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A Journal on Diseases of the Respiratory System


Official Journal of the Italian Society of Thoracic Endoscopy
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Minerva Pneumologica 2014 September;53(3):105-17

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Obesity hypoventilation syndrome: the pressure for effective treatment

Piper A. J. 1, 2

1 Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia; 2 Sleep and Circadian Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia


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The respiratory issues associated with OHS have received increasing attention over the last decade. Identifying and treating sleep disordered breathing remains the most common and effective long-term approach to reverse daytime respiratory failure in these individuals. Nevertheless, there is still insufficient data to confidently state what will be that most effective type of positive airway pressure (PAP) therapy to achieve this in any particular individual or clinical scenario. Improvements in nocturnal gas exchange and reversal of daytime respiratory failure have been reported using both continuous and bilevel modes of PAP. However, whether there are longer term benefits, clinical or fiscal, of one form of therapy over another has not been adequately evaluated. The findings from a number of larger scale, randomized studies currently near completion will provide much needed information regarding longer term outcomes arising from different forms of PAP therapy. This will assist clinicians in decision-making around the most clinical and cost effective PAP options for these individuals. However, it has become apparent that improvement or even normalisation of sleep ventilation and daytime gas exchange may have little impact on vascular and inflammatory factors underlying the high cardiometabolic abnormalities experienced by people with OHS. Identifying those with OHS early and commencing intervention before significant and multiple comorbidities develop may produce improved long-term outcomes. Effective therapy needs to look beyond sleep disordered breathing and include programs encouraging active weight loss and increased physical activity.

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