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Obesity hypoventilation syndrome (OHS)

Pickwickian syndrome

Obesity hypoventilation syndrome (OHS) is a condition in some obese people in which poor breathing leads to lower oxygen and higher carbon dioxide levels in the blood.

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Respiratory system

Causes

The exact cause of OHS is not known. Researchers believe OHS results from a defect in the brain's control over breathing. Excess weight against the chest wall also makes it harder for the muscles to draw in a deep breath and to breathe quickly enough. This worsens the brain's breathing control. As a result, the blood contains too much carbon dioxide and not enough oxygen.

Symptoms

The main symptoms of OHS are due to lack of sleep and include:

Symptoms of low blood oxygen level (chronic hypoxia) can also occur. Symptoms include shortness of breath or feeling tired after very little effort.

Exams and Tests

People with OHS are usually very overweight. A physical exam may reveal:

Tests used to help diagnose and confirm OHS include:

Health care providers can tell OHS from obstructive sleep apnea because a person with OHS has a high carbon dioxide level in their blood when awake.

Treatment

Treatment involves breathing assistance using special machines (mechanical ventilation). Options include:

Treatment is started in the hospital or as an outpatient.

Other treatments are aimed at weight loss, which can reverse OHS.

Outlook (Prognosis)

Untreated, OHS can lead to serious heart and blood vessel problems, severe disability, or death.

Possible Complications

OHS complications related to a lack of sleep may include:

OHS can also cause heart problems, such as:

When to Contact a Medical Professional

Call your provider if you are very tired during the day or have any other symptoms that suggest OHS.

Prevention

Maintain a healthy weight and avoid obesity. Use your CPAP or BiPAP treatment as your provider prescribed.

Related Information

Obstructive sleep apnea - adults
Respiratory acidosis
Blue discoloration of the skin
High blood pressure - adults

References

Malhotra A, Powell F. Disorders of ventilatory control. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 80.

Mokhlesi B. Obesity-hypoventilation syndrome. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 120.

Mokhlesi B, Masa JF, Brozek JL, 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(3):e6-e24. PMID: 31368798 www.ncbi.nlm.nih.gov/pubmed/31368798.

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Review Date: 7/23/2019  

Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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