Medical emergencies

ATS: New Guidelines for Managing Obesity Hypoventilation Syndrome

The American Thoracic Society has published a new clinical guideline for the management of obesity hypoventilation syndrome (OHS).

After a multidisciplinary panel reviewed all the available studies (published up to July 2018), the panel made the following 5 recommendations:

  1. To exclude the diagnosis of OHS in patients with obesity and sleep-disordered breathing, clinicians should use a serum bicarbonate level of less than 27 mmol/L when suspicion for OHS is less than 20% but to measure arterial blood gases in patients strongly suspected of having OHS,
  2. Clinicians should administer positive airway pressure to stable ambulatory patients with OHS,
  3. Clinicians should administer continuous positive airway pressure, rather than noninvasive ventilation, as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea,
  4. Clinicians should prescribe noninvasive ventilation to patients hospitalized with respiratory failure and suspected of having OHS until they undergo outpatient diagnostic procedures and positive airway pressure titration in the sleep laboratory within 2 to 3 months, and
  5. Clinicians should prescribe weight-loss interventions that result in sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS (which is more likely to be obtained with bariatric surgery).

“Clinicians caring for patients with OHS should view severe obesity as a major, modifiable contributing factor to both the development and severity of OHS and engage in health education and shared decision-making with patients about evidence-based weight-loss strategies,” the panel wrote.

“On the basis of our review of available evidence, we propose a diagnostic and therapeutic algorithm for patients with OHS or suspected of having OHS.”

—Amanda Balbi

 

Reference:

Mokhlesi B, Masa JF, Brozek JL, et al; American Thoracic Society Assembly on Sleep and Respiratory Neurobiology. Evaluation and management of obesity hypoventilation syndrome: an official American Thoracic Society clinical practice guideline [published online August 1, 2019]. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.201905-1071ST.