Pulmonary complications of the obese patient
Respiratory work in obesity is excessive, as a chest wall with an increased way must be moved, which, added to the pressure in the diaphragm of high amounts of fat within the abdomen, leads to a poorly effective superficial breathing for oxygen exchange.
Alveolar hypoventilation leads to hypoxemia, occurring as state of confusion, troublesome feeling of obtundation or even loss of consciousness.
Chronic hypoxemia can induce secondary polycythemia, pulmonary hypertension, and right heart failure.
Gas exchange worsens during sleep, resulting in morning headache, quality of sleep disorders, snoring, chronic fatigue, daytime somnolence, and mental confusion.
The progressive breathlessness can cause dyspnea, even on minimum effort.
Advise with Pulmonary complications of the obese patient and Obstructive SAS (SAOS)
- Obese drivers with sleep apnea that are untreated must not drive.
- Patients with SAOS treated and controlled in successive medical revisions, and always with a favorable report, can obtain or renew their driving license at the times established by the law.
- Physicians can provide a great assistance being alert in this field of medicine, with all the patients who visit our clinic, though they do it for another reason.
- The typical case is a middle-aged man with overweight, that visits our clinic with his wife, who complains about the very noisy, intermittent snoring and marked drowsiness of his husband at daytime; sometimes she gets anxious because the patient stops without breathing and he is scared when she wakes him up.
- In the case of a driver, it should be confirmed if he frequently suffers daytime somnolence, if he snores, if he suffers episodes of sleep apnea, and if shows sleep attempts when driving or some accident with this regard.
- We will thus easily detect the obese driver with sleep disturbances in order to advise him to lose weight, and treat him at a Unit of Sleep Disturbances and thus prevent that this causes a traffic accident.
Obstructive SAS (SAOS)
Moderate or marked obesity is the most common predisposing factor in SAOS, and is more common in men who try to sleep lying down on their back.
In obese individuals, snoring is three times more frequent, as well as sleep fragmentation, significant daytime somnolence, slow reflexes and morning headache.
They are frequent in obese individuals with SAOS, disorders of memory, attention, and concentration, with mood and personality changes.
The symptoms increase with alcohol, tranquilizers, and antihistamines before going to bed.
Hypertension, nycturia, and cardiac arrhythmia are also frequent. In advanced situations, pulmonary hypertension and cor pulmonale appear.
Microsleeping is the body defense for not sleeping, and makes that, for a very short time period, consciousness is lost for the road, signals, or other cars.
In sleepy drivers, there is a clear increased risk of having an accident.
They are largely the cause that explains those tracks of emergency braking, with diverted trajectory, that can be seen in many road stretches.
The behavior during driving is impaired in individuals with sleep apnea, who are six times more exposed to traffic accidents than the general population.
Traffic accidents where drivers with sleep apnea are involved are more serious.
Weight loss is mandatory in obese drivers, in order to reduce the rate of accidents and their consequences.
Renal and urinary complications in obese patient
Nephrotic syndrome (NS) for diabetic involvement of the kidneys, focal glomerulosclerosis, and frequently urinary incontinence can occur.
Advise with Renal and urinary complications in obese patient
- Patients with NS cannot drive until the causal disease is adequately treated, shows a favorable outcome and no increased risks when driving.
- Patients with NS due to glomerular disease can have manifestations of their disease that are disabling for driving, such as difficulty to control hypertension, progressive loss of renal function, edema, venous thrombosis, etc.
- Urinary incontinence leads to frequently stopping for urination and disables the patient to drive freely when he has not the necessary means available in the road.