Treatment of Obesity Hypoventilation Syndrome

Weight Loss, Breathing Support Can Be Effective

A scale can be used to measure body weight and this is an important vital sign tracked by your doctor at routine visits. Brandon Peters, M.D.

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.

Treatment Options in Obesity Hypoventilation Syndrome

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 physician. 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.

Currently, weight loss medications are not recommended to manage the obesity in OHS.

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.

It is recommended that bariatric surgery be reserved for people who have a body mass index (BMI) greater than 35 and no other medical conditions that would increase surgical risk. 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.

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 doctor 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, 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, likewise prevent these consequences.

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.

Sources

Chouri-Pontarollo, N et al. "Impaired objective daytime vigilance in obesity-hypoventilation syndrome: impact of noninvasive ventilation." Chest 2007;131:148.

Conway, W et al. "Adverse effects of tracheostomy for sleep apnea." JAMA 1981;246:347.

Perez de Llano, LA et al. "Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome." Chest 2005;128:587.

Scrima, L et al. "Increased severity of obstructive sleep apnea after bedtime alcohol ingestion: diagnostic potential and proposed mechanism of action." Sleep 1982;5:318.

Sugerman, H et al. "Long-term effects of gastric surgery for treating respiratory insufficiency of obesity." Am J Clin Nutr 1992;55:597S.

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