Obesity hypoventilation syndrome: current knowledge and new developments

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Rising rates of obesity worldwide mean that the proportion of people with OHS is increasing. OHS is associated with poor prognosis and early death. It is a heterogenous condition, characterised by different phenotypes and varying diagnosis and treatment trajectories. OHS definitions vary between guidelines and do not adequately account for factors other than disease severity. PAP therapy with CPAP or noninvasive ventilation is the mainstay of OHS treatment. Therapy choice needs to be guided by appropriate SDB phenotyping and daytime hypercapnia severity. Individualised management of comorbidities and weight-loss strategies are essential. Although there is potential for newer pharmacological treatments (e.g. GLP-1 receptor agonists), these have not yet been specifically investigated in OHS populations. Overall, the diverse and complex OHS presentations in clinical practice necessitate changes to current approaches to assessment and care in order to facilitate personalised and evidence-based management. Cite as: Pépin JL, Baillieul S, Tamisier R. Obesity hypoventilation syndrome: current knowledge and new developments. In: Randerath WJ, Pépin JL, Schiza SE, eds. Obstructive and Central Sleep Apnoea (ERS Monograph). Sheffield, European Respiratory Society, 2026; pp. 186–197 [ https://doi.org/10.1183/2312508X.10029825 ].

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