Obesity hypoventilation syndrome medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Reduction in weight, either through a regimen of diet and exercise, medication or sometimes through bariatric surgery, has been shown to improve the symptoms of OHS and resolution of the high carbon dioxide levels. Weight loss may take a long time and is not always successful.

Medical Therapy

Overnight mask ventilation with positive airway pressure may lead to an improvement in most symptoms of OHS. The type of mask ventilation depends on the underlying problem. If the main abnormality on investigations is obstructive sleep apnea, CPAP (continuous PAP) may be sufficient; this involves sleeping with a face mask connected to a machine that delivers a continuously high atmospheric pressure; this stops tissues in the mouth and throat area from collapsing and obstructing air flow. If sleep hypoventilation is the predominant problem, CPAP may be insufficient, and increased pressure ("pressure support") needs to be delivered during inspiration to allow more airflow into the alveoli (the sacs of the lung where gas transport takes place). This is referred to as BIPAP ("bi-level" PAP).[1]

Despite some initial positive reports about improvement of OHS with medroxyprogesterone, this is not recommended in practice.

References

  1. Piper AJ, Sullivan CE (1994). "Effects of short-term NIPPV in the treatment of patients with severe obstructive sleep apnea and hypercapnia" (PDF). Chest. 105 (2): 434–40. PMID 8306742.

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