Obesity hypoventilation syndrome and its treatment

Obesity, a well-established cardiovascular risk factor, can also lead to significant respiratory complications. Respiratory abnormalities associated with obesity range from mild functional impairments without gas exchange alterations to severe hypercapnic respiratory failure, characteristic of obesity hypoventilation syndrome. Hypoventilation in obese patients results from complex interactions between altered respiratory mechanics and impaired ventilatory control. Comorbid conditions, such as chronic obstructive pulmonary disease and obstructive sleep apnea syndrome, which are common in obese individuals, may further worsen hypoventilation. The prevalence of obesity-related hypoventilation is likely underestimated, as diagnosis often occurs during acute exacerbations or evaluation for suspected sleep-disordered breathing. Management includes continuous positive airway pressure or non-invasive ventilation, selected according to the clinical presentation and associated comorbidities. Both therapies have demonstrated efficacy in improving gas exchange, quality of life, and patient survival.