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Session Schedule

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0:00:00
Gender differences in presentation and diagnosis of OHS
Ahmed BaHammam (Saudi Arabia)

0:13:35
Sex disparities impacts patient outcomes in ambulatory and hospitalized patients with OHS
Maria Angeles Sanchez Quiroga (Spain)

0:30:40
Implementing guideline-based care in patients with OHS to minimize gender disparities in care
Amanda Piper (Australia)

0:55:00
Putting it all together: Is gender bias in OHS real and if so, how to avoid it.
Babak Mokhlesi (United States)

1:21:45
Question and answer

Summary

Obesity hypoventilation syndrome (OHS) is the most extreme respiratory complication of severe obesity as well as the most severe form of sleep-disordered breathing with a rising prevalence in parallel with the global obesity epidemic. Compared to patients with OSA, patients with OHS have worse outcomes. Early recognition/treatment of OHS is critically important to avoid adverse outcomes. However, diagnosis is frequently established in the 6th/7th decade of life. This delay in diagnosis is more prevalent in women. There is evidence that the majority of hospitalized patients with OHS who experience an acute-on-chronic hypercapnic respiratory failure are elderly women and a lower proportion of these hospitalized women are discharged on appropriate home noninvasive ventilation when compared to men. Importantly, the delay in diagnosis is more prevalent in women. The panel will present the differences in phenotypic presentation of OHS between men and women, discuss data demonstrating gender bias in diagnosis and treatment of OHS, and review the impact of gender bias on patient outcomes. The faculty will discuss the reasons behind this gender disparity in making a timely diagnosis, including differences in phenotypic presentation of OHS between men and women. A pathway for implementing guideline-based care to minimize the risk of gender bias in patients with OHS will be provided. By gaining knowledge in gender disparities in OHS diagnosis, treatment and outcomes, sleep specialists will be able to implement changes in their clinical practice to improve long-term outcomes of women with OHS, emphasizing the critical role of a multidisciplinary approach in managing OHS.

Learning Objectives:

Upon completion of this CME activity, participants will be able to:
• Discuss gender differences in clinical presentation of patients with OHS, particularly that women have a higher comorbidity index compared to men. This presentation will provide the foundation on why women get diagnosed with OHS later than men
• Provide pathophysiologic explanation that leads to different phenotypic presentation of OHS in men and women
• Provide emerging evidence from the Pickwick Trial (ambulatory patients) and the ATS registry (hospitalized patients) collected for the development of ATS clinical practice guidelines. There are sex disparities in OHS, particularly in hospitalized patients, and the disparities can lead to worse outcome in women
• Discuss the best strategies to implement guideline-based care to minimize gender bias and to potentially avoid worse outcomes in women, emphasizing the critical role of a multidisciplinary approach in managing OHS
• Summarize the evidence and provide take home points for the audience on tools to identify gender bias and strategies to avoid it