Obesity Hypoventilation Syndrome: Causes, Symptoms, Treatment and Cost

Obesity Hypoventilation Syndrome (OHS) is a medical disorder in which a person has trouble breathing owing to excessive weight. This condition is caused by excess weight, which puts pressure on the chest and lungs, making it difficult to inhale and exhale properly.

As a result, people with OHS have low levels of oxygen in their blood and high levels of carbon dioxide, leading to fatigue, confusion, and an increased risk of heart disease, stroke, and respiratory failure.

There are three types of OHS:

• Primary OHS: This type of OHS is caused by excessive body weight and fat accumulation around the chest cavity and abdomen. It is often associated with obstructive sleep apnea (OSA).
• Secondary OHS: This type of OHS occurs when an underlying medical condition causes the individual to be unable to breathe properly due to excess weight or fat accumulation around the chest cavity and abdomen. Common conditions associated with secondary OHS include chronic obstructive pulmonary disease (COPD), heart failure, neuromuscular disorders, stroke, and certain medications or treatments.
• Idiopathic OHS: This type of OHS occurs when there is no identifiable cause for the individual’s difficulty in breathing due to being overweight or obese.

• The primary causes of OHS are obesity, high body fat percentage, and reduced respiratory muscle strength.
• Other contributing factors can include acid reflux, sleep apnea, allergies, hormonal imbalances, smoking, and chronic diseases such as diabetes or heart failure.
• OHS can also be triggered by certain medications that affect the brain's ability to control breathing rate and volume.

• Shortness of breath, especially during physical activity or when lying down
• Rapid breathing (tachypnea)
• Fatigue and excessive daytime sleepiness
• Persistent headaches, especially in the morning
• Persistent coughing or wheezing
• Swelling in the legs and feet due to fluid buildup (edema)
• Breath that smells fruity or sweet due to ketones in the blood
• Pain in the chest, neck, and shoulders due to poor oxygenation of tissues

• Maintain a healthy diet and exercise regularly
• Reduce or quit smoking
• Avoid alcohol and drugs
• Monitor breathing during sleep
• Seek early treatment for OSA
• Monitor weight regularly
• Treat any underlying medical conditions that contribute to obesity

• Pulmonary function tests: These tests measure lung function and can help determine if there is any impairment in breathing.
• Oxygen saturation test: This test measures the amount of oxygen in a person's blood and can help determine if there is a lack of oxygen due to OHS.
• Arterial blood gas (ABG) test: The amounts of oxygen, carbon dioxide, as well as other gases in a person's blood are measured using this test.
• Chest X-ray: This imaging test can help identify any structural abnormalities in the lungs or heart that may be contributing to OHS.
• Sleep studies: A polysomnography or a home-based portable monitor can measure the rate of breathing, blood oxygen levels and other parameters.
• Body Mass Index (BMI): This is a simple way to calculate body fat as weight/height^2 (Kg/m^2) that is commonly used in clinical setting to establish obesity.

• Respiratory failure: OHS can lead to respiratory failure due to the difficulty in breathing that comes with obesity and the lack of ventilation.
• Cardiovascular complications: OHS can cause hypertension and an increase in cardiac output, leading to congestive heart failure and arrhythmias.
• Pulmonary embolism: OHS may raise the likelihood of pulmonary embolism, an obstruction of the arteries that provide oxygenated blood to the lungs.
• Diabetes: Due to insulin resistance and reduced insulin sensitivity, OHS has been associated with a higher risk for type 2 diabetes.
• Sleep apnea and other sleep disorders: OHS is often accompanied by sleep apnea as well as other sleep disorders like insomnia and restless leg syndrome (RLS).
• Kidney disease: People with OHS are more likely to develop chronic kidney disease due to hypertension, fluid retention, and poor nutrition associated with obesity.

• Drink warm water with honey and lemon in the morning: This helps to flush out toxins from the body and improve digestion.
• Take a teaspoon of Triphala powder with warm water before bedtime: Triphala is an Ayurvedic herbal mixture that helps to cleanse the digestive system and reduce fat accumulation in the body.
• Eat more fruits, vegetables, and whole grains: Eating a diet rich in these foods can help to provide essential nutrients, reduce caloric intake, and improve digestion.
• Avoid processed foods: Processed foods are high in calories and low in nutrition which can contribute to weight gain and worsen OHS symptoms.

• A diet rich in fibre and low in fat and sugar is recommended.
• Small, frequent meals and snacks are preferable than three large meals each day.
• Instead of white refined grains, choose whole grains including oats, brown rice, quinoa, and barley.
• Have included a diversity of fresh fruits and vegetables in your daily diet for their vitamin and mineral content.
• Choose lean protein sources such as chicken, fish, eggs, beans, almonds, and tofu above Processed meats such as bacon and salami.
• To keep hydrated, consume large amounts of water and avoid sugary drinks such as soda and juice.

Foods to avoid include:

• High fat, processed foods such as chips, french fries and deep-fried items.
• High-sugar products, such as candy, soda, and other sugary beverages.
• Simple carbs, such as white bread and spaghetti.
• Red meat, in particular processed meats such as bacon and sausage.
• Trans fat- and hydrogenated oil-containing processed goods, such as margarine and shortening.
• Regular or excessive use of alcoholic drinks.

• Establish and maintain a healthy weight: With diet and exercise, losing weight can help reduce the symptoms of OHS.
• Oxygen therapy: This can help improve oxygen levels in the blood and help reduce daytime sleepiness and fatigue.
• Continuous Positive Airway Pressure (CPAP): This is a machine that helps keep the airways open during sleep, decreasing episodes of apnea or hypopnea.
• Noninvasive ventilation (NIV): NIV is often used when CPAP is not successful or tolerated by the patient.
• Bariatric surgery: This is the most effective long-term treatment for obesity hypoventilation syndrome (OHS). It helps to reduce excess weight, leading to improved breathing, oxygenation and quality of life.
• Lung volume reduction surgery: This procedure helps to reduce stress on the lungs by removing portions of damaged tissue, allowing for better airflow and ventilation.
• Nerve stimulation surgery: This technique involves implanting a device that electrically stimulates the phrenic nerve, which controls movement of the diaphragm muscle and can help improve breathing in people with OHS.
• Tracheostomy: A tracheostomy may be performed in severe cases of OHS where intubation is required due to severe respiratory distress or prolonged hypoventilation. A tracheostomy helps bypass any obstruction in the airway and can provide direct access to mechanical ventilation if needed.

The most appropriate doctor to consult for this condition would be a pulmonologist, sleep specialist or bariatric physician.

Pulmonologists are doctors who specialize in treating respiratory illnesses and conditions, such as OHS.

• Bronchodilators: Inhaled bronchodilators like albuterol and ipratropium bromide are prescribed to calm the airways and enhance breathing.
• Corticosteroid: Corticosteroids may be used to minimise inflammation in the lungs, which may aid in the relief of breathing problems caused by OHS.
• Diuretics : Diuretics, such as furosemide, can be prescribed to reduce fluid accumulation in the lungs which may help relieve symptoms of OHS.
• Weight loss medicine: Weight loss medications such as orlistat can be prescribed for those looking to lose weight and treat their OHS symptoms at the same time.

Generally, recovery can take anywhere from weeks to months or even years.

Generally, the positive results of treatment are not permanent, as OHS is a chronic condition and will require ongoing management.

However, with proper dedication to diet and exercise, OHS symptoms can be effectively managed over the long term.

• Post-surgical treatment guidelines for obesity hypoventilation syndrome (OHS) include continuing positive airway pressure (CPAP or BiPAP) therapy.
• Lifestyle modifications such as quitting smoking and reducing alcohol consumption, exercising regularly and eating a healthy diet, and taking medications to reduce inflammation and improve lung function.
• Additionally, patients should follow-up with their physician regularly to monitor their progress and adjust any medications or treatments as needed.
• Other measures such as oxygen therapy may be necessary in some cases.
• Finally, psychological support is also recommended to help manage the emotional aspects of living with OHS.

Generally, the cost of OHS treatment may include hospitalization costs, medications, lifestyle modifications, and oxygen therapy. An estimated value of Rs. 30,000 to Rs. 1 lakh covers the typical cost of OHS treatment in India.

It may also include additional expenses such as nutritional supplements, physical therapy sessions, and home care services. Additionally, patients may need to pay for diagnostics tests such as blood tests and imaging studies which can add up to the total expense of OHS treatment in India.

• Treatments for Obesity Hypoventilation Syndrome can cause headaches, nausea, dizziness, and sleepiness as negative effects.
• Other less common side effects may include confusion, chest pain, anxiety or depression, and changes in heart rate or blood pressure.
• Some patients may experience muscle cramps or joint pain after treatment.
• Long-term side effects can include irregular sleep patterns, increased appetite and weight gain, difficulty concentrating or increased irritability.
• Rarely, some patients may experience severe allergic reactions to the medications used in treatment for OHS such as difficulty breathing and hives.

If you are suffering from any complications relating to obesity Hypoventilation Syndrome then you should consult a doctor nearby as they can cause complications like respiratory failure, cardiovascular complications, pulmonary embolism, etc. in which treatment course can range from a few months to years depending on the severity of the situation.