The treatment for obesity hypoventilation syndrome (OHS) is multifaceted and includes both nonpharmacologic and pharmacologic interventions.
Nonpharmacologic interventions
- Weight loss: Weight loss is a critical component of managing OHS. The American Thoracic Society (ATS) 2019 guidelines recommend offering weight loss interventions that produce sustained weight loss of 25–30% of actual body weight to achieve resolution of hypoventilation in patients with OHS
- Positive airway pressure therapy: Positive airway pressure therapy during sleep is recommended for stable ambulatory patients with OHS. Continuous positive airway pressure (CPAP) therapy is considered the first-line therapy in stable ambulatory patients with OHS and concomitant severe obstructive sleep apnea (apnea-hypopnea index ≥ 30 events/hour)
- Noninvasive ventilation: Noninvasive ventilation (NIV) is recommended before hospital discharge in hospitalized patients with respiratory failure suspected of having OHS, until they undergo outpatient workup and titration of positive airway pressure therapy in the sleep laboratory, ideally within the first 3 months after hospital discharge
Pharmacologic interventions
- Pharmacotherapy for obesity: Pharmacotherapy is recommended as an adjunct to lifestyle modifications in nonpregnant patients with a BMI ≥ 30 kg/m² or with a BMI ≥ 27 kg/m² and any metabolic comorbidities (hypertension, type 2 diabetes mellitus, or dyslipidemia)
Surgical interventions
- Bariatric surgery: Bariatric surgery is recommended for patients with severe obesity (BMI ≥ 40 kg/m² or BMI ≥ 35 kg/m² with comorbidities) who have not achieved significant weight loss through lifestyle modifications and pharmacotherapy
In conclusion, the treatment of OHS is comprehensive and involves a combination of weight loss, positive airway pressure therapy, noninvasive ventilation, pharmacotherapy for obesity, and in some cases, bariatric surgery.