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</div><div><span>Obesity hypoventilation syndrome (OHS)</span></div></div>
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<article><div id="d-article"><div class="page-info"><div class="page-title"><a name="start" id="start">
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</a><h1 class="with-also" itemprop="name">Obesity hypoventilation syndrome (OHS)</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Obesity hypoventilation syndrome (OHS) causes poor breathing in some people with obesity. It leads to lower oxygen and higher carbon dioxide levels in the blood.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>The exact cause of OHS is not known. It is believed that 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.</p><p>During stable conditions, people are not acidemic as the kidneys have enough time to correct the acidity caused by the high carbon dioxide.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>The main symptoms of OHS are due to lack of sleep and include:</p><ul><li>Poor sleep quality</li><li><a test="test" href="./000811.htm">Sleep apnea</a></li><li>Daytime sleepiness</li><li><a test="test" href="./003213.htm">Depression</a></li><li>Headaches</li><li>Tiredness</li></ul><p>Symptoms of low blood oxygen level (chronic hypoxia) and high carbon dioxide can occur. Symptoms include shortness of breath or feeling tired after little effort.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>People with OHS have obesity (body mass index of 30 kg/m<sup>2 </sup>or greater). A physical exam may show:</p><ul><li>Bluish color in the lips, fingers, toes, or skin (<a test="test" href="./003215.htm">cyanosis</a>)</li><li>Reddish skin</li><li>Signs of right-sided heart failure (<a test="test" href="./000129.htm">cor pulmonale</a>), such as swollen legs or feet, shortness of breath, or feeling tired after little effort</li><li>Signs of extreme sleepiness</li></ul><p>Tests used to help diagnose OHS include:</p><ul><li><a test="test" href="./003855.htm">Arterial blood gas</a></li><li><a test="test" href="./003804.htm">Chest x-ray</a> or <a test="test" href="./003788.htm">CT scan of the chest</a> to rule out other possible causes</li><li>Lung function tests (<a test="test" href="./003853.htm">pulmonary function tests</a>)</li><li><a test="test" href="./003932.htm">Sleep study (polysomnography)</a></li><li><a test="test" href="./003869.htm">Echocardiogram</a> (ultrasound of the heart)</li></ul><p>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.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>Treatment involves breathing assistance using special machines (mechanical ventilation). Options include:</p><ul><li>Noninvasive mechanical ventilation such as <a test="test" href="./001916.htm">continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP)</a> through a mask that fits tightly over the nose or nose and mouth (mainly for sleep)</li><li>Oxygen therapy</li><li>Breathing help through an opening in the neck (<a test="test" href="./002955.htm">tracheostomy</a>) for severe cases </li></ul><p>Treatment is started in the hospital or as an outpatient. </p><p>Other treatments are aimed at weight loss, which can reverse OHS, although it is often difficult to achieve.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>Untreated, OHS can lead to serious heart and blood vessel problems, severe disability, or death.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>OHS complications related to a lack of sleep may include:</p><ul><li>Depression, agitation, irritability</li><li>Increased risk for accidents or mistakes at work</li><li>Problems with intimacy and sex </li></ul><p>OHS can also cause heart problems, such as:</p><ul><li>High blood pressure (<a test="test" href="./000468.htm">hypertension</a>)</li><li>Right-sided heart failure (cor pulmonale)</li><li>High blood pressure in the lungs (<a test="test" href="./000112.htm">pulmonary hypertension</a>) </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Contact your provider if you are very tired during the day or have any other symptoms that suggest OHS.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-8" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-8"><p>Maintain a healthy weight. Use your CPAP or BiPAP treatment as your provider prescribed.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Pickwickian syndrome </p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/9248t.jpg" alt="Respiratory system" title="Respiratory system" class="side-img"/><a href="../imagepages/9248.htm">Respiratory system</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Malhotra A, Powell F. Disorders of ventilatory control. In: Goldman L, Cooney KA, eds. <em>Goldman-Cecil Medicine</em>. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 74.</p><p>Mokhlesi B, Tamisier R. Obesity-hypoventilation syndrome. In: Kryger M, Roth T, Goldstein CA, Dement WC, eds. <em>Principles and Practice of Sleep Medicine</em>. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 138.</p><p>Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. <em>Am J Respir Crit Care Med</em>. 2019;200(3):e6-e24. PMID: 31368798 <a href="https://pubmed.ncbi.nlm.nih.gov/31368798/" target="_blank">pubmed.ncbi.nlm.nih.gov/31368798/</a>.</p></div></div></section>
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