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Noninvasive positive airway pressure therapy of the obesity hypoventilation syndrome

Thomas J Martin, MD
Section Editor
M Safwan Badr, MD
Deputy Editor
Geraldine Finlay, MD


Obesity hypoventilation syndrome (OHS) is diagnosed in obese (body mass index [BMI] >30 kg/m2) patients when awake alveolar hypoventilation (partial pressure of arterial carbon dioxide >45 mmHg) cannot be attributed to other causes (eg, neuromuscular diseases) [1]. Noninvasive positive airway pressure (PAP) is the mainstay of therapy for patients with OHS.

In this topic review, PAP therapy for patients with OHS is discussed. The pathogenesis, clinical manifestations, diagnosis, and other treatments for OHS are discussed separately. (See "Clinical manifestations and diagnosis of obesity hypoventilation syndrome" and "Treatment and prognosis of the obesity hypoventilation syndrome" and "Epidemiology and pathogenesis of obesity hypoventilation syndrome".)


Noninvasive positive airway pressure (PAP) therapy during sleep is first-line treatment for patients with OHS based upon the rationale that PAP improves indicators of alveolar ventilation and prevents further disease progression. The effect of PAP on survival is unclear, but appears to be improved as compared with historical controls. (See 'Efficacy' below and 'Efficacy' below.).

Patients should undergo in-laboratory polysomnography (PSG) to detect the associated form of sleep disordered breathing, guide mode selection for PAP therapy, and to determine optimal PAP and supplemental oxygen settings (see "Clinical manifestations and diagnosis of obesity hypoventilation syndrome", section on 'Identify coexistent sleep disordered breathing'):

Approximately 90 percent of patients with OHS have coexisting obstructive sleep apnea (OSA), in which case continuous positive airway pressure (CPAP) is the initial mode of choice. (See 'Continuous positive airway pressure' below.)


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Literature review current through: Jul 2017. | This topic last updated: Jul 06, 2017.
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