A patient with Obesity Hypoventilation Syndrome (OHS) may experience obstructive sleep apnea (OSA). The degree of overlap may determine the best management strategy. The authors are from multiple institutions in the United States and represent the American Thoracic Society.
Patient selection: obese patient with obesity hypoventilation syndrome (OHS)
The patient is evaluated for obstructive sleep apnea (OSA), which is graded from none to severe.
Indications for noninvasive ventilation (NIV) or auto-PAP:
(1) OHS with mild to moderate OSA
(2) inadequate treatment with CPAP (lack of symptom resolution or insufficient improvement in gas exchange)
Indications for CPAP:
(1) OHS with severe OSA
Initially the goal is to identify the appropriate strategy and to optimize it for the patient.
Once the hypoventilation has been addressed, then the obesity needs to be addressed, with the patient being evaluated for suitability of bariatric surgery.
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