Treatment of the obesity hypoventilation syndrome
- Thomas J Martin, MD
Thomas J Martin, MD
- Associate Professor of Clinical Medicine
- University of Virginia School of Medicine
- Assistant Professor of Medicine
- Edward Via Virginia College of Osteopathic Medicine
- Associate Professor of Medicine
- Virginia Tech-Carilion School of Medicine
Obesity hypoventilation syndrome (OHS) exists when an obese individual (body mass index [BMI] >30kg/m2) has awake alveolar hypoventilation (arterial carbon dioxide tension [PaCO2] >45 mmHg), which cannot be attributed to other conditions such as pulmonary disease, skeletal restriction, neuromuscular weakness, hypothyroidism, or pleural pathology [1-3].
Patients with OHS typically have a diminished respiratory drive, obesity-related respiratory impairment, and sleep-related breathing abnormalities . Obstructive sleep apnea (OSA) is particularly common among patients with OHS, occurring in 85 to 92 percent of patients who have OHS [5-7]. Conversely, OHS is less common among patients with OSA, occurring in 4 to 20 percent of patients with OSA [8-11].
The natural history and treatment of OHS are reviewed here. The clinical manifestations, diagnosis, and pathogenesis of OHS are discussed separately. (See "Clinical manifestations and diagnosis of obesity hypoventilation syndrome" and "Pathogenesis of obesity hypoventilation syndrome".)
Treatment is important because untreated obesity hypoventilation syndrome (OHS) can progress to acute, life-threatening cardiopulmonary compromise. In addition, untreated OHS is associated with a high mortality rate, a reduced quality of life, and numerous morbidities, including pulmonary hypertension, right heart failure, angina, and insulin resistance [4,12-14].
A prospective cohort study compared consecutively admitted patients with obesity-associated hypoventilation and severely obese patients without hypoventilation . It found that the patients with obesity-associated hypoventilation had a higher mortality rate 18 months after discharge (23 versus 9 percent) as well as increased rates of invasive mechanical ventilation during the admission and long-term care after discharge. Specific therapy was recommended during the admission for only 13 percent of the patients with obesity-associated hypoventilation.
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