The Malignant Obesity Hypoventilation Syndrome (MOHS)
Paul E. Marik,
We have coined the term “Malignant Obesity Hypoventilation Syndrome” (MOHS) to describe a
severe multisystem disease due to the systemic effects of obesity. Patients with this syndrome have severe
obesity related hypoventilation together with systemic hypertension, diabetes and the metabolic syndrome,
left ventricular hypertrophy with diastolic dysfunction, pulmonary hypertension and hepatic dysfunction.
Patients with MOHS are frequently admitted to the ICU with hypercapnic respiratory failure and have a high
mortality. This syndrome is largely unrecognized as physicians do not make the association between the
patients’ multiple medical problems and obesity. Due to the delayed diagnosis and progressive morbidities of
this condition all patients with a BMI > 40 kg/m2 should be screened for MOHS. The management of patients
with MOHS includes short term measures to improve the patients’ medical condition and long term measures
to achieve enduring weight loss. Bariatric surgery reverses or improves the multiple metabolic and organ
dysfunctions associated with MOHS and should be strongly considered in these patients.
Keywords: Diabetes, diastolic heart failure, metabolic syndrome, myocardial hypotrophy, non-acholic
steato-hepatitis, obesity, obesity hypoventilation syndrome, pulmonary hypertension.
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