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Obesity hypoventilation syndrome

Key sources
The following summarized guidelines for the evaluation and management of obesity hypoventilation syndrome are prepared by our editorial team based on guidelines from the American Thoracic Society (ATS 2019).


1.Diagnostic investigations

Blood gas analysis: consider measuring PaCO2 rather than serum bicarbonate or SpO2 for the diagnosis of OHS in patients with obesity and sleep-disordered breathing with a high pretest probability of having OHS.
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2.Respiratory support

Positive airway pressure therapy
Consider initiating positive airway pressure therapy during sleep in stable ambulatory patients with OHS.
Consider initiating CPAP therapy rather than noninvasive ventilation as first-line therapy in stable ambulatory patients with OHS and concomitant severe obstructive sleep apnea (apnea-hypopnea index ≥ 30 events/hour).

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  • Noninvasive ventilation

3.Nonpharmacologic interventions

Weight loss: consider offering weight loss interventions producing sustained weight loss of 25-30% of actual body weight to achieve resolution of hypoventilation in patients with OHS.