{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T11:48:04Z","timestamp":1782128884748,"version":"3.54.5"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Obes"],"published-print":{"date-parts":[[2026,6]]},"DOI":"10.1038\/s41366-026-02077-4","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T03:37:14Z","timestamp":1775014634000},"page":"1337-1342","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond mean and maximum CO\u2082: introducing hypercapnic burden as a marker of sleep-related hypoventilation"],"prefix":"10.1038","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1740-6782","authenticated-orcid":false,"given":"Alexandros","family":"Kalkanis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mavroudis","family":"Eleftheriou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliki","family":"Karkala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2482-7139","authenticated-orcid":false,"given":"Bertien","family":"Buyse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dries","family":"Testelmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"2077_CR1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1164\/rccm.201608-1666OC","volume":"196","author":"D Adler","year":"2017","unstructured":"Adler D, Pepin J-L, Dupuis-Lozeron E, Espa-Cervena K, Merlet-Violet R, Muller H, et al. Comorbidities and subgroups of patients surviving severe acute hypercapnic respiratory failure in the intensive care unit. Am J Respir Crit care Med. 2017;196:200\u20137.","journal-title":"Am J Respir Crit care Med"},{"key":"2077_CR2","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1164\/rccm.201206-1101OC","volume":"186","author":"A Carrillo","year":"2012","unstructured":"Carrillo A, Ferrer M, Gonzalez-Diaz G, Lopez-Martinez A, Llamas N, Alcazar M, et al. Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;186:1279\u201385.","journal-title":"Am J Respir Crit Care Med"},{"key":"2077_CR3","doi-asserted-by":"crossref","unstructured":"Masa JF, P\u00e9pin JL, Borel JC, Mokhlesi B, Murphy PB, S\u00e1nchez-Quiroga M\u00c1. Obesity hypoventilation syndrome. Eur Respir Rev. 2019;28:180097.","DOI":"10.1183\/16000617.0097-2018"},{"key":"2077_CR4","doi-asserted-by":"crossref","unstructured":"Shah NM, Shrimanker S, Kaltsakas G. Defining obesity hypoventilation syndrome. Breathe (Sheff). 2021;17:210089.","DOI":"10.1183\/20734735.0089-2021"},{"key":"2077_CR5","doi-asserted-by":"publisher","first-page":"597","DOI":"10.5664\/jcsm.2172","volume":"8","author":"RB Berry","year":"2012","unstructured":"Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events: deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8:597\u2013619.","journal-title":"J Clin Sleep Med"},{"key":"2077_CR6","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1177\/0300060517728857","volume":"46","author":"F Trucco","year":"2018","unstructured":"Trucco F, Pedemonte M, Fiorillo C, Tan HL, Carlucci A, Brisca G, et al. Detection of early nocturnal hypoventilation in neuromuscular disorders. J Int Med Res. 2018;46:1153\u201361.","journal-title":"J Int Med Res"},{"key":"2077_CR7","doi-asserted-by":"crossref","unstructured":"Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, et al. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. 2017;49:1600959.","DOI":"10.1183\/13993003.00959-2016"},{"key":"2077_CR8","doi-asserted-by":"crossref","unstructured":"Baglyas S, Valk\u00f3 L, Donka D, Fodor G, Hans\u00e1gi E, M\u00e9h\u00e9sz I, et al. Prevalence of suspected obesity hypoventilation syndrome in Hungarian Intensive Care Units during the COVID-19 pandemic. Clin Respir J. 2023;17:771\u20139.","DOI":"10.1111\/crj.13667"},{"key":"2077_CR9","doi-asserted-by":"publisher","first-page":"181","DOI":"10.15537\/smj.2015.2.9991","volume":"36","author":"AS BaHammam","year":"2015","unstructured":"BaHammam AS. Prevalence, clinical characteristics, and predictors of obesity hypoventilation syndrome in a large sample of Saudi patients with obstructive sleep apnea. Saudi Med J. 2015;36:181.","journal-title":"Saudi Med J"},{"key":"2077_CR10","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1513\/pats.200708-122MG","volume":"5","author":"B Mokhlesi","year":"2008","unstructured":"Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc. 2008;5:218\u201325.","journal-title":"Proc Am Thorac Soc"},{"key":"2077_CR11","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1002\/osp4.27","volume":"2","author":"PE Marik","year":"2016","unstructured":"Marik PE, Chen C. The clinical characteristics and hospital and post-hospital survival of patients with the obesity hypoventilation syndrome: analysis of a large cohort. Obes Sci Pr. 2016;2:40\u20137.","journal-title":"Obes Sci Pr"},{"key":"2077_CR12","unstructured":"Malley WJ. Clinical Blood Gases : Assessment and Intervention. 2nd ed. St. Louis, Mo: Elsevier Saunders, 2005."},{"key":"2077_CR13","doi-asserted-by":"publisher","first-page":"5636","DOI":"10.3390\/s21165636","volume":"21","author":"A Umeda","year":"2021","unstructured":"Umeda A, Ishizaka M, Ikeda A, Miyagawa K, Mochida A, Takeda H, et al. Recent insights into the measurement of carbon dioxide concentrations for clinical practice in respiratory medicine. Sensors. 2021;21:5636.","journal-title":"Sensors"},{"key":"2077_CR14","doi-asserted-by":"publisher","first-page":"5020","DOI":"10.21037\/jtd-sleep-2020-003","volume":"12","author":"AM O\u2019Mahony","year":"2020","unstructured":"O\u2019Mahony AM, Garvey JF, McNicholas WT. Technologic advances in the assessment and management of obstructive sleep apnoea beyond the apnoea-hypopnoea index: a narrative review. J Thorac Dis. 2020;12:5020.","journal-title":"J Thorac Dis"},{"key":"2077_CR15","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.arbres.2022.08.005","volume":"59","author":"MA Martinez-Garcia","year":"2023","unstructured":"Martinez-Garcia MA, Sanchez-de-la-Torre M, White DP, Azarbarzin A. Hypoxic burden in obstructive sleep apnea: present and future. Arch Bronconeumol. 2023;59:36\u201343.","journal-title":"Arch Bronconeumol"},{"key":"2077_CR16","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1093\/eurheartj\/ehy624","volume":"40","author":"A Azarbarzin","year":"2019","unstructured":"Azarbarzin A, Sands SA, Stone KL, Taranto-Montemurro L, Messineo L, Terrill PI, et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J. 2019;40:1149\u201357.","journal-title":"Eur Heart J"},{"key":"2077_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2025.107941","volume":"237","author":"A Kalkanis","year":"2025","unstructured":"Kalkanis A, Eleftheriou M, Demolder S, Borzee P, Parsons B, Buyse B, et al. Hypercapnic burden: A new method for evaluation of nighttime hypercapnia in patients with OHS. Respir Med. 2025;237:107941.","journal-title":"Respir Med"},{"key":"2077_CR18","doi-asserted-by":"publisher","first-page":"209","DOI":"10.5664\/jcsm.2480","volume":"9","author":"N Jaimchariyatam","year":"2013","unstructured":"Jaimchariyatam N, Dweik RA, Kaw R, Aboussouan LS. Polysomnographic determinants of nocturnal hypercapnia in patients with sleep apnea. J Clin Sleep Med. 2013;9:209\u201315.","journal-title":"J Clin Sleep Med"},{"key":"2077_CR19","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1037\/0033-2909.111.1.172","volume":"111","author":"X-L Meng","year":"1992","unstructured":"Meng X-L, Rosenthal R, Rubin DB. Comparing correlated correlation coefficients. Psychol Bull. 1992;111:172\u20135.","journal-title":"Psychol Bull"},{"key":"2077_CR20","unstructured":"Field A, Miles J, Field Z. Discovering statistics using R. London: SAGE Publications; 2012."},{"key":"2077_CR21","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1164\/rccm.201905-1071ST","volume":"200","author":"B Mokhlesi","year":"2019","unstructured":"Mokhlesi B, Masa JF, Brozek JL, Gurubhagavatula I, Murphy PB, Piper AJ, et al. Evaluation and management of obesity hypoventilation syndrome: an official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2019;200:e6\u2013e24.","journal-title":"Am J Respir Crit Care Med"},{"key":"2077_CR22","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1016\/j.chest.2020.03.053","volume":"158","author":"A Azarbarzin","year":"2020","unstructured":"Azarbarzin A, Taranto-Montemurro L, Sofer T, et al. The sleep apnea-specific hypoxic burden predicts incident heart failure. Chest. 2020;158:739\u201350.","journal-title":"Chest"},{"key":"2077_CR23","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1513\/AnnalsATS.202402-224OC","volume":"22","author":"J Einarsson","year":"2025","unstructured":"Einarsson J, Palm A, Ahmadi Z, Ekstr\u00f6m M. Home mechanical ventilation and risk of hospitalization in obesity hypoventilation syndrome: the population-based DISCOVERY study. Ann Am Thorac Soc. 2025;22:422\u20139.","journal-title":"Ann Am Thorac Soc"},{"key":"2077_CR24","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13999","volume":"33","author":"WJ Cheng","year":"2024","unstructured":"Cheng WJ, Finnsson E, \u00c1g\u00fastsson JS, Sands SA, Hang LW. Continuous positive airway pressure and adherence in patients with different endotypes of obstructive sleep apnea. J Sleep Res. 2024;33:e13999.","journal-title":"J Sleep Res"},{"key":"2077_CR25","doi-asserted-by":"publisher","first-page":"597","DOI":"10.5664\/jcsm.9674","volume":"18","author":"MG Silveira","year":"2022","unstructured":"Silveira MG, Sampol G, Mota-Foix M, Ferrer J, Lloberes P. Cluster-derived obstructive sleep apnea phenotypes and outcomes at 5-year follow-up. J Clin Sleep Med. 2022;18:597\u2013607.","journal-title":"J Clin Sleep Med"}],"container-title":["International Journal of Obesity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41366-026-02077-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41366-026-02077-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41366-026-02077-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T11:04:21Z","timestamp":1782126261000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41366-026-02077-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["2077"],"URL":"https:\/\/doi.org\/10.1038\/s41366-026-02077-4","relation":{},"ISSN":["0307-0565","1476-5497"],"issn-type":[{"value":"0307-0565","type":"print"},{"value":"1476-5497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"assertion":[{"value":"5 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}