Weight Loss Interventions as Treatment of Obesity Hypoventilation Syndrome: A Systematic Review. Journal Article

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Authors: Tamae Kakazu, M; Soghier, I; Afshar, M; Brozek, JL; Wilson, KC; Masa, JF; Mokhlesi, B
Article Title: Weight Loss Interventions as Treatment of Obesity Hypoventilation Syndrome: A Systematic Review.
Abstract: RATIONALE: Obesity Hypoventilation Syndrome (OHS) is an undesirable consequence of obesity. Weight loss is an important component of management based upon clinical rationale, but the evidence supporting weight loss has not been summarized and the optimal approach has not been determined. OBJECTIVE: This systematic review informed an international, multi-disciplinary panel of experts who had converged to develop a clinical practice guideline on OHS for the American Thoracic Society. The panel asked, "Should a weight loss intervention be performed in patients with OHS?" METHODS: Medline, the Cochrane Library, and Embase were searched from January 1946 to March 2019 for studies that assessed weight loss interventions in obese adults with confirmed OHS, suspected OHS, or hypercapnia. The quality of the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: The search identified 2994 articles. Six studies were selected including two randomized trials and four non-randomized studies without a comparator. Sample size ranged from 16 to 63 subjects. The studies found that a comprehensive weight loss program (including motivational counseling, dieting, and exercise) can reduce weight by 6-7%, but confers no clinically significant effects compared to standard care. Bariatric surgery, on the other hand, is associated with more robust weight loss (15-64.6% depending on the type of intervention), reduction of obstructive sleep apnea severity (18-44% reduction of the apnea-hypopnea index), and improvement in gas exchange (17-20% reduction in PaCO2), ultimately leading to the resolution of OHS. Moreover, daytime sleepiness and pulmonary artery pressure improve as well with significant weight loss. Bariatric surgery is associated with adverse effects in roughly one-fifth of patients, but serious adverse effects are very rare. The level of certainty in the estimated effects was very low for most outcomes. CONCLUSION: The guideline panel for which the systematic review was performed made a conditional (i.e. weak) recommendation suggesting a weight loss intervention for patients with OHS, targeting a sustained weight loss of 25-30% of actual body weight. This recommendation was based on very low-quality evidence. Although the weight loss target is based upon the observation that greater weight loss is associated with better outcomes, there is a need for better quality studies to ascertain the degree of weight loss necessary to achieve improvement in clinically relevant outcomes in patients with OHS.
Journal Title: Annals of the American Thoracic Society
ISSN: 2325-6621; 2325-6621
Publisher: Unknown  
Date Published: 2020