eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity: Treatment & Medication

Author: Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Coauthor(s): Gila Hertz, PhD, ABSM, Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook
Contributor Information and Disclosures

Updated: Nov 25, 2008

Treatment

Medical Care

  • Dietary/nutritional intervention: Weight loss is recommended in individuals with obesity but is often difficult to achieve and sustain. In addition, although weight loss remains a cornerstone to the treatment of obesity, it may not always improve the symptoms of obstructive sleep apnea (OSA) and hypoventilation or hypopnea (OSA/H).
  • Pharmacologic care: Progesterone, theophylline, protriptyline, and buspirone have been used in limited studies.
  • Perform nasal continuous positive airway pressure ventilation (NCPAP).

Surgical Care

  • Tonsillectomy
  • Adenoidectomy
  • Adenotonsillectomy (may be successful even when weight loss alone does not produce satisfactory resolution of symptoms)
  • Tracheostomy
  • Uvulopalatopharyngoplasty (UPPP)
  • Mandibular advancement surgery

Consultations

In pediatric patients, sleep medicine may be practiced within various subspecialties, including pediatric pulmonology, pediatric otolaryngology, pediatric neurology, and child psychiatry. Also, a small number of board-certified sleep specialists are pediatricians.

  • Pediatric pulmonologist
  • Pediatric cardiologist
  • Pediatric anesthesiologist
  • Pediatric otolaryngologist
  • Pediatric endocrinologist
  • Nutritionist

Diet

  • Tailor specific diets to meet the nutritional and growth requirements of the child and to facilitate weight loss.

Activity

A graded exercise plan is suggested.

  • Consideration of the exercise tolerance of each individual child is important.
  • Awareness of the increased incidence of asthma and lack of physical conditioning in these children is important when designing and implementing a graded exercise program.

Medication

The use of central respiratory stimulants in the treatment of obesity-hypoventilation syndrome intermittently appears in the literature. However, reports are primarily anecdotal or very limited. Currently, noninvasive ventilatory support (eg, nasal continuous positive airway pressure ventilation [NCPAP]) with supplemental oxygen, when necessary, is the treatment of choice along with weight loss.

More on Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity

Overview: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
Differential Diagnoses & Workup: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
Treatment & Medication: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
Follow-up: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
Multimedia: Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity
References
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References

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Further Reading

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Keywords

obesity, hypoventilation syndrome, Pickwick syndrome, pickwickian syndrome, obstructive sleep apnea/hypoventilation, OSA/H, obstructive sleep apnea, hypoventilation, sleep-disordered breathing, hypercarbia, excessive daytime sleepiness, hyperactivity, cor pulmonale, failure to thrive, mental retardation, tonsillar hypertrophy, diabetes, hypertension, gallstones, hypercholesterolemia, reactive airways, poor exercise tolerance, increased work of breathing, increased oxygen consumption, right-sided heart failure, upper respiratory infections, snoring, parasomnias, chronic mouth breathing, asthma, short stature, developmental delay, macroglossia, retrognathia, micrognathia, high-arched palate, thoracic kyphosis, pectus excavatum, scoliosis, abdominal obesity, ankle edema, congestive heart failure

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Contributor Information and Disclosures

Author

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Coauthor(s)

Gila Hertz, PhD, ABSM, Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook
Gila Hertz, PhD, ABSM is a member of the following medical societies: American Academy of Sleep Medicine and American Psychological Association
Disclosure: Nothing to disclose.

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis Center
Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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