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In obesity-hypoventilation syndrome, awake alveolar hypoventilation appears to result from a combination of blunted ventilatory drive and increased mechanical load imposed upon the chest by obesity. Voluntary hyperventilation returns the PCO2 and the PO2 toward normal values, a correction not seen in lung diseases causing chronic respiratory failure, such as COPD. Diagnostic criteria include a body mass index greater than 30, an arterial partial pressure of carbon dioxide greater than 45 mm Hg, and exclusion of other causes of alveolar hypoventilation. Most patients with obesity-hypoventilation syndrome also suffer from obstructive sleep apnea, which must be treated aggressively if identified as a comorbid disorder. Therapy of obesity-hypoventilation syndrome consists mainly of weight loss, which improves hypercapnia and hypoxemia as well as the ventilatory responses to hypoxia and hypercapnia. Avoidance of sedative-hypnotics, opioids, and alcohol is also recommended. NIPPV is helpful in many patients. Patients with obesity-hypoventilation syndrome have a higher risk of complications in the perioperative period, including respiratory failure, intubation, and cardiac failure. Recognition of these patients in the perioperative period is an important safety measure.

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Masa  JF  et al. Obesity hypoventilation syndrome. Eur Respir Rev. 2019;28:180097.
[PubMed: 30872398]  
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Mokhlesi  B  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:e6. Erratum in: Am J Respir Crit Care Med. 2019;200:1326.
[PubMed: 31368798]  
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Ramírez Molina  VR  et al. Effectiveness of different treatments in obesity hypoventilation syndrome. Pulmonology. 2020;26:370.
[PubMed: 32553827]  

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