Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome to HCM!

I understand your concern and would like to explain that low arterial oxygen saturations are generally caused by severe pulmonary or cardiac disorders.

Coming to this point, I would like to know: which is your aunt's cardiac and pulmonary status?

Does she suffer from congestive heart failure or chronic obstructive pulmonary disease?

If cardiac disorder is present, it is necessary to optimize CHF therapy (especially diuretics and vasodilators dosage) according to her cardiac performance (LVEF) and clinical status.

In case of chronic pulmonary disorder (COPD), it is necessary to promptly treat any acute exacerbations of bronchitis (by using antibiotics) and also optimizing the maintenance therapy including long acting bronco- dilators, steroids and mucus fluidificants.

It is important taking into account other potential commorbidities.

Please let me know about her cardiac and pulmonary function (upload any available performed tests) and her actual therapy in order for me to be possible to give a more professional opinion.

Hope to have been helpful!

Kind regards,

Dr. Iliri

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Brief Answer:
My opinion:

Detailed Answer:
Hello again!

Thank you for the additional information provided!

I carefully reviewed all the uploaded medical data and would explain that your aunt is suffering from "Obesity hypoventilation syndrome", which has been complicated by hypocapnia and adverse cardio-metabolic implications and cardio-respiratory insufficiency.

This has led to the need of intensive cardio-respiratory support, to relieve her hypercapnic ventilatory failure and also her clinical signs of subsequent congestive heart failure.

So, I would explain that the primary responsible cause of her clinical situation is obesity and additional disorders like sleep apnea, which has lead to adverse implication of the cardio-circulatory system.

Coming to this point, my advice would be to first correctly address the ventilatory problem (continue with the appropriate non invasive ventilatory support [CPAP, BIPAP] and discuss with sleep apnea specialist [a specialized neurologist or a pneumologist] and also periodically control clinical status of her cardio-vascular system.

Hope to have been helpful!

Greetings!

Dr. Iliri

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Brief Answer:
I would explain:

Detailed Answer:
Hello,

a) As the main health disorder is obesity hypoventilation syndrome, the most important issue in medical management would be decreasing body weight.

It is observed that by decreasing body weight severity of hypoventilation there is a significant improvement in awake respiratory failure, sleep-disordered breathing and in overall lung function.

Obesity hypoventilation syndrome doesn’t occur in the absence of obesity.

b) Regarding ventilatory support, I would explain that non-invasive positive pressure ventilation is the strategy of choice for improving airway obstruction and gas exchanges, leading to less hypoxemia, less hypercapnia, increasing arterial blood saturation, and decreasing blood concentration (increased hematocrit).

If CPAP doesn’t normalize arterial oxygen saturation and hypercapnia, then BIPAP (with IPAP 8 – 10 cm H2O above EPAP) should be continued.

If respiratory work is decreased (<25 breaths/min, there is no acidosis and hypercapnia and we have a sustained improved hypoxemia (SpO2 ≥92%, then the ventilator regimen is successful.

c) Regarding oxygen, there are no large scale studies that continuous oxygen therapy would improve clinical outcomes in obesity hypoventilation syndrome.

Applying the appropriate PAP (positive airway pressure) supportive regimen if quite enough in the majority of patients to relieve airway obstruction and gas exchanges.

Too much oxygen is not beneficial.

d) Regarding diet, I would advise hypo-caloric daily diet, poor in animal fat and salty components, avoid spicy and processed foods.

I recommend a healthy diet like Mediterranean diet.

A carefully scheduled daily diet regimen is necessary.

Hope to have been helpful to you!

Best wishes,

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Hi,

Mediterranean diet is a healthy eating plan based on typical foods and recipes of Mediterranean-style cooking.

It is characterized by some primarily components as follows:

- Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
- Replacing butter with healthy fats, such as olive oil
- Using herbs and spices instead of salt to flavor foods
- Limiting red meat to no more than a few times a month
- Eating fish and poultry at least twice a week
- Drinking red wine in low quantity.

Regarding PAP, I would explain that several regimens may be applied, but they should be tailored according to specific respiratory disorder issues.

We use it on in-hospital conditions, but several types (like CPAP, BIPAP) are also applied on ambulatory settings.

It is important to review periodically these regimens according to clinical status and tests results (polisomnography, arterial blood gas analysis, etc.).

Best regards,

Dr. Iliri

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