Obesity Hypoventilation Syndrome (OHS): What to Know

If you or a loved one has a high body mass index (BMI) and trouble breathing during the day and at night, you might have obesity hypoventilation syndrome (OHS). Obesity hypoventilation syndrome, also known as Pickwickian syndrome, can lead to heavy breathing, shortness of breath, low oxygen levels, and too much carbon dioxide in the blood.

“Hypoventilation” means “slow, shallow breathing.” OHS is different from sleep apnea because it also happens during the day, although about 90% of people with OHS also have sleep apnea. Treatment is important since OHS can be deadly if it’s not addressed. Weight loss is part of a treatment plan but is not the only way to treat OHS.

Continue reading to learn more about OHS, including answers to common questions like “Why am I breathing heavy?” and “Can being overweight cause shortness of breath?”

Obesity Hypoventilation Syndrome and Breathing: What Is the Link?

Obesity hypoventilation syndrome, by definition, occurs in people who are obese (those who have a BMI over 40). It’s most common in people with a BMI of 50 or higher, a condition formerly called morbid obesity.

Healthcare providers don’t know why people with a high body weight develop OHS. The condition is tied to the brain’s ability to control breathing. Leptin, a hormone that impacts body weight, also impacts breathing, so it’s thought that people with OHS have a resistance to leptin. In addition, having more weight on the body can make it difficult for the lungs to expand.

Differences Between OHS and Sleep Apnea

Sleep apnea is another breathing condition that is closely associated with obesity. It causes people to stop breathing while sleeping because their airway becomes blocked temporarily or because the brain is not prompting the body to breathe. This leads to low oxygen levels and other symptoms.

OHS is different from sleep apnea because it can occur both when a person is awake or asleep. People with OHS don’t stop breathing, but they breathe too shallowly and too slowly to get enough oxygen. This also leads to low oxygen levels, and high carbon dioxide levels.

About 90% of people with OHS have sleep apnea. It’s most common for them to have obstructive sleep apnea, the type in which the airway becomes blocked.

Could I Have OHS Symptoms?

The main symptoms of OHS are shortness of breath. People with this condition also experience fatigue because they do not get quality sleep. The symptoms of OHS include:

• Tiredness, including daytime sleepiness
• Poor sleep quality and waking without feeling rested
• Depression
• Headaches
• Feeling tired after a small amount of effort
• Bluish skin, especially on the lips, fingers, and toes
• Reddish skin
• Swollen limbs

Getting an OHS Diagnosis

If you’re experiencing any symptoms of OHS, you should see your healthcare provider immediately. The condition can be deadly if it’s not treated.

A healthcare provider will conduct tests and a physical exam to diagnose you with OHS. The main test is a blood draw that measures the amount of oxygen and carbon dioxide in your blood. In addition, your healthcare provider may order a:

OHS Risks and Complications

OHS is a very serious condition. Without treatment, it can lead to:

• Heart failure and other cardiac complications
• Blood vessel problems
• Mental health problems

It can even be fatal, so getting timely treatment is essential.

Treatment to Manage OHS

Treatments for OHS focus on getting enough oxygen into your blood system and helping you breathe easier. Your healthcare provider will discuss the treatments that are right for you. Treatment options include:

In extreme cases, healthcare providers might recommend a tracheostomy, a surgical procedure to help a person breathe through a neck hole.

Treatment to Reverse OHS

Weight loss is often recommended as a treatment for OHS. For people with a very high body weight—those most likely to have OHS—weight loss is often an important part of overall health. However, studies note that the scientific evidence for weight loss to reverse OHS is weak. Unfortunately, it’s difficult to reverse OHS.

One scientific review found that people who lost 6% to 7% of their body weight didn’t see an improvement in their OHS symptoms compared to other patients who got treatment but didn’t lose weight.

However, people who lost a substantial amount of weight through bariatric surgery did see an improvement in OHS symptoms. Research shows that to see a big improvement in symptoms, people need to lose 25% to 30% of their body weight. If you have OHS, weight loss will likely be part of your treatment and health plan, even if it doesn’t lead to a reversal of your symptoms.

Ask your healthcare provider if any weight loss interventions are right for you.

Summary

Obesity hypoventilation syndrome (OHS) is a condition that makes it difficult to breathe in people who are overweight. Healthcare providers don’t know exactly what causes it, but believe it is tied to leptin, a hormone that regulates weight and breathing, and to the physical pressure of having extra weight on your chest. It’s very, very important to get treatment for OHS.

Without treatment, the condition can lead to heart failure and death. Treatments include oxygen and breathing supports, like a CPAP or BiPAP machine. Weight loss is usually recommended, too, although you need a significant weight loss to reverse OHS.