Obesity Hypoventilation Syndrome (OHS)
Obesity hypoventilation syndrome (OHS) is a breathing disorder in people with obesity that causes elevated carbon dioxide levels while awake. It often occurs alongside obstructive sleep apnea (OSA). Symptoms may include daytime sleepiness, fatigue, morning headaches, and shortness of breath.
Treatment generally combines positive airway pressure (PAP) therapy with a sustained weight-loss plan. For stable adults who also have severe OSA, CPAP is often the recommended first treatment. Noninvasive ventilation, such as bilevel PAP, may be appropriate in other situations or if CPAP does not adequately control breathing. A sleep specialist should assess the treatment approach and follow-up needs.
Cardiogenic Pulmonary Edema
Cardiogenic pulmonary edema occurs when a heart problem causes fluid to build up in the lungs. It can develop suddenly and cause severe shortness of breath, especially when lying flat, as well as coughing, sweating, and sometimes pink, frothy sputum. It is a medical emergency: seek immediate medical care.
In hospital, clinicians treat low oxygen levels and the underlying heart problem. Treatment may include oxygen, diuretics, and other medicines according to the cause and the person's blood pressure. For people with significant breathing distress, noninvasive positive pressure support, such as CPAP or bilevel ventilation, may be considered. Some people require invasive ventilation.
Once the person is stable, the care team investigates the cause and plans longer-term treatment to reduce the chance of another episode.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea (OSA) occurs when the upper airway repeatedly narrows or closes during sleep, causing breathing to stop or become shallow. Common signs include loud snoring, witnessed pauses in breathing, gasping during sleep, and daytime sleepiness. Untreated OSA is associated with a higher risk of high blood pressure and cardiovascular problems.
Risk factors include excess weight, enlarged tonsils, certain facial or airway features, and older age. Alcohol and sedatives may make airway obstruction worse.
Symptoms may also include morning headaches, dry mouth, poor concentration, and waking frequently at night. A sleep study can help confirm the diagnosis and guide treatment.
Positive airway pressure (PAP) therapy, including CPAP, is a common and effective treatment. Depending on the person, other options may include a custom oral appliance, weight management, changes to sleep habits, or surgery. A clinician can recommend the most appropriate approach.
Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a long-term lung condition in which airflow is limited, making it harder to breathe. It commonly includes emphysema and chronic bronchitis. Symptoms may develop gradually and can worsen over time.
Smoking is a major risk factor. Exposure to air pollution, occupational dust or fumes, and certain inherited conditions, such as alpha-1 antitrypsin deficiency, can also contribute.
Common symptoms include a persistent cough, mucus production, wheezing, and shortness of breath, especially during activity. A flare-up may cause a sudden worsening of breathlessness, cough, or sputum. Spirometry is used to confirm airflow obstruction.
Treatment is tailored to symptoms and the risk of flare-ups. It may include long-acting inhaled bronchodilators; inhaled corticosteroids are added for selected patients. Smoking cessation, vaccinations, pulmonary rehabilitation, and exercise are important parts of care. Long-term oxygen therapy is reserved for people who meet specific criteria for severe chronic low blood oxygen. Some people with advanced disease may be considered for procedures or surgery.
COPD–OSA Overlap Syndrome
COPD–OSA overlap syndrome means that a person has both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). Symptoms may include snoring and breathing pauses during sleep alongside chronic cough, mucus production, and shortness of breath on exertion. Nighttime oxygen levels may fall more than they would with either condition alone.
Treatment addresses both conditions. Positive airway pressure (PAP) therapy is commonly used to treat the OSA component, while COPD care may include inhaled medicines, pulmonary rehabilitation, and other treatments as appropriate. The choice of CPAP or noninvasive ventilation depends on the person's breathing pattern, carbon dioxide levels, and clinical assessment. Supplemental oxygen may be needed for some patients, but oxygen alone does not treat airway obstruction during sleep.
