Voluntary breath holding in the obese.

Alveolar gas tensions and arterial O2 saturation (Sao2) during a voluntary breath hold at functional residual capacity (FRC) were examined in 13 healthy seated subjects. An excellent correlation (r = 0.80) was found between the fall of alveolar O2 tensions (delta PETo2) and body weight, expressed as the ratio of weight to height (wt/ht, kg/cm). An even greater correlation (r = 0.89) was found between delta PETo2 and the ratio of breath-hold time X O2 consumption/FRC. Alveolar Po2 decreased to 70 mmHg in the obese group after just 15 s of apnea, whereas this degree of hypoxia did not occur in the nonobese until the breath hold was sustained for 30 s. This variable rate of fall of alveolar Po2 during a breath hold can be ascribed to the changes of O2 consumption (Vo2) and FRC associated with changing body weight. In the obese, Vo2/FRC was twice as large as in the nonobese, thus accounting for the differences of breath-hold time needed to obtain the same alveolar Po2. Sao2 measured at the end of the breath hold was the same as that value predicted from the reduction of PETo2. This suggests that the fall of alveolar Po2 can entirely account for the observed fall of O2 saturation and that venous admixture had not increased during the 15-s apnea. In patients with sleep apnea, the ratio of Vo2/(initial lung volume) may also be an important determinant of the severity of hypoxemia observed.