由于大部分肥胖通气不足综合征 (OHS) 患者都联合阻塞性睡眠呼吸暂停，因此可首先使用持续气道正压通气来治疗 OHS。重度阻塞性睡眠呼吸暂停通气不足综合征 (OSAHS) 患者的症状严重程度：有低质量的证据显示，与安慰剂、假持续气道正压通气 (CPAP) 或保守疗法相比，鼻持续气道正压通气对于减轻日间嗜睡或睡眠障碍性呼吸可能更为有效，但并不能更有效地改善重度 OSAHS 患者的某些认知表现的测量值。鼻持续气道正压通气是否能更有效地降低重度 OSAHS 患者的血压目前仍不清楚（低质量证据）。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。有报告称使用持续气道正压通气成功治疗 OHS，[47]Mokhlesi B, Tulaimat A, Evans AT, et al. Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea. J Clin Sleep Med. 2006;2:57-62.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894747/http://www.ncbi.nlm.nih.gov/pubmed/17557438?tool=bestpractice.com[48]Hida W, Okabe S, Tatsumi K, et al. Nasal continuous positive airway pressure improves quality of life in obesity hypoventilation syndrome. Sleep Breath. 2003;7:3-12.http://www.ncbi.nlm.nih.gov/pubmed/12712392?tool=bestpractice.com[49]Banerjee D, Yee, BJ, Piper AJ, et al. Obesity hypoventilation syndrome: hypoxemia during continuous positive airway pressure. Chest. 2007;131:1678-1684.http://journal.publications.chestnet.org/article.aspx?articleid=1085161http://www.ncbi.nlm.nih.gov/pubmed/17565018?tool=bestpractice.com[50]Laaban JP, Orvoen-Frija E, Cassuto D, et al. Mechanisms of diurnal hypercapnia in sleep apnea syndromes associated with morbid obesity. Presse Med. 1996;25:12-16. (in French)http://www.ncbi.nlm.nih.gov/pubmed/8728885?tool=bestpractice.com[51]Shivaram U, Cash ME, Beal A. Nasal continuous positive airway pressure in decompensated hypercapnic respiratory failure as a complication of sleep apnea. Chest. 1993;104:770-774.http://journal.publications.chestnet.org/data/Journals/CHEST/20382/770.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/8365287?tool=bestpractice.com 通常需要 12 至 14 cm H2O 的压力。[13]Perez de Llano LA, Golpe R, Ortiz Piquer M, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest. 2005;128:587-594.http://journal.publications.chestnet.org/article.aspx?articleid=1083605http://www.ncbi.nlm.nih.gov/pubmed/16100142?tool=bestpractice.com[47]Mokhlesi B, Tulaimat A, Evans AT, et al. Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea. J Clin Sleep Med. 2006;2:57-62.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894747/http://www.ncbi.nlm.nih.gov/pubmed/17557438?tool=bestpractice.com 然而，也有单独使用持续气道正压通气治疗失败的报告。[47]Mokhlesi B, Tulaimat A, Evans AT, et al. Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea. J Clin Sleep Med. 2006;2:57-62.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894747/http://www.ncbi.nlm.nih.gov/pubmed/17557438?tool=bestpractice.com[49]Banerjee D, Yee, BJ, Piper AJ, et al. Obesity hypoventilation syndrome: hypoxemia during continuous positive airway pressure. Chest. 2007;131:1678-1684.http://journal.publications.chestnet.org/article.aspx?articleid=1085161http://www.ncbi.nlm.nih.gov/pubmed/17565018?tool=bestpractice.com[52]Laaban JP, Chailleux E. Daytime hypercapnia in adult patients with obstructive sleep apnea syndrome in France, before initiating nocturnal nasal continuous positive airway pressure therapy. Chest. 2005;127:710-715.http://journal.publications.chestnet.org/article.aspx?articleid=1083165http://www.ncbi.nlm.nih.gov/pubmed/15764748?tool=bestpractice.com[53]Mokhlesi B. Positive airway pressure titration in obesity hypoventilation syndrome: continuous positive airway pressure or bilevel positive airway pressure. Chest. 2007;131:1624-1626.http://journal.publications.chestnet.org/article.aspx?articleid=1085173http://www.ncbi.nlm.nih.gov/pubmed/17565013?tool=bestpractice.com[54]Schafer H, Ewig S, Hasper E, et al. Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure. Respir Med. 1998;92:208-215.http://www.ncbi.nlm.nih.gov/pubmed/9616514?tool=bestpractice.com
可单独调节吸气期气道正压和呼气期气道正压的双水平气道正压可能是逆转 OHS 相关高碳酸血症的最有效的无创治疗法。[13]Perez de Llano LA, Golpe R, Ortiz Piquer M, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest. 2005;128:587-594.http://journal.publications.chestnet.org/article.aspx?articleid=1083605http://www.ncbi.nlm.nih.gov/pubmed/16100142?tool=bestpractice.com[55]Budweiser S, Riedl SG, Jorres RA, et al. Mortality and prognostic factors in patients with obesity-hypoventilation syndrome undergoing noninvasive ventilation. J Intern Med. 2007;261:375-383.http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2007.01765.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17391112?tool=bestpractice.com[56]Storre JH, Seuthe B, Fiechter R, et al. Average volume-assured pressure support in obesity hypoventilation: a randomized crossover trial. Chest. 2006;130:815-821.http://journal.publications.chestnet.org/article.aspx?articleid=1084691http://www.ncbi.nlm.nih.gov/pubmed/16963680?tool=bestpractice.com[45]Berry RB, Chediak A, Brown LK, et al. Best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation (NPPV) in stable chronic alveolar hypoventilation syndromes. J Clin Sleep Med. 2010;6:491-509.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952756/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/20957853?tool=bestpractice.com
大多数研究都已证明吸气期气道正压和呼气期气道正压之间的压差必须至少在 8 至 10 cm H2O 的水平，从而能够长期通过双水平气道正压疗法来纠正高碳酸血症和低氧血症。[13]Perez de Llano LA, Golpe R, Ortiz Piquer M, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest. 2005;128:587-594.http://journal.publications.chestnet.org/article.aspx?articleid=1083605http://www.ncbi.nlm.nih.gov/pubmed/16100142?tool=bestpractice.com[58]Berger KI, Ayappa I, Chatr-Amontri B, et al. Obesity hypoventilation syndrome as a spectrum of respiratory disturbances during sleep. Chest. 2001;120:1231-1238.http://journal.publications.chestnet.org/article.aspx?articleid=1080061http://www.ncbi.nlm.nih.gov/pubmed/11591566?tool=bestpractice.com[59]Redolfi S, Corda L, La Piana G, et al. Long-term non-invasive ventilation increases chemosensitivity and leptin in obesity-hypoventilation syndrome. Respir Med. 2007;101:1191-1195.http://www.ncbi.nlm.nih.gov/pubmed/17189682?tool=bestpractice.com[60]de Lucas-Ramos P, de Miguel-Diez J, Santacruz-Siminiani A, et al. Benefits at 1 year of nocturnal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Respir Med. 2004;98:961-967.http://www.ncbi.nlm.nih.gov/pubmed/15481272?tool=bestpractice.com
通过气管造口术进行夜间有创机械通气可有效地用于那些对无创形式的正压通气治疗不耐受或治疗失败的重度肥胖-通气不足综合征患者。
