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Eur Respir Rev. 2019 Mar 14;28(151). pii: 180097. doi: 10.1183/16000617.0097-2018. Print 2019 Mar 31.

Obesity hypoventilation syndrome.

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San Pedro de Alcántara Hospital, Cáceres, Spain
CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE) , Cáceres, Spain.
Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France.
CHU de Grenoble, Laboratoire EFCR, Pôle Thorax et Vaisseaux, Grenoble, France.
AGIR à dom. Association, Meylan, France.
University of Chicago, Chicago, IL, USA.
Guy's & St Thomas' NHS Foundation Trust, London, UK.
Centre for Human & Applied Physiological Sciences King's College London, London, UK.
Virgen del Puerto Hospital, Cáceres, Spain.


Obesity hypoventilation syndrome (OHS) is defined as a combination of obesity (body mass index ≥30 kg·m-2), daytime hypercapnia (arterial carbon dioxide tension ≥45 mmHg) and sleep disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. OHS prevalence has been estimated to be ∼0.4% of the adult population. OHS is typically diagnosed during an episode of acute-on-chronic hypercapnic respiratory failure or when symptoms lead to pulmonary or sleep consultation in stable conditions. The diagnosis is firmly established after arterial blood gases and a sleep study. The presence of daytime hypercapnia is explained by several co-existing mechanisms such as obesity-related changes in the respiratory system, alterations in respiratory drive and breathing abnormalities during sleep. The most frequent comorbidities are metabolic and cardiovascular, mainly heart failure, coronary disease and pulmonary hypertension. Both continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) improve clinical symptoms, quality of life, gas exchange, and sleep disordered breathing. CPAP is considered the first-line treatment modality for OHS phenotype with concomitant severe obstructive sleep apnoea, whereas NIV is preferred in the minority of OHS patients with hypoventilation during sleep with no or milder forms of obstructive sleep apnoea (approximately <30% of OHS patients). Acute-on-chronic hypercapnic respiratory failure is habitually treated with NIV. Appropriate management of comorbidities including medications and rehabilitation programmes are key issues for improving prognosis.

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Conflict of interest statement

Conflict of interest: J.F. Masa has nothing to disclose. Conflict of interest: J-L. Pépin reports grants and research funds from Air Liquide Foundation, Agiradom, AstraZeneca, Fisher and Paykel, Mutualia, Philips and Resmed. He has also received fees from Agiradom, AstraZeneca, Boehringer Ingelheim, Jazz pharmaceutical, Night Balance, Philips, Resmed and Sefam. Conflict of interest: J-C. Borel reports grants and personal fees from Philips, personal fees and other fees from Resmed, and other fees from AGIR à dom (for salaries) and NOMICS (for patents), outside the submitted work. Conflict of interest: B. Mokhlesi has nothing to disclose. Conflict of interest: P.B. Murphy reports grants and personal fees from Philips and Resmed, and personal fees from Fisher-Paykel, outside the submitted work. Conflict of interest: M.A. Sánchez Quiroga has nothing to disclose.

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