Evaluation and Management of Obesity Hypoventilation Syndrome
Publication Date: August 1, 2019
Key Points
Key Points
Obesity hypoventilation syndrome (OHS) is defined by the combination of obesity (body mass index [BMI] ≥30 kg/m2), sleep-disordered breathing (SDB) and awake daytime hypercapnia (awake resting partial pressure of arterial CO2 or PaCO2 ≥45 mmHg at sea level), after excluding other causes for hypoventilation.
OHS is the most severe form of obesity-induced respiratory compromise and leads to serious sequelae, including increased rates of mortality, chronic heart failure, pulmonary hypertension, and hospitalization due to acute-on-chronic hypercapnic respiratory failure, among others.
While the definition of OHS suggests a diurnal pathology, polysomnography or sleep respiratory polygraphy is required to determine the pattern of SDB and hypoventilation (obstructive or non-obstructive), to tailor treatment, and to establish the optimal settings of positive airway pressure (PAP) therapy.
PAP has become the primary management option for controlling SDB and reversing awake hypoventilation in patients with OHS.
OHS is the most severe form of obesity-induced respiratory compromise and leads to serious sequelae, including increased rates of mortality, chronic heart failure, pulmonary hypertension, and hospitalization due to acute-on-chronic hypercapnic respiratory failure, among others.
While the definition of OHS suggests a diurnal pathology, polysomnography or sleep respiratory polygraphy is required to determine the pattern of SDB and hypoventilation (obstructive or non-obstructive), to tailor treatment, and to establish the optimal settings of positive airway pressure (PAP) therapy.
PAP has become the primary management option for controlling SDB and reversing awake hypoventilation in patients with OHS.
Evaluation
...Evaluation...
Figure 1. Summary Guideline FlowchartFlowchart...
Management
...Management...
...A: For obese patients with sleep-di...
...or patients with low to moderate probability o...
...ATS suggests that clinicians avoid using oxy...
...able ambulatory patients diagnosed w...
...For stable ambulatory patients diagnosed with...
...S suggests that hospitalized patients with r...
...: For patients with OHS the ATS suggests u...