Learn About Obesity Hypoventilation Syndrome

What is the definition of Obesity Hypoventilation Syndrome (OHS)?

Obesity hypoventilation syndrome (OHS) causes poor breathing in some people with obesity. It leads to lower oxygen and higher carbon dioxide levels in the blood.

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What are the alternative names for Obesity Hypoventilation Syndrome (OHS)?

Pickwickian syndrome

What are the causes of Obesity Hypoventilation Syndrome (OHS)?

The exact cause of OHS is not known. It is believed that OHS results from a defect in the brain's control over breathing. Excess weight against the chest wall also makes it harder for the muscles to draw in a deep breath and to breathe quickly enough. This worsens the brain's breathing control. As a result, the blood contains too much carbon dioxide and not enough oxygen.

What are the symptoms of Obesity Hypoventilation Syndrome (OHS)?

The main symptoms of OHS are due to lack of sleep and include:

  • Poor sleep quality
  • Sleep apnea
  • Daytime sleepiness
  • Depression
  • Headaches
  • Tiredness

Symptoms of low blood oxygen level (chronic hypoxia) and high carbon dioxide can occur. Symptoms include shortness of breath or feeling tired after little effort.

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What are the current treatments for Obesity Hypoventilation Syndrome (OHS)?

Treatment involves breathing assistance using special machines (mechanical ventilation). Options include:

  • Noninvasive mechanical ventilation such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) through a mask that fits tightly over the nose or nose and mouth (mainly for sleep)
  • Oxygen therapy
  • Breathing help through an opening in the neck (tracheostomy) for severe cases

Treatment is started in the hospital or as an outpatient.

Other treatments are aimed at weight loss, which can reverse OHS, although it is often difficult to achieve.

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What is the outlook (prognosis) for Obesity Hypoventilation Syndrome (OHS)?

Untreated, OHS can lead to serious heart and blood vessel problems, severe disability, or death.

What are the possible complications of Obesity Hypoventilation Syndrome (OHS)?

OHS complications related to a lack of sleep may include:

  • Depression, agitation, irritability
  • Increased risk for accidents or mistakes at work
  • Problems with intimacy and sex

OHS can also cause heart problems, such as:

  • High blood pressure (hypertension)
  • Right-sided heart failure (cor pulmonale)
  • High blood pressure in the lungs (pulmonary hypertension)
When should I contact a medical professional for Obesity Hypoventilation Syndrome (OHS)?

Contact your provider if you are very tired during the day or have any other symptoms that suggest OHS.

How do I prevent Obesity Hypoventilation Syndrome (OHS)?

Maintain a healthy weight. Use your CPAP or BiPAP treatment as your provider prescribed.

Respiratory system
What are the latest Obesity Hypoventilation Syndrome Clinical Trials?
Does Domiciliary Nasal High Flow (NHF) Therapy Improve Patient Outcomes in Chronic Hypercapnic Respiratory Failure (CHRF) in the United Kingdom (UK): A Pre and Post Interventional Study

Summary: Chronic hypercapnic respiratory failure (CHRF) in the context of Chronic Obstructive Pulmonary Disease (COPD) and Obesity Hypoventilation Syndrome (OHS) is associated with increased mortality. The availability and effectiveness of domiciliary Non-invasive ventilation (NIV) treatment (when indicated) is key as this treatment can improve quality of life and reduce health-care costs from associated b...

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Evaluation of An Optical Measurement Algorithm Combined With Patient and Provider Input to Reduce Mask Exchanges During Initial Positive Airway Pressure Therapy

Summary: Continuous positive airway pressure and non-invasive ventilation are common treatment modalities for obstructive sleep apnea, central sleep apnea, and chronic alveolar hypoventilation from a variety of causes. Use of positive airway pressure (PAP) requires use of an interface, commonly referred to as a mask. There are a range of mask options available, differing in configuration and sizing, includ...

What are the Latest Advances for Obesity Hypoventilation Syndrome?
Who are the sources who wrote this article ?

Published Date: August 01, 2021
Published By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 05/23/2022.

What are the references for this article ?

Malhotra A, Powell F. Disorders of ventilatory control. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 80.

Mokhlesi B, Tamisier R. Obesity-hypoventilation syndrome. In: Kryger M, Roth T, Goldstein CA, Dement WC, eds. Principles and Practice of Sleep Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 138.

Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019;200(3):e6-e24. PMID: 31368798 pubmed.ncbi.nlm.nih.gov/31368798/.