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Obesity Hypoventilation Syndrome - Evaluation and Management

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Table 1. Recommendations Recommendations Explanations and other considerations 3: For stable ambulatory patients diagnosed with OHS and concomitant severe OSA (apnea-hypopnea index ≥30 events/hour), the ATS suggests initiating 1 st line treatment with CPAP therapy rather than noninvasive ventilation (NIV). (Conditional recommendation, very low level of certainty in the evidence) More than 70% of patients with OHS also have severe OSA; therefore, this recommendation applies to the majority of patients with OHS who have concomitant severe OSA. However, panel members lacked certainty on the clinical benefits of initiating treatment with CPAP, rather than NIV, in patients with OHS who have sleep hypoventilation without severe OSA. 4: e ATS suggests that hospitalized patients with respiratory failure suspected of having OHS be started on NIV therapy before being discharged from the hospital until they undergo outpatient workup and titration of PAP therapy in the sleep laboratory, ideally within the first 3 months aer hospital discharge. (Conditional recommendation, very low level of certainty in the evidence) Note: Discharging patients from hospital with NIV should not be a substitute for arranging the outpatient sleep study and PAP titration in the sleep laboratory, as soon as it is feasible. 5: For patients with OHS the ATS suggests using weight-loss interventions that produce sustained weight loss of 25–30% of actual body weight. is level of weight loss is most likely required to achieve resolution of hypoventilation. (Conditional recommendation, very low level of certainty in the evidence) Note: Many patients may not be able to achieve this degree of sustained weight loss despite participating in multifaceted comprehensive weight-loss lifestyle intervention program. ose who have no contraindications may benefit from being evaluated for bariatric surgery. (cont'd)

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