Babak Mokhlesi

Caregivers have a new tool for tackling an under-recognized breathing disorder that can crop up in bariatric patients — especially those with sleep apnea.

Obesity hypoventilation syndrome (OHS) affects about 8% to 20% of people who are obese and have sleep apnea, causing them to have too much carbon dioxide and too little oxygen in their blood. It’s a potentially life-threatening condition that is often misdiagnosed or missed altogether, according to the American Thoracic Society.

The organization last week released a set of clinical guidelines (summarized here) to help bring the problem to light and improve care for these patients:

  1. How and in what cases to look for OHS
  2. How to identify OHS patients who should receive positive airway pressure (PAP)
  3. How to identify OHS patients who should receive continuous positive airway pressure (CPAP) treatment rather than noninvasive ventilation
  4. How to best manage discharged patients who were hospitalized with respiratory failure and suspected OHS
  5. How OHS may be resolved (by weight loss of at least 25%, most likely to be obtained with bariatric surgery rather than with diet and exercise)

The guidelines also address patient-centered outcomes, such as improving quality of life, quality of sleep and daytime sleepiness. Clinical management of gas exchange, need for supplemental oxygen and hospital resource utilization are also covered. The authors emphasize that shared decision-making between clinician and patient is key to resolving the condition.

“The panel believes that early recognition and effective treatment of OHS are important in improving morbidity and mortality,” said guideline panel chair and pulmonologist Babak Mokhlesi, M.D., of the University of Chicago. 

But he and his colleagues caution that the guidelines should not be applied in a blanket fashion.

“No recommendation can take into account all of the variable and often compelling circumstances that might affect the potential benefits, harms and burdens of an intervention in specific cases and contexts,” they wrote.

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline,” was published in the American Journal of Respiratory and Critical Care Medicine.