Obesity Hypoventilation: Pathophysiology, Diagnosis, and Treatment

  • Bernie Young SunwooEmail author
Sleeping and Breathing (S Shafazand, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Sleeping and Breathing


Purpose of Review

This is a review of the current understanding of the pathophysiology behind the development of daytime hypercapnia in a subset of obese patients. It provides an overview of the recent evidence to guide physicians in the diagnosis and treatment of patients with obesity hypoventilation syndrome (OHS).

Recent Findings

OHS results from a complex interplay between obesity-related changes in respiratory mechanics, sleep-disordered breathing, changes in central ventilatory drive, and neurohormonal changes. Diagnosis is important given the associated morbidity, but reliance on a single measurement of PaCO2 on the arterial blood gas has been questioned. Positive airway pressure (PAP) has been shown to improve gas exchange, sleep-disordered breathing, and symptoms in OHS, and is an effective therapy. More recent studies have not shown bilevel positive airway pressure or volume-targeted pressure support to be superior to CPAP in treating stable OHS, but NIV treatment studies are limited by variability in the settings used.


The development of daytime hypercapnia in a subset of obese patients is multifactorial. Phenotyping OHS patients can allow for individualization of therapies. Further long-term longitudinal studies exploring varying severities and clinical phenotypes of OHS are needed. There is also a need for additional studies to guide providers on the optimal PAP settings in OHS.


Obesity hypoventilation syndrome Hypercapnic obstructive sleep apnea Morbid obesity 


Compliance with Ethical Standards

Conflict of Interest

Bernie Sunwoo declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.University of California, San DiegoSan DiegoUSA

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