Obesidad IMC ≥30 kg/m² El Síndrome de Hipoventilación por Obesidad en este contexto implica a un paciente con obesidad (IMC ≥30 kg/m²), hipercapnia diurna (CO₂ arterial ≥45 mmHg) y trastornos respiratorios del sueño. La característica definitoria de este fenotipo es la apnea obstructiva del sueño grave concomitante (índice de apnea/hipopnea ≥30 eventos/h), una presentación compartida por cerca del 70% de los pacientes con SHO y el factor crítico que determina qué modalidad de tratamiento se elige en primer lugar.
Para este fenotipo de SHO, el tratamiento de primera línea se centra en una modalidad específica de presión positiva en la vía aérea administrada como parte de una estrategia terapéutica multimodal estructurada; el régimen completo, los requisitos de titulación y los criterios para intervenciones adicionales en pacientes elegibles se detallan en el protocolo completo.
El objetivo principal es la corrección de la hipercapnia diurna (CO₂ arterial <45 mmHg), con un control clínico y gasométrico adecuado evaluado durante los primeros 2–3 meses de tratamiento.
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.
CPAP is considered the first-line treatment modality for OHS phenotype with concomitant severe obstructive sleep apnoea, whereas NIV is preferred in the minority of OHS patients with hypoventilation during sleep with no or milder forms of obstructive sleep apnoea (approximately <30% of OHS patients).
Nearly 70% of patients have concomitant severe OSA (AHI ⩾30 events·h⁻¹).
Continuous positive airway pressure (CPAP) could be first-line treatment for OHS patients with concomitant severe obstructive sleep apnoea (OSA).
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.
Bariatric surgery is a cost-effective strategy for managing severe obesity with comorbidity such as OSA with long-term efficacy data.
Both PAP modalities seek to correct sleep hypoxaemia, obstructive events and hypercapnia.
However, we encourage clinicians to monitor these patients closely for the first 2–3 months after initiating PAP therapy.
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