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Positive Airway Pressure Titration in Obesity Hypoventilation Syndrome: Continuous Positive Airway Pressure or Bilevel Positive Airway Pressure

Babak Mokhlesi, MD, MSc, FCCP
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Affiliations: Chicago, IL ,  Dr. Mokhlesi is Assistant Professor of Medicine, Section of Pulmonary and Critical Care Medicine, and Director of the Sleep Disorders Center, The University of Chicago Pritzker School of Medicine.

Correspondence to: Babak Mokhlesi, MD, MSc, Assistant Professor of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Pritzker School of Medicine, 5841 S Maryland Ave, MC 0999, Room L11B, Chicago, IL 60637; e-mail: bmokhles@medicine.bsd.uchicago.edu



Chest. 2007;131(6):1624-1626. doi:10.1378/chest.07-0384
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In the United States, a third of the adult population is obese and the prevalence of extreme obesity (body mass index [BMI] ≥ 40 kg/m2) is increasing rapidly. From 1986 to 2000, the prevalence of BMI ≥ 40 kg/m2 has quadrupled, and that of BMI ≥ 50 kg/m2 has increased fivefold.1 The obesity epidemic is not only impacting adults in the United States, it is a global phenomenon affecting children and adolescents.2 With such a global epidemic of obesity, the prevalence of obesity hypoventilation syndrome (OHS)—defined as a combination of obesity, awake chronic hypercapnia, and sleep-disordered breathing, in the absence of other known causes of hypercapnia—is likely to increase. In patients with OHS, sleep-disordered breathing can occur in three forms: obstructive apneas and hypopneas, obstructive hypoventilation due to increased upper airway resistance, and central hypoventilation.34 In approximately 90% of patients with OHS, the sleep-disordered breathing consists predominantly of obstructive apneas and hypopneas (obstructive sleep apnea [OSA]).46 In patients with OSA and extreme obesity, the prevalence of OHS is as high as 25%.67

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