What is the best choice for initial therapy in a patient with obesity hypoventilation syndrome and obstructive sleep apnea?

Nocturnal continuous positive airway pressure (CPAP) is considered the best initial therapy for patients with obesity hypoventilation syndrome and obstructive sleep apnea. This device works by delivering a continuous stream of air that helps keep the upper airway open during sleep, which is crucial in preventing the apneic episodes that characterize these conditions.

In patients with obesity hypoventilation syndrome, there is a combination of factors leading to hypoventilation during sleep, including excess body weight that can affect respiratory mechanics and a reduction in functional residual capacity. Combining CPAP with weight management strategies can significantly improve ventilation and reduce blood carbon dioxide levels, ultimately leading to better overall outcomes.

While bilevel positive airway pressure (BiPAP) might be considered in certain circumstances—particularly in more severe cases where a patient has difficulty with CPAP tolerability—CPAP remains the first-line therapy. Theophylline is generally not used for this indication due to its side effects and limited efficacy, while supplemental oxygen does not address the underlying obstruction and can mask hypercapnia without treating the condition itself.

Therefore, starting treatment with nocturnal continuous positive airway pressure effectively addresses the respiratory issues associated with obesity hypoventilation syndrome and obstructive sleep apnea, making it the