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Treatment and prognosis of the obesity hypoventilation syndrome

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


Obesity hypoventilation syndrome (OHS; "pickwickian syndrome") 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 (eg, neuromuscular disease). Untreated OHS is a progressive disorder that is associated with significant morbidity such that prompt recognition and treatment is critical.

The treatment and prognosis of OHS are reviewed here. The clinical manifestations, diagnosis, complications, and pathogenesis of OHS are discussed separately. (See "Clinical manifestations and diagnosis of obesity hypoventilation syndrome" and "Epidemiology and pathogenesis of obesity hypoventilation syndrome".)


Noninvasive positive airway pressure (PAP) together with weight loss are the initial first line therapies for patients with OHS. A comprehensive and multidisciplinary approach utilizing experts in obesity, sleep, and pulmonary medicine is recommended.

Positive airway pressure — All patients with OHS have some form of sleep disordered breathing, typically obstructive sleep apnea (OSA; 90 percent) or sleep-related hypoventilation (10 percent), warranting treatment with noninvasive PAP. PAP therapy should not be delayed while the patient tries to lose weight. Selection of the appropriate mode of PAP (eg, continuous PAP [CPAP], bilevel PAP [BPAP], volume cycled or hybrid modes of noninvasive ventilation) [1] and approach to initiating PAP therapy in patients with OHS are described in detail separately. (See "Noninvasive positive airway pressure therapy of the obesity hypoventilation syndrome".)

Obesity hypoventilation plus obstructive sleep apnea (continuous positive airway pressure) — CPAP is the typical mode chosen for treatment for OHS plus OSA, while BPAP, usually in the spontaneous–timed mode, is indicated in those who fail CPAP. (See "Noninvasive positive airway pressure therapy of the obesity hypoventilation syndrome", section on 'Obesity hypoventilation and obstructive sleep apnea'.)

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Literature review current through: Nov 2017. | This topic last updated: Aug 18, 2017.
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