{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:20:16Z","timestamp":1793506816377,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,5,28]],"date-time":"2023-05-28T00:00:00Z","timestamp":1685232000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL135483"],"award-info":[{"award-number":["R01HL135483"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objective<\/jats:title><jats:p>Obesity hypoventilation syndrome (OHS) causes hypercapnia which is often refractory to current therapies. We examine whether hypercapnia in OHS can be improved by a ketogenic dietary intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a single\u2010arm crossover clinical trial to examine the impact of a ketogenic diet on CO<jats:sub>2<\/jats:sub> levels in patients with OHS. Patients were instructed to adhere to 1\u2009week of regular diet, 2\u2009weeks of ketogenic diet, followed by 1\u2009week of regular diet in an ambulatory setting. Adherence was assessed with capillary ketone levels and continuous glucose monitors. At weekly visits, we measured blood gases, calorimetry, body composition, metabolic profiles, and sleep studies. Outcomes were assessed with linear mixed models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 20 subjects completed the study. Blood ketones increased from 0.14\u2009\u00b1\u20090.08 during regular diet to 1.99\u2009\u00b1\u20091.11\u2009mmol\/L (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) after 2\u2009weeks of ketogenic diet. Ketogenic diet decreased venous CO<jats:sub>2<\/jats:sub> by 3.0\u2009mm Hg (<jats:italic>p<\/jats:italic>\u2009=\u20090.008), bicarbonate by 1.8\u2009mmol\/L (<jats:italic>p<\/jats:italic>\u2009=\u20090.001), and weight by 3.4\u2009kg <jats:italic>(p\u2009&lt;<\/jats:italic>\u20090.001)<jats:italic>.<\/jats:italic> Sleep apnoea severity and nocturnal oxygen levels significantly improved. Ketogenic diet lowered respiratory quotient, fat mass, body water, glucose, insulin, triglycerides, leptin, and insulin\u2010like growth factor 1. Rebound hypercapnia was observed after resuming regular diet. CO<jats:sub>2<\/jats:sub> lowering was dependent on baseline hypercapnia, and associated with circulating ketone levels and respiratory quotient. The ketogenic diet was well tolerated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates for the first time that a ketogenic diet may be useful for control of hypercapnia and sleep apnoea in patients with obesity hypoventilation syndrome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.14526","type":"journal-article","created":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T02:44:07Z","timestamp":1685328247000},"page":"784-793","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Ketogenic diet acutely improves gas exchange and sleep apnoea in obesity hypoventilation syndrome: A non\u2010randomized crossover study"],"prefix":"10.1111","volume":"28","author":[{"given":"Adam","family":"Osman","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenjuan","family":"Gu","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Duan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobbie","family":"Barron","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Translational Research Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luu V.","family":"Pham","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2951-7535","authenticated-orcid":false,"given":"Vsevolod Y.","family":"Polotsky","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5788-3535","authenticated-orcid":false,"given":"Jonathan C.","family":"Jun","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0097-2018"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0117808"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201410-1900OC"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.89.5.627"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197605132942003"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2011.05.005"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000001007"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2008.01824.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-018-0373-9"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-00619"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.2172"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607186010002151"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.2385"},{"issue":"5","key":"e_1_2_10_15_1","first-page":"960","article-title":"Effects of a large carbohydrate load on walking performance in chronic air\u2010flow obstruction","volume":"132","author":"Brown SE","year":"1985","journal-title":"Am Rev Respir Dis"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1985.58.4.1340"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.100.3.792"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00263863"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.102.2.551"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(74)90131-4"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-96460-y"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1113\/JP270308"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.5.9809025"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2017.00848"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-209826"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2017.00256"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2011.223925"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202109-2043OC"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/med.21713"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2004.072371"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01082.2001"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1080\/09637486.2021.1993154"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.57.1.75"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/130.12.3127S"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ghir.2009.11.004"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2019.100910"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.26436"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2007.01765.x"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.4103\/atm.ATM_29_19"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201905-1071ST"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00959-2016"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-1279"}],"container-title":["Respirology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/resp.14526","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T11:31:58Z","timestamp":1692271918000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/resp.14526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,28]]},"references-count":41,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1111\/resp.14526"],"URL":"https:\/\/doi.org\/10.1111\/resp.14526","archive":["Portico"],"relation":{},"ISSN":["1323-7799","1440-1843"],"issn-type":[{"value":"1323-7799","type":"print"},{"value":"1440-1843","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,28]]},"assertion":[{"value":"2023-01-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}