Treatment of Obesity Hypoventilation Syndrome

Obesity hypoventilation syndrome is defined as alveolar hypoventilation while awake in an obese individual where there is no other cause of the hypoventilation (such as a sedating drug). Ninety percent of people with obesity hypoventilation syndrome (OHS) also have an associated obstructive sleep apnea.

For those who suffer from obesity hypoventilation syndrome, it is critically important to seek treatment. As the condition may have serious and even fatal consequences, early and aggressive intervention may prove necessary. Learn about some of the possible treatment options for obesity hypoventilation syndrome and the goals of these treatments.

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Treatment Options

The treatment options for obesity hypoventilation syndrome (OHS) can be divided into tackling the two most important features of the disorder: weight loss and breathing support.

Weight Loss

As the name implies, obesity is a key contributor to the disorder. If substantial weight loss can be achieved, relief is obtained. This may be achieved through diet and exercise, but more than 100 pounds of weight loss may be necessary. As rapid weight loss could be dangerous, it is recommended that people do this under the supervision of their healthcare provider. Nutritionists may provide helpful guidance in making behavioral changes. Unfortunately, it is not possible to predict the exact amount of weight that must be lost for an individual to cure OHS.

Weight loss medications with close healthcare provider supervision might be considered in individuals who have been unable to lose weight with diet and lifestyle modifications.

As diet and exercise may not have sustained effects on reducing weight, it may be necessary to turn to surgical options such as gastric bypass surgery. These procedures in people who are overweight and have sleep apnea have increased risks. In particular, the airway may collapse under the anesthesia used for surgery and recovery may be complicated.

Bariatric surgery may be considered for people with a body mass index (BMI) of 35 or more. It is helpful to have a sleep study called a polysomnogram before and after the surgery to monitor the benefits of the procedure. As the weight loss occurs over a period of months, it may be necessary to support breathing during this time with other treatments. If a patient has developed pulmonary hypertension as a consequence of the OHS, surgery may be considered too risky.

Breathing Support

The mainstay of treatment in OHS is to provide breathing support, often through the use of continuous positive airway pressure (CPAP) or bilevel. These devices generate a pressurized flow of air that can keep the upper airway from collapsing during sleep.

If OHS relates to a problem with breathing, can oxygen be used to treat it? Supplemental oxygen therapy may be added if there is underlying lung disease such as COPD, but it is inadequate by itself. In fact, using oxygen alone in OHS may actually suppress breathing.

In severe cases, it may be necessary to perform a tracheostomy. This procedure involves the insertion of a small plastic breathing tube at the front of the throat. This bypasses the upper airway, which is prone to collapse or obstruction in people with OHS. Though a tracheostomy is effective, there are problems associated with its use. It can be difficult to adjust to the change, especially how it impacts speech. Bronchitis may also occur more frequently. In general, given the other treatment options, it is now rarely used.

It is also necessary to avoid alcohol and certain drugs that suppress your ability to breathe. Possible culprits include prescription medications, such as benzodiazepines, opiates, and barbiturates. You should review your medications with your healthcare provider to ensure that none of them put you at increased risk.

Goals of Treatment

Ultimately, the purpose of any treatment in obesity hypoventilation syndrome is to correct the underlying problems that contribute to the disease. The dysfunctional breathing that characterizes the disease leads to an imbalance in the chemical levels of the blood. When carbon dioxide cannot be properly removed, its levels increase and make the blood more acidic. This triggers a number of changes in the body that can have negative consequences.

Treatment can prevent drops in the oxygen saturation of your blood, elevation in the red blood cell count called erythrocytosis, pulmonary hypertension, and heart failure (known as cor pulmonale). Weight loss normalizes oxygen and carbon dioxide levels. The use of CPAP or bilevel, as well as other measures, helps decrease the degree of these complications.

Ultimately, sleep becomes less fragmented and this improves excessive daytime sleepiness. This results in an improved quality of life, which is the goal of any successful medical treatment.

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By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.