Follow-up and monitoring for people with obesity hypoventilation syndrome (OHS)

Follow-up and monitoring for people with obesity hypoventilation syndrome (OHS)

Tailor follow-up to the person's overall treatment plan, which may include lifestyle changes and treating comorbidities

Follow-up for people using CPAP or non-invasive ventilation

Offer face-to-face, video or phone consultations, including review of telemonitoring data (if available), to people with OHS having non-invasive ventilation or CPAP. This should include:

• an initial consultation within 1 month and
• subsequent follow-up according to the person's needs and until optimal control of symptoms, AHI or ODI, oxygenation and hypercapnia is achieved

When non-invasive ventilation or CPAP (with or without oxygen therapy) has been optimised for people with OHS and their symptoms are controlled, consider 6-monthly to annual follow-up according to the person's needs.

Offer people with OHS having non-invasive ventilation or CPAP access to a sleep and ventilation service for advice, support and equipment between follow-up appointments

Follow-up for drivers with excessive sleepiness

• ensure follow-up is in line with Driver and Vehicle Licensing Agency guidance on assessing fitness to drive.

Monitoring treatment efficacy for people with obesity hypoventilation syndrome (OHS)

Assess the effectiveness of treatment with CPAP or non-invasive ventilation in people with OHS by reviewing the following:

• OHS symptoms, including the Epworth Sleepiness Scale and vigilance, for example, when driving
• severity of OSAHS, using AHI or ODI
• improvement in oxygenation and hypercapnia while awake and asleep
• adherence to therapy
• telemonitoring or download information from the device (if available)

Explore with the person their understanding and experience of treatment, and review the following:

• mask type and fit, including checking for leaks
• nasal and mouth dryness, and the need for humidification
• other factors affecting sleep disturbance such as insomnia, restless legs and shift work
• sleep hygiene
• cleaning and maintenance of equipment

For people with OHS having supplemental oxygen therapy, review whether this is still needed after treatment with non-invasive ventilation or CPAP has been optimised.

Reference:

• NICE (August 2021). Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s