From the Guidelines
Bariatric surgery is a highly effective treatment for obesity hypoventilation syndrome (OHS) and should be considered a primary treatment option for eligible patients, as it can lead to substantial improvements in OHS symptoms and even complete resolution of the syndrome in many patients. The effectiveness of bariatric surgery in treating OHS is supported by the most recent and highest quality study, which recommends that patients with OHS use weight-loss interventions that produce sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS, and notes that this is more likely to be obtained with bariatric surgery 1.
Key Benefits of Bariatric Surgery for OHS
- Substantial weight loss, which reduces fat deposits around the chest, abdomen, and airways, improving lung mechanics and breathing function
- Improved oxygen levels and reduced carbon dioxide retention
- Decreased daytime sleepiness and better sleep quality
- Reduced need for positive airway pressure therapy
- Resolution of comorbidities like obstructive sleep apnea that contribute to OHS
Recommendations for Bariatric Surgery in OHS
- Patients with OHS should be evaluated by a multidisciplinary team to determine surgical candidacy 1
- The choice of surgical procedure should be based on weighing potential risks of surgery against the maximum possible anticipated weight loss 1
- Bariatric surgery should be considered for patients with OSA and obesity (class II/III, BMI ≥ 35) who are intolerant or unaccepting of PAP as part of a patient-oriented discussion of alternative treatment options 1
Postoperative Care
- Respiratory monitoring is essential in the immediate recovery period when anesthesia and pain medications may temporarily worsen hypoventilation
- Patients should be closely monitored for potential complications of bariatric surgery, such as iron malabsorption, gastric ulcer, vitamin deficiency, bowel obstruction or leak, gastrointestinal reflux disorder, and gastric band slippage 1
From the Research
Bariatric Surgery for Obesity Hypoventilation Syndrome (OHS)
- Bariatric surgery is often considered an effective treatment for obesity and its related comorbidities, including obstructive sleep apnea (OSA) 2, 3, 4.
- Studies have shown that bariatric surgery can significantly improve or resolve OSA in patients with obesity 2, 3, 4.
- However, the effectiveness of bariatric surgery for OHS specifically is not as well-studied, with one study finding a high prevalence of OHS in bariatric surgery patients, especially in men 5.
- The study found that higher levels of BMI, neck circumference, serum bicarbonate, and C-reactive protein were associated with a higher risk of OHS 5.
- Another study found that laparoscopic Roux-en-Y gastric bypass surgery was effective in improving OSA in a Chinese population with obesity and type 2 diabetes mellitus (T2DM) 4.
- Bariatric surgery has been reported to improve most obesity-related conditions, reduce the risk of premature death, and improve quality of life 6.
Effectiveness of Bariatric Surgery for OHS
- While there is limited direct evidence on the effectiveness of bariatric surgery for OHS, studies suggest that it can be an effective treatment for OSA, which is often comorbid with OHS 2, 3, 4.
- The improvement in OSA after bariatric surgery may also lead to an improvement in OHS symptoms, although more research is needed to confirm this 5.
- Bariatric surgery should be considered as a potential treatment option for patients with OHS, especially those with severe obesity and related comorbidities 6.