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Key Features

  • Hypoventilation resulting from blunted ventilatory drive and increased mechanical load imposed on the chest

  • Obstructive sleep apnea in most

  • Patients with obesity-hypoventilation syndrome have a higher risk of complications in the perioperative period, including respiratory failure, intubation and heart failure

Clinical Findings

  • Obesity

  • Lethargy, headache, hypersomnolence

  • Loud snoring if accompanied by obstructive sleep apnea

  • Dyspnea often absent

  • Signs of cyanosis and cor pulmonale may be found

  • Many patients have erythrocytosis


  • Diagnostic criteria

    • BMI > 30

    • Arterial partial pressure of carbon dioxide > 45 mm Hg

    • Exclusion of other causes of alveolar hypoventilation

  • Arterial blood gas measurements confirm daytime hypoxemia and hypercapnia, which improve with voluntary hyperventilation

  • Nocturnal sleep study helpful to evaluate for obstructive sleep apnea


  • Weight loss is key

  • Noninvasive positive pressure ventilation is helpful in many patients

  • Sedative hypnotics, opioids, and alcohol should be avoided

  • If present, obstructive sleep apnea must be treated aggressively (eg, nasal CPAP)

  • Treatment of comorbid conditions

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