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A middle aged morbidly obese lady with symptoms of obstructive sleep apnea and obesity hypoventilation syndrome was admitted to our hospital emergency in circulatory and Type II respiratory failure. She was resuscitated and put on invasive mechanical ventilation. After extubationshe was put on non invasive bilevel positive airway pressure ventilation. Despite two weeks on ventilatory support the patients blood gas did not show significant improvement. The patient was given a trial of oral medroxyprogesterone and aectazolomide with continuation of BiPAP support. By two weeks the patient could be discharged on nocturnal non invasive BiPAP ventilation

A difficult case of obstructive sleep apnea with obesity hypoventilation syndrome