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Abstract：
Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS).Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations.Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level <27 mmol/L to exclude the diagnosis of OHS in obese patients with sleep-disordered breathing when suspicion for OHS is not very high (<20%) but to measure arterial blood gases in patients strongly suspected of having OHS, 2) stable ambulatory patients with OHS receive positive airway pressure (PAP), 3) continuous positive airway pressure (CPAP) rather than noninvasive ventilation be offered as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, 4) patients hospitalized with respiratory failure and suspected of having OHS be discharged with noninvasive ventilation until they undergo outpatient diagnostic procedures and PAP titration in the sleep laboratory (ideally within 2-3 mo), and 5) patients with OHS use weight-loss interventions that produce sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS (which is more likely to be obtained with bariatric surgery).Conclusions: Clinicians may use these recommendations, on the basis of the best available evidence, to guide management and improve outcomes among patients with OHS.
摘要：
背景：本指南的目的是优化肥胖低通气综合征（OHS）患者的评估和管理。方法：多学科小组确定并优先考虑五个临床问题。该小组对现有研究进行了系统评价（截至2018年7月），并遵循了建议的分级，评估,发展,和评估证据决策框架，以制定建议。所有小组成员都讨论并批准了建议。建议：在考虑到证据的总体质量很低之后，小组提出了五项有条件的建议。我们建议：1）当怀疑OHS不是很高（<20％）时，临床医生使用血清碳酸氢盐水平<27mmol/L来排除患有睡眠呼吸障碍的肥胖患者的OHS诊断，但要测量强烈怀疑患有OHS的患者的动脉血气，2）OHS的稳定非卧床患者接受气道正压通气（PAP），3）持续气道正压通气（CPAP）而不是无创通气作为一线治疗提供给OHS和并存的重度阻塞性睡眠呼吸暂停的稳定卧床患者。4）因呼吸衰竭住院并怀疑患有OHS的患者应接受无创通气治疗，直到他们在睡眠实验室接受门诊诊断程序和PAP滴定（理想情况下在2-3个月内），和5）OHS患者使用体重减轻干预措施，使体重持续减轻25％至30％，以实现OHS的解决（这更可能通过减肥手术获得）。结论：临床医生可以使用这些建议，根据现有的最佳证据,指导OHS患者的管理和改善预后。
