Do you consider tracheostomy for the management of continued hypercapnea despite compliance with PAP in patients with OHS and OSA?  

I would try AVAPS such as trelegy machine first before considering Tracheotomy. In most circumstances with good compliance, it helps with the hypercapnic failure.

No, I would generally not consider this unless there was convincing evidence of persistent upper airway obstruction as the cause of hypercapnia. Approximately 10% of patients with OHS do not have OSA, and therefore have hypoventilation that would not resolve with CPAP. Among the 90% of patients with...