علاج متلازمة نقص التهوية في السمنة (مؤشر كتلة الجسم ≥30 كجم/م²) مع فرط ثاني أكسيد الكربون أثناء النهار وبدون انقطاع نفس انسدادي أو مع انقطاع نفس انسدادي خفيف

References

DOI: 10.1183/16000617.0097-2018

• Obesity hypoventilation syndrome (OHS) is defined as a combination of obesity (body mass index ⩾30 kg·m⁻²), daytime hypercapnia (arterial carbon dioxide tension ⩾45 mmHg) and sleep disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation.
• The remaining patients have non-obstructive sleep hypoventilation with no or mild OSA.
• Noninvasive ventilation (NIV) should be considered as first-line therapy for OHS patients with no OSA or milder forms of OSA.
• Accordingly, for patients with more pure forms of hypoventilation and with fewer obstructive events during sleep (i.e. mild to no OSA), the treatment of choice would be NIV.
• Regardless of the chosen modality, PAP titration during sleep is strongly recommended.
• Therefore, a multimodality therapeutic approach is necessary to combine PAP therapy with strategies aimed at weight reduction and increased physical activity.
• Ventilatory support produces an improvement in gas exchange, which translates into a significant reduction in daytime wake PaCO₂ and an increase in arterial oxygen tension.
• Both PAP modalities seek to correct sleep hypoxaemia, obstructive events and hypercapnia.