Clinical manifestations and diagnosis of obesity hypoventilation syndrome
- Amanda Piper, PhD
Amanda Piper, PhD
- Associate Professor
- Faculty of Medicine, University of Sydney
- Brendon Yee, MBChB, PhD
Brendon Yee, MBChB, PhD
- Associate Professor, University of Sydney
- Royal Prince Alfred Hospital Sydney, Woolcock Institute of Research
Obesity Hypoventilation Syndrome (OHS) is defined as the presence of awake alveolar hypoventilation in an obese individual which cannot be attributed to other conditions associated with alveolar hypoventilation [1-3]. OHS is associated with increased cardiovascular morbidity and mortality but is a diagnosis that is frequently overlooked. Consequently, early detection, and commencement on appropriate therapy are considered crucial in order to minimize the adverse effects of this disorder.
The clinical manifestations, diagnosis, and complications of OHS are reviewed here, while the pathogenesis and treatment are discussed separately. (See "Epidemiology and pathogenesis of obesity hypoventilation syndrome" and "Treatment and prognosis of the obesity hypoventilation syndrome" and "Noninvasive positive pressure therapy of the obesity hypoventilation syndrome".)
The major risk factor for OHS is obesity (body mass index [BMI] >30 kg/m2), in particular, severe obesity (BMI >50 kg/m2), where prevalence may be as high as 50 percent. However, not all patients with obesity develop OHS.
Risk factors in obese patients are poorly defined but may include [4-6]:
●Significant increase in waist:hip ratio (ie, central obesity)
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- RISK FACTORS
- CLINICAL MANIFESTATIONS
- Symptoms and signs
- Laboratory tests
- Pulmonary function tests
- Imaging and cardiac studies
- DIAGNOSTIC APPROACH
- Suspecting obesity hypoventilation
- Indicators of chronic alveolar hypoventilation
- Exclude other causes of hypercapnia and alveolar hypoventilation
- IDENTIFY COEXISTENT SLEEP DISORDERED BREATHING
- DIFFERENTIAL DIAGNOSIS
- ASSESS COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS