Weight Loss May Be Key to Resolving OHS, Says Atul Malhotra, MD

At SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies in Seattle, Atul Malhotra, PhD, a sleep medicine specialist at UC San Diego Health, presented “Obesity Hypoventilation Syndrome - Updates in Diagnosis, PAP, and Weight Management” on June 10th in Seattle. HCPLive sat down with Malhotra at the meeting to discuss updates in weight management for obesity hypoventilation syndrome (OHS).

In the first half of the interview, Malhotra shared OHS updates regarding diagnosis and positive airway pressure (PAP), which can be viewed here. He discussed how, despite OHS being a common issue, arterial blood gases are not checked as often as they used to be.

However, examining serum bicarbonate is helpful for identifying OHS, a disorder that often worsens the prognosis of obstructive sleep apnea (OSA). OHS and OSA tend to occur at the same time with a raised bicarbonate level.

Many patients with OHS do not find relief with PAP. Even though Malhotra offered suggestions to improve PAP adherence—patient education, intensive support, maintaining nasal pain—he said weight management is the most helpful.

“Data suggest you need to lose about 25 or 30% [of] your body weight to resolve obesity hypoventilation syndrome,” Malhotra said.

Malhotra conducted a big clinical trial recently that showed appetite therapy was helpful in improving OSA and cardiovascular symptoms, such as systolic blood pressure, reactive protein sleep apnea, and hypoxic burden. In that study, weight loss of 18 to 20% was substantial.

“So, if I started 200 pounds, 20% weight loss would be 40 pounds, or bring me 260 pounds, quite a game changer for those patients,” Malhotra said. “But given the need [of] 25% - 30% weight loss to resolve obesity hypoventilation syndrome... current data suggests that your tirzepatide may not be enough to get you to resolution of that subset of patients.”

Malhotra highlighted another drug in the pipeline—retatrutide (Triple G), a GLP-1 with a glucagon agonist. He said that retatrutide looks promising in preliminary studies, providing up to 25% of weight loss.

“That might be what we need to see [for] resolution of obesity hypervalent syndrome, but bottom line is, we need more data,” he said.

Relevant disclosures for Malhotra include Eli Lilly and Company, LivaNova, Itamar, ZOLL Respicardia, Impulse Dynamics, Jazz Pharmaceuticals, and Eisai Inc.

References

Nowalk N, Malhotra A, Mokhlesi B, et al. Obesity Hypoventilation Syndrome - Updates in Diagnosis, PAP, and Weight Management. Presented at SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies, on Tuesday, June 10 in Seattle.