Obesity hypoventilation syndrome: therapeutic implications for treatment

Obesity hypoventilation syndrome occurs in obese individuals who are unable to compensate for the added load of obesity on the respiratory system, with resultant daytime hypercapnia in the absence of other causes of alveolar hypoventilation. Significant morbidity and mortality is seen in this disorder if appropriate treatment is not undertaken. Unfortunately, the diagnosis is frequently missed despite these individuals being heavy users of healthcare resources. The pathogenesis of obesity hypoventilation syndrome is multifactorial, but reversal of sleep-disordered breathing or significant weight loss improves respiratory function and daytime ventilation. However, a paucity of well-designed clinical trials and the absence of data from long-term follow-up means that comparison between various treatment options is not possible. Consequently, evidence-based treatment guidelines are currently lacking.