Comprehensive Clinical Insights into the Diagnosis, Management and Complications of Pickwickian Syndrome | Chapter 8 | Medical Science: Updates and Prospects Vol. 2

 

The aim of this study is to provide a comprehensive and up-to-date synthesis of the clinical understanding of Pickwickian Syndrome, with a focus on its diagnosis, management, and associated complications. Pickwickian Syndrome, or Obesity Hypoventilation Syndrome (OHS), is a serious obesity-related respiratory disorder defined by chronic daytime hypercapnia (PaCO₂ > 45 mmHg), obesity (BMI ≥ 30 kg/m²), and exclusion of other hypoventilation causes. It arises from a complex interplay of impaired ventilatory drive, leptin resistance, and mechanical respiratory restriction, often coexisting with obstructive sleep apnea (OSA) in nearly 90% of cases. OHS leads to chronic hypoxemia, pulmonary hypertension, and cor pulmonale if untreated. Diagnosis relies on arterial blood gas analysis, polysomnography, and exclusion of alternative etiologies. A key diagnostic feature is chronic hypercapnia (PaCO₂ >45 mmHg), often accompanied by compensated metabolic alkalosis due to renal bicarbonate retention.  There may also be hypoxemia (PaO₂ <70 mmHg), particularly in more severe cases. Management requires a multidisciplinary approach emphasising weight reduction, lifestyle modification, and positive airway pressure (PAP) therapy—CPAP for OHS with OSA and BiPAP for persistent hypercapnia. Bariatric surgery offers substantial improvement in severe cases. Pharmacologic agents like acetazolamide and medroxyprogesterone serve limited roles. Early recognition and adherence to therapy markedly improve outcomes, reducing mortality from 30% to under 10%. Despite advancements, OHS remains underdiagnosed and undertreated, highlighting the need for greater clinical awareness, digital monitoring integration, and personalised management strategies.

 

 

Author(s) Details

Harsahaj Singh Wilkhoo
Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.

 

Afra Wasama Islam
Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v2/6708

Educational Impact on Patient Adherence in Use of Continuous Positive Airway Treatment | Chapter 9 | Current Progress in Medicine and Medical Research Vol. 3

 This affiliate evaluates a comprehensive course of study provided to adults accompanying Obstructive Sleep Apnea to compare bettering in Continuous Positive Airway Pressure (CPAP) adherence distinguished to adults receiving standard instruction. Obstructive Sleep Apnea (OSA) is a common disorder and is guide an increased risk of adverse cardiovascular occurrences, neurocognitive impairment, vehicular and business accidents, increased healthcare exercise and decreased productivity. OSA is an under pronounced and common disorder namely associated with an raised risk of adverse cardiovascular events and neuro-intelligent impairment. Management of OSA contains treatment goals to advance optimal sleep and decline of cardiovascular risk. Continuous Positive Airway Pressure (CPAP) therapy is the pillar of treatment for OSA. Adherence to CPAP therapy mirrors the rates of devotion seen in additional chronic afflictions, with up to 50% of OSA subjects abandoning cure within one old age. The aim of this ship study is to examine if implementation of a comprehensive instructional OSA program improves CPAP devotion in OSA patients. Strategies to enhance CPAP adherence include providing instruction and support during the first two weeks of remedy when the risk abandoning therapy is capital. Descriptions of educational content are wanting in the literature and outside an established curriculum, it is troublesome to measure if CPAP adherence is had connection with education.

Author(s) Details:

A. M. Wellins,

School of Nursing, Stony Brook University, Stony Brook, New York, USA.

K. Shurpin,

School of Nursing, Stony Brook University, Stony Brook, New York, USA.

P. Hood,

School of Nursing, Stony Brook University, Stony Brook, New York, USA.

L. Shangold,

School of Nursing, Stony Brook University, Stony Brook, New York, USA.

Please see the link here: https://stm.bookpi.org/CPMMR-V3/article/view/11242

A Validation of Stop-bang Score and ESS in Presumptive Sleep Apnoeic Individuals| Chapter 7 | Perspective of Recent Advances in Medical Research Vol. 3

 Background: Worldwide, the predominance of sleep apnea is growing. In contrast to win standard test overnight polysomnography, the STOP-BANG (Snoring, Tiredness, Observed Choking, Pressure, Body Mass Index (BMI), Age, Neck circumference, and Gender) Score and Epworth torpor scale (ESS) are available as person being treated for medical problem evaluation scores to suspect and estimate the severity of opposing sleep apnea (OSA).Objective: The purpose of the item search out validate and organize a link betwixt the polysomnography variables STOP-BANG Score, ESS, and Apnea-Hypopnea Index (AHI).Methods: Patients who denounced of harsh daytime torpor and were referred to the Department of Pulmonary Medicine at the BJMC in Ahmedabad 'tween April 2017 and December 2020 experienced nocturnal polysomnography following a medical examination in the person being treated for medical problem department.Results: Of the 200 partners in our study, 137 (68.5%) were men and 63 (31.5%) were girls, for a male to female percentage of 2.17:1. The averages for the neck perimeter, ESS, STOP-BANG Score, and AHI were 32.78 kg/m2, 39.49 cm, 14.48 cm, 5.34 cm, and 48.22 cm, individually. The number of patients was shabby into temperate (16%), moderate (18%), and severe (146%) classifications. The neck circumference (r = 0.68), ESS (r = 0.73), and STOP-BANG Score (r = 0.55) had meaningful Pearson correlations (p 0.0001) accompanying the AHI.Conclusion: The most usual sign of OSA in people is wheezing. According to the study, skilled is a direct association middle from two points BMI, neck edge, ESS >10, and STOP-BANG Score >3 accompanying the degree of OSA as visualized on polysomnography.

Author(s) Details:

Keyur M. Patel,
Dr. M. K. Shah Medical College and Research Centre, Ahmedabad, India.

Nalin T. Shah,
Department of Pulmonary Medicine, BJ Medical College, Ahmedabad, Gujarat, India.

Please see the link here: https://stm.bookpi.org/PRAMR-V3/article/view/9066

Effect of Mandibular Advancement Splint in Edentulous Class II OSA Patients | Chapter 20 | New Horizons in Medicine and Medical Research Vol. 9

 The goal of this chapter is to assess changes in upper airway volume and sleep characteristics in edentulous class II OSA patients treated with a mandibular advancement splint (MAS) constructed at various jaw locations.

Thirty-five patients were chosen at random and divided into two groups based on inclusion and exclusion criteria, Group I and Group II. All of the people demonstrated an increase in pharyngeal volume at both degrees of mandibular advancement. AHI values declined from 21.76 to 15.82 at 60 percent mandibular advancement and to 17.76 at 70 percent mandibular advancement. To determine the percentage change in pharyngeal volume at various stages of mandibular advancement, the following equation was created using regression analysis: Volume change as a percentage (Y) = 0.347*X +57.55. Where the percentage change in volume is dependent (Y) and the percentage change in mandibular advancement is independent (X).

In the current study, the mandibular advancement splint was found to be beneficial in expanding upper airway volume and reducing OSA severity. Furthermore, the percentage change in posterior pharyngeal volume is related to mandibular advancement up to a point.

Author(S) Details

Ashutosh Gupta
Department of Prosthodontics, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India.

Arvind Tripathi
Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India.

Praveen Rai
Department of Prosthodontics, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India.

Piyush Sharma
Department of Orthodontics, Dental College, Azamgarh, India.

Suryakant Tripathi
Department of Pulmonary Medicine, King George’s Medical University, Lucknow, India.

View Book:- https://stm.bookpi.org/NHMMR-V9/article/view/6916

Study on Spatial Relationship of Metabolomics, OSA and Diabetes Mellitus | Chapter 07 | Emerging Trends in Disease and Health Research Vol. 1

 The study of metabolites, whether focused or untargeted, is known as metabolomics. They can be discovered in bodily fluids such as urine, blood, and saliva. They have a low molecular weight (less than 1 kilodaltons). These are representations of the metabolic process. The one that is being targeted is limited to known metabolites. Metabolomes are unidentified compounds identified by the untargeted. Sleep is divided into three phases: Sleep Latency, Synchronized Sleep Phase (SWS), and Rapid Eye Movement (REM).

Neurohormonal and metabolic alterations are mostly responsible for this. Obesity and Diabetes Mellitus can be caused by a variety of sleep disorders and hormonal abnormalities. As a result, this pathophysiological process can be reflected in aberrant metabolomics mimics. In the future, metabolite research could be an economical technique to diagnose this condition, supplementing or replacing polysomnography. There are a variety of sleep problems, some of which are linked to modern lifestyle factors such as reduced sleep duration, shift work, and pre-existing Diabetes Mellitus and/or OSA.

 
Author(S) Details

P. V. Prabhakar Rao
Department of Pulmonology, MNR Medical College, Sangareddy, Telengana, India.

Kandamaran Krishnamurthy
Queen Elizabeth Hospital, Barbados and Faculty of Medical Sciences, Cave Hill Campus, The University of the West Indies, Barbados.

View Book:- https://stm.bookpi.org/ETDHR-V1/article/view/5208

Uvula in Snoring and Obstructive Sleep Apnea: An Approach to Surgical Intervention | Chapter 3 | Recent Developments in Medicine and Medical Research Vol. 1

 Objective: There is currently insufficient data for objective interpretation of the enlarged uvula as a cause of snoring and Obstructive Sleep Apnea (OSA). If the length or width of a uvula surpassed 15 mm or 10 mm, it was deemed expanded (i.e., longer, wider). This article focused on various ideas for dealing with an enlarged uvula in snoring and OSA situations. The goal of this essay is to compare and contrast the costs of uvular surgery and preservation.

Conclusion: The direct link between the uvula and OSA needs to be reconsidered in order to strike a balance between preserving its anatomical and physiological functions while surgically manipulating it as part of palatopharyngeal surgery; however, more objective research is needed to achieve optimal results.

Author(S) Details

A. M. Elbassiouny
Department of Otolaryngology, Cairo University, Egypt.

View Book:- https://stm.bookpi.org/RDMMR-V1/article/view/4066

Letter to the Editor: Streamlined Upper Airway Collapsibility Measurement for Uvulopalatopharyngoplasty (UPPP): Perspectives | Chapter 14 | Current Topics in Medicine and Medical Research Vol. 10

 Dilating a narrow airway may be an effective treatment aspect of therapy as a surgical solution for the treatment of adults with obstructive sleep apnea (OSA), but may not be a primary surgical objective. The surgical aim must be to stabilize the upper airway in patients with OSA against dynamic collapse that threatens its patency. For this reason, it would be useful to test pharyngeal collapsibility (critical pressure: Pcrit) for individual OSA patients in particular for streamlined Pcrit measurements before and after surgery.

Author (s) Details

Dr. Yoichi Nishimura
Department of Otorhinolaryngology, Teikyo University Chiba Medical Center, Chiba, Japan

Alan R. Schwartz
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States and Universidad Peruana Cayetano Heredia, Lima, Peru.

View Book :- https://bp.bookpi.org/index.php/bpi/catalog/book/323

Does Uvulopalatopharyngoplasty Change the Airway Volume?| Chapter 13 | Current Topics in Medicine and Medical Research Vol. 10

 The risk of developing heart disorders and hypertension is enhanced by obstructive sleep apnea (OSA) syndrome. Successful care of OSA patients is therefore, important. The goal of this study was to investigate changes in the morphology and volume after uvulopalatopharyngoplasty (UPPP) of the velopharyngeal and glossopharyngeal airway in three adult OSA patients who had bilateral broad tonsils using three-dimensional computed tomography. Case Report: All three patients with a history of extreme snoring and prolonged daytime sleepiness (one male and two female) were tested with overnight nocturnal polysomnography, suggesting mild to severe OSA. UPPP was supposed to widen the pharyngeal airway since all patients had large tonsils. Polysomnography and three-dimensional computed tomography (3D CT) scanning, both before and 3 months after UPPP, were performed and compared. 

Results: Unexpectedly, although the morphology of the glossopharyngeal airway clearly changed after UPPP, the volume changes in the velopharyngeal and glossopharyngeal airways were negligible. In conclusion, in our patients, the morphology of the velopharyngeal and glossopharyngeal airway changed after UPPP; however, the volume did not change. Further analysis of 3D CT images could contribute to our understanding of changes in morphology and air volume in the upper airway that are caused by UPPP.


Author (s) Details

Dr. Yoichi Nishimura
Department of Otorhinolaryngology, Teikyo University Chiba Medical Center, Chiba, Japan

Sarah D. Moral-Ramos
Center for Snoring and Sleep Disorders, The Medical City, Philippines.

Misato Nishimura
Department of Radiology, Second Hospital, Fujita Health University School of Medicine, Japan.

Mahmood A. Hamed
Department of Otorhinolaryngology, Sohag University, Sohag, Egypt.


Wael A. Ahmed
Department of Otorhinolaryngology, Sohag University, Sohag, Egypt.


Masatoshi Hirata
Department of Sleep Technology, Second Hospital, Fujita Health University School of Medicine, Japan.

Naoko Fujii
Department of Radiology, Second Hospital, Fujita Health University School of Medicine, Japan.

View Book :- https://bp.bookpi.org/index.php/bpi/catalog/book/323