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)