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Thorax Online First, published on May 23, 2014 as 10.1136/thoraxjnl-2014-205656
PostScript
CORRESPONDENCE
Rebuttal: ‘Obesity
hypoventilation syndrome
(OHS): does the current
definition need revisiting?’
In response to the comments by Tulaimat
and Littleton,1 we will clarify our original
statement on ‘Obesity hypoventilation
syndrome (OHS): does the current definition need revisiting?2 The two issues that
these authors raise are curious and indeed
re-enforce the statement we made previously, and we wholly appreciate this. We
highlighted that the use of ‘calculated
arterial standard bicarbonate (HCO−
3)
level from a conventional blood gas
machine, in the absence of another influence on metabolic acid-base status’ should
be considered, and this is supported by
Tulaimat and Littleton’s comments.
Additionally, we did not suggest removing
obstructive sleep apnoea (OSA) from the
definition of OHS, but rather, we wished
to extend the definition, with a PaCO2
≥45 mm Hg (6 kPa) OR an arterial base
excess >3 mmol/L OR a standard HCO−
3
>27 mmol/L (in the absence of another
cause for a metabolic alkalosis). We agree
that the phenotyping of such patients into
OSA, combined OSA-OHS, and lone
OHS, would be clinically useful and
enhance the long-term management, but
we did not necessarily address this in our
original statement.3
Contributors All author contributed to the planning,
conduct and reporting of the manuscript. JRS is
responsible for the overall manuscript
Competing interests None.
Provenance and peer review Not commissioned;
internally peer reviewed.
To cite Hart N, Mandal S, Manuel A, et al. Thorax
Published Online First: [ please include Day Month Year]
doi:10.1136/thoraxjnl-2014-205656
Received 30 April 2014
Accepted 1 May 2014
Nicholas Hart,1 Swapna Mandal,1 Ari Manuel,2
Babak Mokhlesi,3 Jean-Louis Pepin,4
Amanda Piper,5 John Stradling6
1
Lane Fox Respiratory Unit, GSTFT and KCL Biomedical
Research Centre, London, UK
2
Oxford Sleep Unit, Respiratory Department, Churchill
Hospital, Oxford, UK
3
Medicine/Pulmonary & Crit Care, University of
Chicago, Chicago, Illinois, USA
4
Laboratoire HP2, Hypoxie Physiopathologies, Université
Joseph Fourier; INSERM U 1042, Grenoble Cedex 09,
France
5
Respiratory Medicine, Royal Prince Alfred Hospital,
Sydney, New South Wales, Australia
6
Oxford Sleep unit, Oxford University Hospitals,
Oxford, UK
Correspondence to Dr Ari Manuel, Oxford Sleep
Unit, Respiratory Department, Churchill Hospital, Oxford
OX3 7LE, UK; [email protected]
▸ http://dx.doi.org/10.1136/thoraxjnl-2013-204298
▸ http://dx.doi.org/10.1136/thoraxjnl-2013-204992
Thorax 2014;0:1. doi:10.1136/thoraxjnl-2014-205656
REFERENCES
1
2
3
Tulaimat A, Littleton S. Defining obesity
hypoventilation syndrome. Thorax 2014;69:491.
Hart N, Mandal S, Manuel A, et al. Obesity
hypoventilation syndrome: does the current definition
need revisiting? Thorax 2014;69:83–4.
Mandal S, Hart N. Respiratory complications of
obesity. Clin Med 2012;12:75–8.
Thorax MonthArticle
2014 Vol author
0 No 0
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(or their employer) 2014. Produced by BMJ Publishing Group Ltd (& BTS) under licence.
Downloaded from http://thorax.bmj.com/ on June 17, 2017 - Published by group.bmj.com
Rebuttal: 'Obesity hypoventilation syndrome
(OHS): does the current definition need
revisiting?'
Nicholas Hart, Swapna Mandal, Ari Manuel, Babak Mokhlesi, Jean-Louis
Pepin, Amanda Piper and John Stradling
Thorax published online May 23, 2014
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