Obesity Hypoventilation

Obesity Hypoventilation Syndrome (OHS)

Man sleeping with a positive airway pressure mask

Obesity hypoventilation syndrome (OHS) is a breathing disorder in which people with obesity do not breathe deeply or often enough, leading to high carbon dioxide and often low oxygen levels in the blood, even while awake. Most people with OHS also have obstructive sleep apnea. Because it involves both the lungs and sleep, OHS is best managed by physicians trained in pulmonary and sleep medicine.

Symptoms can include:

  • Daytime sleepiness and fatigue
  • Morning headaches
  • Shortness of breath, especially with activity
  • Loud snoring and pauses in breathing during sleep
  • Swelling of the legs and feet
  • Low oxygen levels

Without treatment, OHS can lead to pulmonary hypertension, heart failure and repeated hospital stays.

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Diagnosis & Treatment

How we diagnose OHS

  • Blood tests, including an arterial blood gas or bicarbonate level, to measure carbon dioxide
  • Pulmonary function tests and imaging to rule out other lung or chest wall causes
  • A sleep study to measure breathing and oxygen levels during sleep
  • An echocardiogram in some patients to check heart pressures

Treatment options

  • Positive airway pressure therapy: CPAP for many patients who also have severe sleep apnea, or BiPAP / noninvasive ventilation to help remove carbon dioxide
  • Supplemental oxygen when needed, in addition to airway pressure therapy
  • A weight-loss plan, including referral for medical or surgical weight-loss options
  • Regular follow-up of blood gases, symptoms and device data

See also: Sleep Apnea · Pulmonary Medicine

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