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In medicine, hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (hypo meaning "below") to perform needed gas exchange.^[1] By definition it causes an increased concentration of carbon dioxide (hypercapnia) and respiratory acidosis.

Causes

Hypoventilation can be caused by medical conditions, such as stroke affecting the brainstem, by holding one's breath, like during hypoventilation training,^[2] or by drugs, typically when taken in overdose. Opiates in particular cause respiratory depression. Hypocapnia stimulates hypoventilation. Hypoventilation may also occur in chronic mountain sickness to conserve energy.^[3]

Effects

As a side effect of medicines or recreational drugs, hypoventilation may become potentially life-threatening. Many different central nervous system (CNS) depressant drugs such as ethanol, benzodiazepines, barbiturates, GHB, sedatives and opiates produce respiratory depression when taken in large or excessive doses; however this is most commonly seen as a cause of death with opiates or opioids, particularly when they are combined with sedatives such as alcohol or benzodiazepines. Strong opiates, (fentanyl, heroin, morphine, etc.), barbiturates, and the benzodiazepine, temazepam, are notorious for producing this effect; in an overdose, an individual may cease breathing entirely (go into respiratory arrest) which is rapidly fatal without treatment.

Treatment

Respiratory stimulants such as nikethamide were traditionally used to counteract respiratory depression from CNS depressant overdose, but were of only limited effectiveness. A new respiratory stimulant drug called BIMU8 is being investigated which seems to be significantly more effective and may be useful for counteracting the respiratory depression produced by opiates and similar drugs without offsetting their therapeutic effects.

If the respiratory depression is from opioid overdose, then the overdose itself is usually treated with an antagonist, most likely naloxone, which will itself almost instantaneously stop the respiratory depression if caused by an opioid (and also, depending on the dose, plunge the patient into precipitated withdrawal).

Associated conditions

Disorders like Congenital Central Hypoventilation Syndrome (CCHS) and Rapid-Onset Obesity, Hypothalamic Dysfunction, Hypoventilation, with Autonomic Dysregulation (ROHHAD) are recognized as conditions that are associated with hypoventilation. CCHS may be a significant factor in some cases of sudden infant death syndrome (SIDS), often termed "cot death" or "crib death".

The opposite condition is hyperventilation (too much ventilation), resulting in low carbon dioxide levels (hypocapnia), rather than hypercapnia.

References

^ "hypoventilation" at Dorland's Medical Dictionary
^ Woorons, Xavier, Hypoventilation training, push your limits! Arpeh, 2014, 164p. (ISBN 978-2-9546040-1-5)
^ Zubieta-Calleja, GR; Paulev, PE; Zubieta-Calleja, L; Zubieta-Calleja, N; Zubieta-Castillo, G (September 2006). "Hypoventilation in chronic mountain sickness: a mechanism to preserve energy.". Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society. 57 Suppl 4: 425–30. PMID 17072073.

UpToDate Contents

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1. 換気調節障害 disorders of ventilatory control
2. 肥満低換気症候群の臨床症状および診断 clinical manifestations and diagnosis of obesity hypoventilation syndrome
3. 肥満低換気症候群の治療 treatment of the obesity hypoventilation syndrome
4. 低酸素血症の酸素供給およびメカニズム oxygenation and mechanisms of hypoxemia
5. 肥満低換気症候群の病因 pathogenesis of obesity hypoventilation syndrome

English Journal

Backup respiratory rate during noninvasive positive pressure ventilation in obesity hypoventilation syndrome: can this difficult puzzle be resolved?

Esquinas AM.
Chest.Chest.2013 Apr 1;143(4):1182-3. doi: 10.1378/chest.12-2408.
PMID 23546498

Limbic encephalitis and related cortical syndromes.

Rubio-Agusti I, Salavert M, Bataller L.SourceDepartment of Neurology, Hospital Universitari I Politècnic La Fe, Boulevar Sur s/n, 46026, Valencia, Spain, vikja@hotmail.com.
Current treatment options in neurology.Curr Treat Options Neurol.2013 Apr;15(2):169-84. doi: 10.1007/s11940-012-0212-7.
OPINION STATEMENT: Patients with limbic encephalitis and related cortical syndromes develop neurologic and psychiatric symptoms due to autoimmune damage of limbic and extralimbic brain areas. Some patients develop limbic encephalitis as a paraneoplastic manifestation of systemic cancer, where immune
PMID 23250843

Anesthesia for the horse with colic.

Boesch JM.SourceDepartment of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY 14850, USA. Electronic address: jmb264@cornell.edu.
The Veterinary clinics of North America. Equine practice.Vet Clin North Am Equine Pract.2013 Apr;29(1):193-214. doi: 10.1016/j.cveq.2012.11.005. Epub 2013 Jan 18.
This article discusses anesthesia for horses with colic from acute gastrointestinal disease. Emphasis is placed on new developments in pre-, intra-, and immediate postoperative management over the last decade, including early goal-directed therapy (EGDT) in the resuscitation of septic patients, the
PMID 23498053

Japanese Journal

症例持続陽圧呼吸により高ヘマトクリット血症が改善した肥満を伴う睡眠時無呼吸症候群の2例

安間文彦,近藤直英,澤村昭典 [他]
呼吸と循環 63(4), 388-392, 2015-04
NAID 40020405334

臨床研究・症例報告 27ポリアラニン伸長変異を認めた先天性中枢性肺胞低換気症候群の1例

金井祐二,本田義信
小児科臨床 68(3), 435-439, 2015-03
NAID 40020368045

A Case of Obesity Hypoventilation Syndrome with Respiratory Failure that Improved with Abdominoplasty

Kuwahara Hiroaki,Kubo Kazuhito,Akiyama Goh,Takayama Yasuhiro,Tosa Ryouichi,Hyakusoku Hiko
Journal of Nippon Medical School 82(1), 39-42, 2015
… We report on a 70-year-old man with severe respiratory failure caused by obesity hypoventilation syndrome due to abdominal adiposis. … Obesity hypoventilation syndrome is a severe condition that is diagnosed when all of the following criteria are satisfied: body-mass index >30 kg/m2; …
NAID 130004926738