In an official American Thoracic Society clinical practice guideline, published in the Aug. 1 issue of the American Journal of Respiratory and Critical Care Medicine, recommendations are presented to guide management and improve outcomes for patients with obesity hypoventilation syndrome (OHS).

Babak Mokhlesi, M.D., from the University of Chicago, and colleagues performed a systematic review of the literature and developed recommendations to optimize evaluation and management of OHS.

The panel made five conditional recommendations after considerating the overall very low quality of evidence. For obese patients with sleep disordered breathing for whom suspicion for OHS is not high, clinicians should use a serum bicarbonate level <27 mmol/L to exclude diagnosis of OHS; in patients strongly suspected of having OHS, arterial blood gases should be measured. Positive airway pressure (PAP) should be used for stable ambulatory patients with OHS. For stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, continuous PAP should be offered as first-line treatment rather than noninvasive ventilation. Patients hospitalized with respiratory failure and suspected of having OHS should be discharged with noninvasive ventilation until undergoing outpatient diagnostic procedures and PAP titration. To achieve resolution of OHS, patients should use weight-loss interventions that produce sustained weight loss of 25 to 30 percent of body weight (more likely with bariatric surgery).

"Providers must consider options on the basis of resource availability and health care policies unique to their geographical regions," the authors write.

Several authors disclosed financial ties to the biopharmaceutical, medical device, and medical technology industries; one author served as an expert witness for a law firm.

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