nonspecific, but almost always include disturbed sleep and impaired daytime function.
- Physical exam often reveals signs of cor pulmonale in addition to those associated with the primary disorder.
- Diagnosis is usually made by the clinician's awareness that alveolar hypoventilation is often associated with certain medical disorders. Investigations include arterial blood gas analysis, pulmonary function tests, measurement of respiratory muscle strength, and an overnight polysomnogram.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed, text revision. Darien, IL: American Academy of Sleep Medicine; 2023.
Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019 Aug 1;200(3):e6-e24.[Abstract][Full Text]
Khan A, Frazer-Green L, Amin R, et al. Respiratory management of patients with neuromuscular weakness: an American College of Chest Physicians clinical practice guideline and expert panel report. Chest. 2023 Mar 13;S0012-3692(23)00353-7.[Abstract][Full Text]
National Institute for Health and Care Excellence. Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s. Aug 2021 [internet publication].[Full Text]
Miller RG, Jackson CE, Kasarskis EJ, et al; Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009 Oct 13;73(15):1218-26. (Re-affirmed 2023.)[Abstract][Full Text]
1. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed, text revision. Darien, IL: American Academy of Sleep Medicine; 2023.
2. Mokhlesi B, Tulaimat A, Faibussowitsch I, et al. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007;11:117-124.[Abstract]
3. Kessler R, Chaouat A, Schinkewitch P, et al. The obesity-hypoventilation syndrome revisited: a prospective study of 34 consecutive cases. Chest. 2001;120:369-376.[Abstract][Full Text]
4. Lecube A, Sampol G, Lloberes P, et al. Asymptomatic sleep-disordered breathing in premenopausal women awaiting bariatric surgery. Obes Surg. 2010;20:454-461.[Abstract]
5. Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalences, consequences, and presentations. Circulation. 1998;97:2154-2159.[Abstract][Full Text]
6. Sin DD, Fitzgerald F, Parker JD, et al. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. 1999;160:1101-1106.[Abstract][Full Text]
7. Oldenburg O, Lamp B, Faber L, et al. Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail. 2007;9:251-257.[Abstract]
8. Krachman SL, D'Alonzo GE, Berger TJ, et al. Comparison of oxygen therapy with nasal continuous positive airway pressure on Cheyne-Stokes respiration during sleep in congestive heart failure. Chest. 1999;116:1550-1557.[Abstract][Full Text]
9. Berthon-Jones M, Sullivan CE. Ventilatory and arousal responses to hypoxia in sleeping humans. Am Rev Respir Dis. 1982;125:632-639.[Abstract]
10. Berthon-Jones M, Sullivan CE. Ventilation and arousal responses to hypercapnia in normal sleeping humans. J Appl Physiol. 1984;57:59-67.[Abstract]
11. Berthon-Jones M, Sullivan CE. Time course of change in ventilatory response to CO2 with long-term CPAP therapy for obstructive sleep apnea. Am Rev Respir Dis. 1987;135:144-147.[Abstract]
12. Zwillich CW, Sutton FD, Pierson DJ, et al. Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome. Am J Med. 1975;59:343-348.[Abstract]
13. Perez de Llano LA, Golpe R, Ortiz Piquer M, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest. 2005;128:587-594.[Abstract][Full Text]
14. Phipps PR, Starritt E, Caterson I, et al. Association of serum leptin with hypoventilation in human obesity. Thorax. 2002;57:75-76.[Abstract]
15. Piper AJ, Grunstein RR. Obesity hypoventilation syndrome: mechanisms and management. Am J Respir Crit Care Med. 2011;183:292-298.[Abstract]
16. Ragette R, Mellies U, Schwake C, et al. Patterns and predictors of sleep disordered breathing in primary myopathies. Thorax. 2002;57:724-728.[Abstract]
17. Bourke SC, Bullock RE, Williams TL, et al. Noninvasive ventilation in ALS: indications and effect on quality of life. Neurology. 2003;61:171-177.[Abstract]
18. Naughton M, Benard D, Tam A, et al. Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure. Am Rev Respir Dis. 1993;148:330-338.[Abstract]
19. Hanly P, Zuberi N, Gray R. Pathogenesis of Cheyne-Stokes respiration in patients with congestive heart failure: relationship to arterial PCO2. Chest. 1993;104:1079-1084.[Abstract]
20. Javaheri S. A mechanism of central sleep apnea in patients with heart failure. N Engl J Med. 1999;341:949-954.[Abstract][Full Text]
21. Wilcox I, McNamara SG, Dodd MJ, et al. Ventilatory control in patients with sleep apnoea and left ventricular dysfunction: comparison of obstructive and central sleep apnoea. Eur Respir J. 1998;11:7-13.[Abstract]
22. Arzt M, Harth M, Luchner A, et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and central sleep apnea. Circulation. 2003;107:1998-2003.[Abstract][Full Text]
23. Mokhlesi B, Tulaimat A. Recent advances in obesity hypoventilation syndrome. Chest. 2007;132:1322-1336.[Abstract][Full Text]
24. Trang H, Dehan M, Beaufils F, et al; French CCHS Working Group. The French Congenital Central Hypoventilation Syndrome Registry: general data, phenotype, and genotype. Chest. 2005;127:72-79.[Abstract][Full Text]
25. Berry-Kravis EM, Zhou L, Rand CM, et al. Congenital central hypoventilation syndrome: PHOX2B mutations and phenotype. Am J Respir Crit Care Med. 2006;174:1139-1144.[Abstract][Full Text]
26. Doherty LS, Kiely JL, Deegan PC, et al. Late-onset central hypoventilation syndrome: a family genetic study. Eur Respir J. 2007;29:312-316.[Abstract][Full Text]
27. Weese-Mayer DE, Berry-Kravis EM, Ceccherini I, et al. An official ATS clinical policy statement: congenital central hypoventilation syndrome: genetic basis, diagnosis and management. Am J Respir Crit Care Med. 2010;181:626-644.[Abstract][Full Text]
28. Culebras A. Sleep disorders and neuromuscular disease. Semin Neurol. 2005;25:33-38.[Abstract]
29. Ozsancak A, D'Ambrosio C, Hill NS. Nocturnal noninvasive ventilation. Chest. 2008;133:1275-1286.[Abstract][Full Text]
30. Alves RS, Resende MB, Skomro RP, et al. Sleep and neuromuscular disorders in children. Sleep Med Rev. 2009;13:133-148.[Abstract]
31. Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc. 2008;5:218-225.[Abstract][Full Text]
32. Koenig SM. Pulmonary complications of obesity. Am J Med Sci. 2001;321:249-279.[Abstract]
33. Sawicka EH, Branthwaite MA. Respiration during sleep in kyphoscoliosis. Thorax. 1987;42:801-808.[Abstract]
34. Barthlen GM. Nocturnal respiratory failure as an indication of noninvasive ventilation in the patient with neuromuscular disease. Respiration. 1997;64(suppl 1):S35-S38.[Abstract]
35. Pradella M. Sleep polygraphic parameters in neuromuscular diseases. Arq Neuropsiquiatr. 1994;52:476-483.[Abstract]
36. Bourke SC, Gibson GJ. Sleep and breathing in neuromuscular disease. Eur Respir J. 2002;19:1194-1201.[Abstract][Full Text]
37. Lofaso F, Quera-Salva MA. Polysomnography for the management of progressive neuromuscular disorders. Eur Respir J. 2002;19:989-990.[Abstract][Full Text]
38. Sivam S, Yee B, Wong K, et al. Obesity hypoventilation syndrome: early detection of nocturnal-only hypercapnia in an obese population. J Clin Sleep Med. 2018 Sep 15;14(9):1477-1484.[Abstract][Full Text]
39. Sugerman HJ, Fairman RP, Baron PL, et al. Gastric surgery for respiratory insufficiency of obesity. Chest. 1986;90:81-86.[Abstract]
40. Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019 Aug 1;200(3):e6-e24.[Abstract][Full Text]
41. Laveneziana P, Albuquerque A, Aliverti A, et al. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019 Jun 13;53(6):1801214.[Abstract][Full Text]
42. Suresh S, Wales P, Dakin C, et al. Sleep-related breathing disorder in Duchenne muscular dystrophy: disease spectrum in the paediatric population. J Paediatr Child Health. 2005;41:500-503.[Abstract]
43. Ellis ER, Grunstein RR, Chan S, et al. Noninvasive ventilatory support during sleep improves respiratory failure in kyphoscoliosis. Chest. 1998;94:811-815.[Abstract]
44. Ward S, Chatwin M, Heather S, et al. Randomized controlled trial on non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax. 2005;60:1019-1024.[Abstract]
45. Khan A, Frazer-Green L, Amin R, et al. Respiratory management of patients with neuromuscular weakness: an American College of Chest Physicians clinical practice guideline and expert panel report. Chest. 2023 Mar 13;S0012-3692(23)00353-7.[Abstract][Full Text]
46. Epworth Sleepiness Scale
47. Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021 Jul 20;144(3):e56-67.[Abstract][Full Text]
48. National Institute for Health and Care Excellence. Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s. Aug 2021 [internet publication].[Full Text]
49. Weinberg J, Klefbeck B, Borg J, et al. Polysomnography in chronic neuromuscular disease. Respiration. 2003 Jul-Aug;70(4):349-54[Abstract]
50. Lechtzin N, Scott Y, Busse AM, et al. Early use of non-invasive ventilation prolongs survival in subjects with ALS. Amyotroph Lateral Scler. 2007;8:185-188.[Abstract]
51. Sancho J, Servera E, Bañuls P, et al. Prolonging survival in amyotrophic lateral sclerosis: efficacy of noninvasive ventilation and uncuffed tracheostomy tubes. Am J Phys Med Rehabil. 2010;89:407-411.[Abstract]
52. Berry RB, Chediak A, Brown LK, et al. Best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation (NPPV) in stable chronic alveolar hypoventilation syndromes. J Clin Sleep Med. 2010;6:491-509.[Abstract][Full Text]
53. McKim DA, Road J, Avendano M, et al; Canadian Thoracic Society Home Mechanical Ventilation Committee. Home mechanical ventilation: a Canadian Thoracic Society clinical practice guideline. Can Respir J. 2011;18:197-215.[Abstract][Full Text]
54. Mokhlesi B, Tulaimat A, Evans AT, et al. Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea. J Clin Sleep Med. 2006;2:57-62.[Abstract][Full Text]
55. Hida W, Okabe S, Tatsumi K, et al. Nasal continuous positive airway pressure improves quality of life in obesity hypoventilation syndrome. Sleep Breath. 2003;7:3-12.[Abstract]
56. Banerjee D, Yee, BJ, Piper AJ, et al. Obesity hypoventilation syndrome: hypoxemia during continuous positive airway pressure. Chest. 2007;131:1678-1684.[Abstract][Full Text]
57. Laaban JP, Orvoen-Frija E, Cassuto D, et al. Mechanisms of diurnal hypercapnia in sleep apnea syndromes associated with morbid obesity. Presse Med. 1996;25:12-16. (in French)[Abstract]
58. Shivaram U, Cash ME, Beal A. Nasal continuous positive airway pressure in decompensated hypercapnic respiratory failure as a complication of sleep apnea. Chest. 1993;104:770-774.[Abstract]
59. Piper AJ, Wang D, Yee BJ, et al. Randomised trial of CPAP vs bilevel support in the treatment of obesity hypoventilation syndrome without severe nocturnal desaturation. Thorax. 2008 May;63(5):395-401.[Abstract][Full Text]
60. Howard ME, Piper AJ, Stevens B, et al. A randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome. Thorax. 2017 May;72(5):437-444.[Abstract]
61. Laaban JP, Chailleux E. Daytime hypercapnia in adult patients with obstructive sleep apnea syndrome in France, before initiating nocturnal nasal continuous positive airway pressure therapy. Chest. 2005;127:710-715.[Abstract][Full Text]
62. Mokhlesi B. Positive airway pressure titration in obesity hypoventilation syndrome: continuous positive airway pressure or bilevel positive airway pressure. Chest. 2007;131:1624-1626.[Abstract][Full Text]
63. Schafer H, Ewig S, Hasper E, et al. Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure. Respir Med. 1998;92:208-215.[Abstract]
64. Budweiser S, Riedl SG, Jorres RA, et al. Mortality and prognostic factors in patients with obesity-hypoventilation syndrome undergoing noninvasive ventilation. J Intern Med. 2007;261:375-383.[Abstract][Full Text]
65. Storre JH, Seuthe B, Fiechter R, et al. Average volume-assured pressure support in obesity hypoventilation: a randomized crossover trial. Chest. 2006;130:815-821.[Abstract][Full Text]
66. Priou P, Hamel JF, Person C, et al. Long-term outcome of noninvasive positive pressure ventilation for obesity hypoventilation syndrome. Chest. 2010;138:84-90.[Abstract]
67. Berger KI, Ayappa I, Chatr-Amontri B, et al. Obesity hypoventilation syndrome as a spectrum of respiratory disturbances during sleep. Chest. 2001;120:1231-1238.[Abstract][Full Text]
68. Redolfi S, Corda L, La Piana G, et al. Long-term non-invasive ventilation increases chemosensitivity and leptin in obesity-hypoventilation syndrome. Respir Med. 2007;101:1191-1195.[Abstract]
69. de Lucas-Ramos P, de Miguel-Diez J, Santacruz-Siminiani A, et al. Benefits at 1 year of nocturnal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Respir Med. 2004;98:961-967.[Abstract]
70. Masa JF, Corral J, Alonso ML, et al. Efficacy of different treatment alternatives for obesity hypoventilation syndrome. Am J Respir Crit Care Med. 2015;192:86-95.[Abstract][Full Text]
71. Bouloukaki I, Mermigkis C, Michelakis S, et al. The association between adherence to positive airway pressure therapy and long-term outcomes in patients with obesity hypoventilation syndrome: a prospective observational study. J Clin Sleep Med. 2018 Sep 15;14(9):1539-1550.[Abstract][Full Text]
72. Masa JF, Celli BR, Riesco JA, et al. Noninvasive positive pressure ventilation and not oxygen may prevent overt ventilatory failure in patients with chest wall diseases. Chest. 1997 Jul;112(1):207-13.[Abstract]
73. Hollier CA, Harmer AR, Maxwell LJ, et al. Moderate concentrations of supplemental oxygen worsen hypercapnia in obesity hypoventilation syndrome: a randomised crossover study. Thorax. 2014 Apr;69(4):346-53.[Abstract]
74. Masa JF, Celli BR, Riesco JA, et al. The obesity hypoventilation syndrome can be treated with noninvasive mechanical ventilation. Chest. 2001;119:1102-1107.[Abstract]
75. Heinemann F, Budweiser S, Dobroschke J, et al. Non-invasive positive pressure ventilation improves lung volumes in the obesity hypoventilation syndrome. Respir Med. 2007;101:1229-1235.[Abstract]
76. Poulter NR, Chang CL, Farley TM, et al. Risk of cardiovascular diseases associated with oral progestagen preparations with therapeutic indications. Lancet. 1999;354:1610.[Abstract]
77. Kimura H, Tatsumi K, Kunitomo F, et al. Obese patients with sleep apnea syndrome treated by progesterone. Tohoku J Exp Med. 1988;156:151-157.[Abstract]
78. Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med 2008;4:333-338.[Abstract][Full Text]
79. Young HK, Lowe A, Fitzgerald DA, et al. Outcome of noninvasive ventilation in children with neuromuscular disease. Neurology. 2007;68:198-201.[Abstract]
80. Piper AJ, Sullivan CE. Effects of long-term nocturnal nasal ventilation on spontaneous breathing during sleep in neuromuscular and chest wall disorders. Eur Respir J. 1996;9:1515-1522.[Abstract][Full Text]
81. Mellies U, Ragette R, Dohna Schwake CD, et al. Longterm noninvasive ventilation in children and adolescents with neuromuscular disorders. Eur Respir J. 2003;22:631-636.[Abstract][Full Text]
82. Annane D, Orlikowski D, Chevret S. Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders. Cochrane Database Syst Rev. 2014;(12):CD001941.[Abstract][Full Text]
83. Laub M, Midgren B. Survival of patients on home mechanical ventilation: a nationwide prospective study. Respir Med. 2007;101:1074-1078.[Abstract]
84. Bourke SC, Tomlinson M, Williams TL, et al. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurol. 2006;5:140-147.[Abstract]
85. Miller RG, Jackson CE, Kasarskis EJ, et al; Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009 Oct 13;73(15):1218-26. (Re-affirmed 2023.)[Abstract][Full Text]
86. Takasaki Y, Orr D, Popkin J, et al. Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure. Am Rev Respir Dis. 1989;140:1578-1584.[Abstract]
87. Kohnlein T, Welte T, Tan LB, et al. Assisted ventilation for heart failure patient with Cheyne-Stokes respiration. Eur Respir J. 2002;20:934-941.[Abstract][Full Text]
88. Naughton MT, Liu PP, Benard DC, et al. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure. Am J Respir Crit Care Med. 1995;151:92-97.[Abstract]
89. Arzt M, Schulz M, Wensel R, et al. Nocturnal continuous positive airway pressure improves ventilatory efficiency during exercise in patients with chronic heart failure. Chest. 2005;127:794-802.[Abstract][Full Text]
90. Naughton MT, Benard DC, Liu PP, et al. Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med. 1995;152:473-479.[Abstract]
91. Walsh JT, Andrews R, Starling R, et al. Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure. Br Heart J. 1995;73:237-241.[Abstract]
92. Naughton MT, Benard DC, Rutherford R, et al. Effect of continuous positive airway pressure on central sleep apnea and nocturnal PCO2 in heart failure. Am J Respir Crit Care Med. 1994;150:1598-1604.[Abstract]
93. Bradley TD, Logan AG, Kimoff RJ, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2005;353:2025-2033.[Abstract][Full Text]
94. Arzt M, Floras JS, Logan AG, et al. Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure. Circulation. 2007 Jun 26;115(25):3173-80.[Abstract][Full Text]
95. Teschler H, Döhring J, Wang YM, et al. Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med. 2001;164:614-619.[Abstract][Full Text]
96. Arzt M, Wensel R, Montalvan S, et al. Effects of dynamic bilevel positive airway pressure support on central sleep apnea in men with heart failure. Chest. 2008;134:61-66.[Abstract][Full Text]
97. Pepperell JC, Maskell NA, Jones DR, et al. A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure. Am J Respir Crit Care Med. 2003;168:1109-1114.[Abstract][Full Text]
98. Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med. 2015;373:1095-105.[Abstract][Full Text]
99. Perger E, Lyons OD, Inami T, et al. Predictors of 1-year compliance with adaptive servoventilation in patients with heart failure and sleep disordered breathing: preliminary data from the ADVENT-HF trial. Eur Respir J. 2019 Feb 21;53(2).[Abstract]
100. Hanly PJ, Millar TW, Steljes DG, et al. The effect of oxygen on respiration and sleep in patients with congestive heart failure. Ann Intern Med. 1989;111:777-782.[Abstract]
101. Franklin KA, Eriksson P, Sahlin C, et al. Reversal of central sleep apnea with oxygen. Chest. 1997 Jan;111(1):163-9.[Abstract]
102. Lorenzi-Filho G, Rankin F, Bies I, et al. Effects of inhaled carbon dioxide and oxygen on Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med. 1999;159:1490-1498.[Abstract][Full Text]
103. Krachman SK, Nugent T, Crocetti J, et al. Effects of oxygen therapy on left ventricular function in patients with Cheyne-Stokes respiration and congestive heart failure. J Clin Sleep Med. 2005;1:271-276.[Abstract]
104. Sanders JS, Berman TM, Barlett MM, et al. Increased hypoxic ventilatory drive due to administration of aminophylline in normal men. Chest. 1980;78:279-282.[Abstract]
105. Javaheri S, Parker TJ, Wexler L, et al. Effect of theophylline on sleep-disordered breathing in heart failure. N Engl J Med. 1996;335:562-567.[Abstract][Full Text]
106. DeBacker WA, Verbraecken J, Willemen M, et al. Central apnea index decreases after prolonged treatment with acetazolamide. Am J Respir Crit Care Med. 1995;151:87-91.[Abstract]
107. Javaheri S. Acetazolamide improves central sleep apnea in heart failure: a double-blind, prospective study. Am J Respir Crit Care Med. 2006;173:234-237.[Abstract][Full Text]
108. Aurora RN, Chowdhuri S, Ramar K, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep. 2012;35:17-40.[Abstract][Full Text]
109. Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med. 1998;339:429-435.[Abstract][Full Text]
110. Krachman SL, Quaranta AJ, Berger TJ, et al. Effects of noninvasive positive pressure ventilation on gas exchange and sleep in COPD patients. Chest. 1997 Sep;112(3):623-8.[Abstract]
111. Jones SE, Packham S, Hebden M, et al. Domiciliary nocturnal intermittent positive pressure ventilation in patients with respiratory failure due to severe COPD: long-term follow-up and effect on survival. Thorax. 1998:53:495-498.[Abstract]
112. McEvoy RD, Pierce JR, Hillman PD, et al. Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial. Thorax. 2009;64:561-566.[Abstract]
113. Elliott MW, Simonds AK, Carroll MP, et al. Domiciliary nocturnal nasal intermittent positive pressure ventilation in hypercapnic respiratory failure due to chronic obstructive lung disease: effects on sleep and quality of life. Thorax. 1992;47:342-348.[Abstract]
114. Clini E, Sturani C, Rossi A, et al. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. Eur Respir J. 2002;20:529-538.[Abstract][Full Text]
115. Murphy PB, Rehal S, Arbane G, et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial. JAMA. 2017 Jun 6;317(21):2177-2186.[Abstract][Full Text]
116. Anon. Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation: a consensus conference report. Chest. 1999;116:521-534.[Abstract][Full Text]
117. Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med. 1980;93:391-398.[Abstract]
118. Chaouat A, Weitzenblum E, Kessler R, et al. A randomized trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease patients. Eur Respir J. 1999;14:1002-1008.[Abstract][Full Text]
119. Tuggey JM, Elliott MW. Titration of non-invasive positive pressure ventilation in chronic respiratory failure. Respir Med. 2006;100:1262-1269.[Abstract]
120. Ekkernkamp E, Storre JH, Windisch W, et al. Impact of intelligent volume-assured pressure support on sleep quality in stable hypercapnic chronic obstructive pulmonary disease patients: a randomized, crossover study. Respiration. 2014;88:270-276.[Abstract]
121. Mehra R, Chung MK, Olshansky B, et al. Sleep-disordered breathing and cardiac arrhythmias in adults: mechanistic insights and clinical implications: a scientific statement from the American Heart Association. Circulation. 2022 Aug 30;146(9):e119-e136.[Abstract][Full Text]
122. Gottesman RF, Lutsey PL, Benveniste H, et al. Impact of sleep disorders and disturbed sleep on brain health: a scientific statement from the American Heart Association. Stroke. 2024 Mar;55(3):e61-76.[Abstract][Full Text]
123. Titova OE, Yuan S, Baron JA, et al. Sleep-disordered breathing-related symptoms and risk of stroke: cohort study and Mendelian randomization analysis. J Neurol. 2022 May;269(5):2460-8.[Abstract][Full Text]
124. Xie C, Zhu R, Tian Y, et al. Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open. 2017 Dec 22;7(12):e013983.[Abstract][Full Text]
125. Dong JY, Zhang YH, Qin LQ. Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies. Atherosclerosis. 2013 Aug;229(2):489-95.[Abstract]
126. Tsai MS, Li HY, Huang CG, et al. Risk of alzheimer's disease in obstructive sleep apnea patients with or without treatment: real-world evidence. Laryngoscope. 2020 Sep;130(9):2292-8.[Abstract]
127. Guay-Gagnon M, Vat S, Forget MF, et al. Sleep apnea and the risk of dementia: a systematic review and meta-analysis. J Sleep Res. 2022 Oct;31(5):e13589.[Abstract]
128. Nowbar S, Burkart KM, Gonzales R, et al. Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome. Am J Med. 2004;116:1-7.[Abstract]
129. Kaw R, Bhateja P, Mar HP, et al. Postoperative complications in patients with unrecognized obesity hypoventilation syndrome undergoing elective noncardiac surgery. Chest. 2016;149:84-91.[Abstract]
130. Kreivi HR, Itäluoma T, Bachour A. Effect of ventilation therapy on mortality rate among obesity hypoventilation syndrome and obstructive sleep apnoea patients. ERJ Open Res. 2020 May 11;6(2):00101-2019.[Abstract][Full Text]
131. Hanly PJ, Zuberi-Khokhar NS. Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure. Am J Respir Crit Care Med. 1996;153:272-6.[Abstract]
132. Miske LJ, Hickey EM, Kolb SM, et al. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004 Apr;125(4):1406-12.[Abstract]
