Obesity Hypoventilation Syndrome Ups Risk in DKA Hospitalization

Obesity Hypoventilation Syndrome Ups Risk in DKA Hospitalization

The study covered in this summary was published in Preprints With The Lancet and has not yet been peer reviewed.

Key Takeaways

  • Patients with diabetes who were hospitalized for diabetic ketoacidosis (DKA) had worse outcomes if they also had obesity hypoventilation syndrome (OHS).

  • Compared with patients with DKA, those who also had OHS were more likely to need invasive mechanical ventilation, have a longer and costlier hospital stay, and have a greater likelihood of dying before hospital discharge — independent of differences in demographics or comorbidities including degree of obesity.

Why This Matters

  • This is the first study to examine how OHS may affect outcomes in patients who are hospitalized with DKA.

  • The findings highlight the importance of diagnosing OHS in patients with diabetes and obesity who are hospitalized for DKA, because OHS is an independent predictor of greater risk.

  • Further study is needed in hospitalized patients with DKA and OHS to determine whether early initiation of treatment with noninvasive ventilation or continuous positive airway pressure (CPAP) therapy may prevent the need for mechanical ventilation and may improve in-hospital survival.

Study Design

  • A retrospective, cross-sectional study of patients aged 18 and older with DKA, based on data from the US National Inpatient Sample database during 2017 and 2018.

  • The researchers identified 60,435 patients hospitalized for DKA without OHS and 172 patients hospitalized for DKA with OHS hospitalized for DKA.

  • The analysis compared these two patient groups by their in-hospital mortality (primary outcome), as well as by other in-hospital outcomes using multivariate logistic regression that adjusted for several potential confounders.

  • The authors used an OHS definition of patients without significant lung or respiratory muscle disease who had a body mass index of at least 30 kg/m2, daytime alveolar hypoventilation causing hypercapnia and hypoxia, and sleep-disordered breathing in the absence of significant lung or respiratory muscle disease.

Key Results

  • The prevalence of OHS in this representative sample of US inpatients with DKA was 0.28%.

  • Roughly half of the patients with/without OHS were women.

  • Patients with OHS were older, were less likely to smoke, were more likely to have a body mass index of 30 kg/m2 or greater, and were more likely to have several comorbidities, including obstructive sleep apnea, chronic obstructive pulmonary disease, chronic kidney disease, and heart failure.

  • Compared to patients with DKA without OHS, those with DKA with OHS had a 1.79-fold greater risk of in-hospital mortality, a 1.43-fold greater risk of acute kidney failure, and a 1.62-fold greater risk of needing mechanical ventilation. All these differences were significant after adjusting for multiple potential confounders.

  • DKA with OHS vs without OHS was associated with a longer hospital stay, 10 days vs 4.7 days, and a costlier one, with average hospital costs for patients with OHS more than double the cost for patients with DKA but without OHS.


  • This was a retrospective cross-sectional analysis of data from a national hospital inpatient database, so it cannot draw cause-and-effect conclusions.

  • The database lacked information about patient adherence to diabetes medications, use of CPAP, duration of OHS, and laboratory test results.

  • There may be unknown confounders not accounted for in the multivariable analyses.


  • The study received no commercial funding.

  • None of the authors had disclosures.

This is a summary of a preprint research study, “The Influence of Obesity Hypoventilation Syndrome on the Outcomes of Patients with Diabetic Ketoacidosis: An Analysis of National Inpatient Sample,” written by researchers from the Brooklyn Hospital Center, NY, and Rapides Regional Medical Center, Alexandria, Louisiana, on Preprints With The Lancet, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on papers.ssrn.com.

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