Obesity hypoventilation syndrome: symptoms, causes and treatment

Obesity hypoventilation syndrome is a medical condition associated, as the name suggests, with advanced overweight.. The sufferer has difficulty breathing during the day, which makes it difficult for them to sleep at night.

It is a disease that affects many obese people, so a key aspect in preventing and treating it is weight loss through exercise and proper diet, although surgery and surgery may also be necessary.

Below, we will talk in more detail about this respiratory disease, its main symptoms, the physical tests and tests performed to diagnose it, and how it is treated.

    What is Obesity Hypoventilation Syndrome?

    Obesity hypoventilation syndrome is a respiratory disease that can present in obese people. Due to being overweight, they cannot breathe properly during the day or at night, Seeing their health and mood affected.

    During the day, her poor breathing causes her blood oxygen levels to be low and carbon dioxide levels high, known as daytime hypoventilation.

    At night, they also can’t breathe well, which means they don’t get restful sleep or get good rest. In addition, their breathing difficulties are further exacerbated by the fact that they may suffer from obstructive sleep apnea. This causes them to stop breathing for short periods of time, making the brain unable to get the oxygen it needs to function.

    In obesity hypoventilation syndrome it has also been called Pickwick syndrome. The reason is quite curious and is linked to the famous British writer and novelist Charles Dickens, who in his essay The Posthumous Papers of the Pickwick Club describes symptoms very similar to those related to the syndrome.


    As we have seen, obesity hypoventilation syndrome is a condition associated with obesity that causes breathing problems both day and night. Among the main symptoms we have the abnormal levels of oxygen and carbon dioxide in the blood, respectively lower and higher. This medical condition is called chronic hypoxia.

    Since people with this syndrome cannot sleep properly, having poor quality sleep at night upon waking up suffers from daytime sleepiness. This causes them to have a great lack of energy and to feel tired from making the slightest effort. They may also suffer from headaches associated with irregular blood gas levels and lack of rest.

    While you are asleep, you may momentarily interrupt your breathing; in addition, they can make very loud snoring. These two symptoms are not detected by the patient himself, but by people living with him, such as his partner or roommates. While this does not necessarily affect the patient’s social life, the fact that he or she snores very loudly can make it difficult for others to sleep, causing a problem in the coexistence of the household.

    But not everything has to do with breathing. By not being able to sleep well for a long consecutive period, the patient’s mood is affected and he may have problems such as depression, irritation and restlessness. Since he suffers from drowsiness, he is more likely to have accidents, both at work and at home. It can also affect the patient’s sex life as they feel less inclined to have sex and prefer to sleep, even though they know they won’t be able to rest at all.

      Causes of hypoventilation due to obesity

      Not all of the causes of obesity hypoventilation syndrome are known, although, as the name suggests, obesity plays a very important role in the severity and development of this medical condition.

      It can be a combination of several health problemsAmong them, the inability of the brain to properly handle breathing, excess body fat that produces hormones that change the respiratory rate, and the extra weight against the chest wall, which makes it difficult for the respiratory muscles to work.


      In order to be able to correctly diagnose this medical condition, it is necessary to perform a series of physical tests and examinations. In addition, he will be asked about any medical problems that he and his immediate environment have noticed, such as fatigue, snoring and apnea during sleep.

      The first thing to do is to assess the patient’s physical condition, Starting with your body mass index (BMI). If the patient has a BMI greater than 30, it means that he is obese.

      In addition to that, they will look at each other other physical signs associated with hypoventilation due to obesity, Among which we have:

      • Cyanosis: bluish discoloration of the lips, fingers and toes or of the skin.
      • Reddish skin.
      • Hypertension: high blood pressure
      • Pulmonary hypertension: high blood pressure in the lungs
      • Pulmonary heart: right heart failure
      • Swelling of the legs or feet.
      • Difficulty in breathing.
      • Feeling tired after minimal effort.
      • Signs of excessive sleepiness.

      In order to diagnose this medical condition, it is necessary to assess the levels of gases in the blood, especially oxygen and carbon dioxide. for that Arterial gas testing is usually done, taking samples of the patient’s bloodUsually, checking out your wrist and checking your gas levels. A pulse oximeter can also be used, a sensor placed on the finger of the hand that measures the amount of oxygen in the blood, although this is not as accurate a technique as an arterial blood sample.

      A chest x-ray or CT scan of the same area should be taken to rule out other possible physical causes that explain the patient’s breathing problems. An echocardiogram is also usually done in which a heart ultrasound is done to see how this organ behaves.

      Finally, one of the must-see tests for diagnosing obesity hypoventilation syndrome is polysomnography, which is a sleep study. It is a technique which makes it possible to know if the patient suffers from sleep apnea, its severity and to guide the treatment most suited to the case.


      In the treatment of obesity hypoventilation syndrome a weight loss program accompanied by therapy focused on respiratory disease is usually applied.

      Sometimes the simple act of losing weight allows the person to improve significantly, snore less and have more restful sleep, as well as breathe better during the day and, in many cases, correct the problem. obstructive sleep apnea. In other cases, surgery is required by performing a gastric bypass in which the size of the stomach is reduced and the patient eats less.

      To get the patient to lose weight, what is usually done is to give him a program in which he is presented with a menu with limited calories, in addition to presenting foods that meet his nutritional needs but losing weight. Many diets focus on protein and vegetablesAs it is these two types of foods that contribute to a fuller stomach with less calorie intake. In addition, protein helps build muscle, altering the patient’s body composition and reducing the production of hormones associated with fat.

      To help the patient control their cravings for food, it is recommended that they have good sleep hygiene, going to bed between 10 and 12 hours at night. While it is true that the quality of your sleep is poor, going to bed early will reduce your chances of feeling tired the next day. People who get up in a bad mood and exhausted tend to counter their fatigue by overeating, which would be very counterproductive in the treatment of this syndrome.

      The air masks are often used to treat respiratory deficitIn other words, a positive pressure support in the airways. These masks deliver constant air at a certain pressure, which allows the patient to inhale and exhale in a healthy way. He can breathe better at night, so he rests better and his blood levels of oxygen and carbon dioxide return to normal.

      Bibliographical references:

      • Vidya Krishnan MD, MHS and Pedro Genta MD (2014) Obesity Hypoventilation Syndrome.Am J Breathe Crit Care Med, Air Travel. 189, P15-P16.
      • Malhotra A, Powell F (2020). Fan control problems. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier: cape 80.
      • Mokhlesi B (2017). Obesity-hypoventilation syndrome. A: Kryger M, Roth T, Demented WC, eds. Principles and practice of sleep medicine. 6th ed. Philadelphia, PA: Elsevier ;: chap 120.
      • Mokhlesi B, Masa JF, Brozek JL et al. (2019). Assessment and management of obesity hypoventilation syndrome. An official clinical practice guide from the American Thoracic Society. Am J Respir Crit Care Med .; 200 (3): e6-e24. PMID: 31368798 www.ncbi.nlm.nih.gov/pubmed/31368798.

      Leave a Comment