# Obesity Hypoventilation Syndrome in Children and Adolescents

## TL;DR

Obesity hypoventilation syndrome in children is a serious but under-recognized condition that causes breathing issues and needs better awareness and treatment strategies.

## Contribution

This review synthesizes current knowledge on pediatric OHS, emphasizing the need for earlier recognition and tailored therapeutic strategies.

## Key findings

- Pediatric OHS is under-recognized and often leads to delayed diagnosis and acute complications.
- Positive airway pressure therapy is the main treatment, but weight reduction remains challenging in children.
- Pharmacological treatments like medroxyprogesterone and acetazolamide have limited evidence in pediatric populations.

## Abstract

Obesity hypoventilation syndrome (OHS) is a severe and underrecognized respiratory disorder characterized by the coexistence of obesity, daytime hypercapnia, and sleep-disordered breathing. Although well described in adults, pediatric OHS remains poorly defined despite the rising prevalence of childhood obesity. Its pathophysiology is multifactorial, involving obesity-related mechanical constraints, impaired ventilatory control, altered chemosensitivity, and frequent overlap with obstructive sleep apnea. Clinical manifestations in children are often subtle and nonspecific, including snoring, sleep fragmentation, daytime sleepiness, and neurocognitive impairment, frequently leading to delayed diagnosis and, in some cases, acute cardiopulmonary decompensation. Management of pediatric OHS is challenging and largely extrapolated from adult data. Positive airway pressure therapy remains the cornerstone of treatment, while weight reduction is essential but difficult to achieve in pediatric populations. Pharmacological approaches such as medroxyprogesterone or acetazolamide remain experimental, with limited pediatric evidence. This review synthesizes current knowledge on pediatric OHS, focusing on epidemiology, pathophysiology, clinical presentation, diagnostic challenges, and therapeutic strategies. Increased awareness and earlier recognition are essential to prevent progression to chronic respiratory failure and long-term cardiovascular complications.