NIV for obesity hypoventilation syndrome (OHS)

All patients who are overweight and obese should begin a controlled weight loss programme. In addition to improving general health, weight loss can improve alveolar ventilation [PaCO2] and arterial oxygen tension [PaO2].

Therapeutic goals for patients with OHS include normalization of arterial carbon dioxide tension (i.e. PaCO2 <45 mmHg) as well as prevention of oxyhemoglobin desaturation during sleep and wakefulness. Therapy goals also include prevention of erythrocytosis, pulmonary hypertension, and cor pulmonale and relief of hypersomnia and altered mentation.

To achieve these goals, all OHS patients need to be managed with nocturnal positive airway pressure. NIV has been widely observed to be the effective treatment for OHS1.

Addressing the Ventilation Needs of OHS Patients

  • Patients with OHS require increased levels of medical care and are more likely to be hospitalized. Hospitalization rates of OHS patients were found to be 8.6 times higher than for general population control subjects.2
  • OHS patients have been found to make 11.2 physician visits per year compared to 5.7 visits for obese-only patients.2
  • OHS often results in right-sided heart failure, pulmonary hypertension and polycythemia.3
  • Effective treatment of OHS has shown a significant reduction in physician fees and a 68.4% decrease in annual hospitalization days.2

For OHS patients, NIV significantly improves blood gases during the night, but the effect also remains during the day4. NIV provides relief for the ventilatory muscles and has been proven to have a positive effect on lung function, especially when residual capacity is increased5

References

  • 01

    Storre JH, Seuthe B, Fiechter R, Milioglou S, Dreher M, Sorichter S, Windisch W. Average volume-assured pressure support in obesity hypoventilation: A randomised crossover trial. Chest. 2006 Sep; 130(3): 815-21.

  • 02

    Berg G, Delaive K, Manfreda J, et al. The use of healthcare resources in obesity hypoventilation syndrome. Chest. 2001 120: 377-383

  • 03

    Chest. 2007 Oct;132(4):1322-36. Recent advances in obesity hypoventilation syndrome. Mokhlesi B, Tulaimat A.

  • 04

    Povitz M, Hanly PJ, Sachin PR, et al. Treatment of Sleep Disordered Breathing Liberates Obese Hypoxemic Patients from Oxygen. PLoS One. 2015; 10(10): e0140135.Published online 2015 Oct 9.

  • 05

    Budweiser, S., Hitzl A.P., Jörres, R.A., Schmidbauer, K., Heinemann, F., Pfeifer, M., (2007). Health-related quality of life and long-term prognosis in chronic hypercapnic respiratory failure: a prospective survival analysis. Respir Res. 8(17): 92

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