Skip to main content
SpringerLink
Log in

Noninvasive Ventilation in Patients with Obesity Hypoventilation Syndrome

  • Chapter
  • First Online:
Noninvasive Mechanical Ventilation

  • 581 Accesses

Abstract

Obesity hypoventilation syndrome (ΟHS) has increased in recent decades because of the increasing prevalence of obesity. Early diagnosis is essential because these patients suffer from poor quality of life and severe comorbidities. Further examinations must be conducted to exclude other diseases that also cause hypoventilation. A polysomnography is often necessary to determine the form of sleep-disordered breathing (obstructive or non-obstructive) and individualize the treatment mode. CPAP is the first step in the treatment of patients with OHS who also suffer from severe OSA (AHI ≥ 30). NIV is usually chosen when response to previous CPAP treatment is inadequate or in cases where there is mainly nocturnal hypoventilation without severe OSA (ΑΗΙ < 30). It is also used in obese patients with acute-on-chronic respiratory failure. AVAPS mode should be applied when the treatment with other PAP modalities has failed. Oxygen therapy should be added when needed, but never as a monotherapy. NIV is well documented to treat nocturnal hypoventilation and OSA if it co-exists, daytime hypercapnia, TST < 90%, quality of sleep, gas exchange, hospital admissions, and quality of life. It also prevents severe complications such as cardiovascular diseases. Consequently, early application is essential to reduce mortality and morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sturm R. Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med. 2003;163:2146–8.

    Article  PubMed  Google Scholar 

  2. Mokhlesi B. Obesity hypoventilation syndrome a state-of-the-art review. Respir Care. 2010;55(10):1347–65.

    PubMed  Google Scholar 

  3. Mokhlesi B, Tulaimat A, Faibussowitsch I, et al. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007;11(2):117.

    Article  PubMed  Google Scholar 

  4. Macavei VM, Spurling KJ, Loft J, Makker HK. Diagnostic predictors of obesity-hypoventilation syndrome in patients suspected of having sleep disordered breathing. J Clin Sleep Med. 2013;9(9):879–84.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Akashiba T, Akahoshi T, Kawahara S, et al. Clinical characteristics of obesity-hypoventilation syndrome in Japan: a multi-center study. Intern Med. 2006;45:1121–5.

    Article  PubMed  Google Scholar 

  6. Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, Sánchez-Quiroga MÁ. Obesity hypoventilation syndrome. Eur Respir Rev. 2019;28(151):180097.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc. 2008;5:218–25.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American thoracic society clinical practice guideline. Am J Respir Crit Care Med. 2019;200(3):6–24.

    Article  Google Scholar 

  9. Masa JF, Corral J, Alonso ML, Ordax E, et al. Efficacy of different treatment alternatives for obesity hypoventilation syndrome. Pickwick study. Am J Respir Crit Care Med. 2015;192:86–95.

    Article  PubMed  Google Scholar 

  10. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. J Clin Sleep Med. 2012;8:597–619.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sharp JT, Henry JP, Sweany SK, Meadows WR, Pietras RJ. The total work of breathing in normal and obese men. J Clin Invest. 1964;43:728–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Zavorsky GS, Hoffman SL. Pulmonary gas exchange in the morbidly obese. Obes Rev. 2008;9:326–39.

    Article  CAS  PubMed  Google Scholar 

  13. Piper AJ, Grunstein RR. Obesity hypoventilation syndrome mechanisms and management. Am J Respir Crit Care Med. 2011;183:292–8.

    Article  PubMed  Google Scholar 

  14. Kessler R, Chaouat A, Schinkewitch P, et al. The obesity-hypoventilation syndrome revisited: a prospective study of 34 consecutive cases. Chest. 2001;120:369–76.

    Article  CAS  PubMed  Google Scholar 

  15. Sullivan CE, Berthon-Jones M, Issa FG. Remission of severe obesity-hypoventilation syndrome after short-term treatment during sleep with nasal continuous positive airway pressure. Am Rev Respir Dis. 1983;128:177–81.

    Article  CAS  PubMed  Google Scholar 

  16. Piper AJ, Wang D, Yee BJ, Barnes DJ, Grunstein RR. Randomised trial of CPAP vs bilevel support in the treatment of obesity hypoventilation syndrome without severe nocturnal desaturation. Thorax. 2008;63(5):395–401.

    Article  CAS  PubMed  Google Scholar 

  17. Mokhlesi B, Tulaimat A, Evans AT, et al. Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea. J Clin Sleep Med. 2006;2(1):57–62.

    Article  PubMed  Google Scholar 

  18. Steier J, Jolley CJ, Seymour J, et al. Neural respiratory drive in obesity. Thorax. 2009;64(8):719–25.

    Article  CAS  PubMed  Google Scholar 

  19. Hida W, Okabe S, Tatsumi K, et al. Nasal continuous positive airway pressure improves quality of life in obesity hypoventilation syndrome. Sleep Breath. 2004;7(1):3–12.

    Article  Google Scholar 

  20. Borel JC, Tamisier R, Gonzalez-Bermejo J, et al. Noninvasive ventilation in mild obesity hypoventilation syndrome: a randomized controlled trial. Chest. 2012;141(3):692–702.

    Article  PubMed  Google Scholar 

  21. Orfanos S, Jaffuel D, Perrin C, et al. Switch of noninvasive ventilation (NIV) to continuous positive airway pressure (CPAP) in patients with obesity hypoventilation syndrome: a pilot study. BMC Pulm Med. 2017;17(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Banerjee D, Yee BJ, Piper AJ, et al. Obesity hypoventilation syndrome: hypoxemia during continuous positive airway pressure. Chest. 2007;131(6):1678–84.

    Article  PubMed  Google Scholar 

  23. De Llano LAP, Golpe R, et al. Clinical heterogeneity among patients with obesity hypoventilation syndrome: therapeutic implications. Respiration. 2008;75(1):34–9.

    Article  Google Scholar 

  24. Masa JF, Benítez I, Sánchez-Quiroga MÁ, et al. Long-term noninvasive ventilation in obesity hypoventilation syndrome without severe OSA. The pickwick randomized controlled trial. Chest. 2020;158(3):1176–86.

    Article  CAS  PubMed  Google Scholar 

  25. Masa JF, Corral J, Caballero C, et al. Non-invasive ventilation in obesity hypoventilation syndrome without severe obstructive sleep apnoea. Thorax. 2016;71(10):899–906.

    Article  PubMed  Google Scholar 

  26. Royer CP, Schweiger C, Manica D, et al. Efficacy of bilevel ventilatory support in the treatment of stable patients with obesity hypoventilation syndrome: systematic review and meta-analysis. Sleep Med. 2019;53:153–64.

    Article  PubMed  Google Scholar 

  27. Masa JF, Mokhlesi B, Benítez I, et al. Echocardiographic changes with positive airway pressure therapy in obesity hypoventilation syndrome. Long-term pickwick randomized controlled clinical trial. Am J Respir Crit Care Med. 2020;201(5):586–97.

    Article  CAS  PubMed  Google Scholar 

  28. Álvarez RF, Ramire JB, Cuadrado GR, et al. Obesity-hypoventilation syndrome: baseline hemodynamic status and impact of non-invasive ventilation. Arch Bronconeumol. 2020;56(7):441–5.

    Google Scholar 

  29. Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomized controlled trial. Thorax. 2012;67:727–34.

    Article  PubMed  Google Scholar 

  30. Patout M, Gagnadoux F, Rabec C, et al. AVAPS-AE versus ST mode: a randomized controlled trial in patients with obesity hypoventilation syndrome. Respirology. 2020;25(10):1073–81.

    Article  PubMed  Google Scholar 

  31. Howard ME, Piper AJ, Stevens B, et al. A randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome. Thorax. 2017;72:437–44.

    Article  PubMed  Google Scholar 

  32. Masa JF, Mokhlesi B, Benítez I, de Terreros Caro FJG, et al. Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea. Thorax. 2020;75(6):459–67.

    Article  PubMed  Google Scholar 

  33. Soghier I, Brożek JL, Afshar M, et al. Noninvasive ventilation versus CPAP as initial treatment of obesity hypoventilation syndrome. Ann ATS. 2019;16(10):1295–303.

    Article  Google Scholar 

  34. Marik PE, Desai H. Characteristics of patients with the “malignant obesity hypoventilation syndrome” admitted to an ICU. J Intensive Care Med. 2013;28(2):124–30.

    Article  PubMed  Google Scholar 

  35. Oliveros H, Villamor E. Obesity and mortality in critically ill adults: a systematic review and meta-analysis. Obesity. 2008;16(3):515–21.

    Article  PubMed  Google Scholar 

  36. Davidson AC, Banham S, Elliott M, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax. 2016;71(Suppl 2):ii1–35.

    Article  PubMed  Google Scholar 

  37. Carrillo A, Ferrer M, Gonzalez-Diaz G, et al. Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;186:1279–85.

    Article  PubMed  Google Scholar 

  38. Lemyze M, Taufour P, Duhamel A, et al. Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure. PLoS One. 2014;9(5):e97563.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Chebib N, Nesme P, Freymond N, Argaud L, Rimmelé T, Bohé J, et al. Acute respiratory failure in obesity-hypoventilation syndrome managed in the ICU. Respir Care. 2019;64(12):1545–54.

    Article  PubMed  Google Scholar 

  40. Nicolini A, Lemyze M, Esquinas, Barlascini C, Cavalleri MA. Predictors of noninvasive ventilation failure in critically ill obese patients: a brief narrative review. Adv Respir Med. 2017;85(5):264–70.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Intensive Care Unit, ‘Agios Dimitrios’ General Hospital of Thessaloniki, Thessaloniki, Greece

    Maria Papathanasiou

  2. Department of Pulmonary Medicine, “Georgios Papanikolaou” General Hospital of Thessaloniki, Thessaloniki, Greece

    Dimitra Siopi

Authors
  1. Maria Papathanasiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitra Siopi
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Murcia, Spain

    Antonio M. Esquinas

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Papathanasiou, M., Siopi, D. (2023). Noninvasive Ventilation in Patients with Obesity Hypoventilation Syndrome. In: Esquinas, A.M. (eds) Noninvasive Mechanical Ventilation. Springer, Cham. https://doi.org/10.1007/978-3-031-28963-7_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-28963-7_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-28962-0

  • Online ISBN: 978-3-031-28963-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation