{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:27:28Z","timestamp":1790879248464,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2025,5,13]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bicarbonate above the upper limit of normal is used as an indicator of sleep-related hypoventilation in patients with diseases frequently associated with hypoventilation, such as obesity or neuromuscular diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research question<\/jats:title>\n                    <jats:p>The aim was to evaluate the diagnostic accuracy of bicarbonate from daytime arterial blood gas analysis for sleep-related hypoventilation measured via transcutaneous nocturnal capnometry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a diagnostic accuracy study, the sensitivity and specificity of bicarbonate concentration for detecting nocturnal hypoventilation were tested using a receiver operating curve (ROC) and logistic regression analysis in patients undergoing both an in-laboratory sleep study with transcutaneous capnometry and daytime arterial blood gas analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 510 patients (mean\u00b1SD\u2009age 52\u00b115 years, BMI 34\u00b110\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), the area under the ROC curve for bicarbonate (HCO\n                      <jats:sub>3-<\/jats:sub>\n                      ) and median nocturnal tcpCO\n                      <jats:sub>2<\/jats:sub>\n                      \u226550\u2009mm Hg (45% yes, 55% no) was 0.70 (95% CI 0.65 to 0.75). Sensitivity of HCO\n                      <jats:sub>3-<\/jats:sub>\n                      of 26.5\u2009mmol\/L and 27.0\u2009mmol\/L was 61.0% and 54.1%, specificity 71.3% and 79.6%, and the likelihood ratio for sleep-related hypoventilation (median tcpCO\n                      <jats:sub>2<\/jats:sub>\n                      \u226550\u2009mm Hg) 2.1 and 2.6. HCO\n                      <jats:sub>3-<\/jats:sub>\n                      was significantly higher in those with (n=231, 27.6\u00b13.0\u2009mmol\/L) versus without (n=279, 25.8\u00b11.9\u2009mmol\/L) sleep-related hypoventilation (p&lt;0.001). Increasing awake HCO\n                      <jats:sub>3-<\/jats:sub>\n                      was associated with a higher likelihood of nocturnal hypoventilation (OR 1.4 (95% CI 1.3 to 1.5), p&lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The sensitivity of elevated bicarbonate from awake arterial blood gas analysis using common cut-off values such as 27\u2009mmol\/L is only moderate, and bicarbonate as an integral part of the assessment of sleep hypoventilation (likelihood ratio) must be interpreted in the context of other assessments. A normal bicarbonate does not rule out sleep hypoventilation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2024-002591","type":"journal-article","created":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T16:35:11Z","timestamp":1748795711000},"page":"e002591","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Bicarbonate from arterial blood gas analysis as predictor of sleep-related hypoventilation: a diagnostic accuracy study"],"prefix":"10.1136","volume":"12","author":[{"given":"Sanja","family":"Pocrncic","sequence":"first","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel J","family":"Herzig","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Benning","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Mollet","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6380-7395","authenticated-orcid":false,"given":"Matteo","family":"Bradicich","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Lichtblau","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Mayer","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Kohler","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"},{"name":"Competence Centre Sleep & Health, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ulrich","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"},{"name":"Competence Centre Sleep & Health, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8840-981X","authenticated-orcid":false,"given":"Esther Irene","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland"},{"name":"Competence Centre Sleep & Health, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,1]]},"reference":[{"key":"2026010701502504000_12.1.e002591.1","doi-asserted-by":"crossref","first-page":"105877","DOI":"10.1016\/j.rmed.2020.105877","article-title":"Time-to-death in chronic respiratory failure on home mechanical ventilation: A cohort study","volume":"162","author":"Schwarz","year":"2020","journal-title":"Respir Med"},{"key":"2026010701502504000_12.1.e002591.2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2019-214204"},{"key":"2026010701502504000_12.1.e002591.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.02.064"},{"key":"2026010701502504000_12.1.e002591.4","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-1792"},{"key":"2026010701502504000_12.1.e002591.5","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01082.2001"},{"key":"2026010701502504000_12.1.e002591.6","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S0272-5231(21)00395-6","article-title":"Control of ventilation during sleep","volume":"6","author":"Douglas","year":"1985","journal-title":"Clin Chest Med"},{"key":"2026010701502504000_12.1.e002591.7","doi-asserted-by":"publisher","DOI":"10.1136\/thx.37.11.840"},{"key":"2026010701502504000_12.1.e002591.8","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00043.2008"},{"key":"2026010701502504000_12.1.e002591.9","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.039388"},{"key":"2026010701502504000_12.1.e002591.10","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S2705"},{"key":"2026010701502504000_12.1.e002591.11","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00003113"},{"key":"2026010701502504000_12.1.e002591.12","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/978-0-387-73693-8_75","article-title":"Potential mechanism for transition between acute hypercapnia during sleep to chronic hypercapnia during wakefulness in obstructive sleep apnea","volume":"605","author":"Berger","year":"2008","journal-title":"Adv Exp Med Biol"},{"key":"2026010701502504000_12.1.e002591.13","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2017-316515"},{"key":"2026010701502504000_12.1.e002591.14","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03733"},{"key":"2026010701502504000_12.1.e002591.15","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-006-0092-8"},{"key":"2026010701502504000_12.1.e002591.16","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201905-1071ST"},{"key":"2026010701502504000_12.1.e002591.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0117808","article-title":"Obesity-hypoventilation syndrome: increased risk of death over sleep apnea syndrome","volume":"10","author":"Castro-A\u00f1\u00f3n","year":"2015","journal-title":"PLoS One"},{"key":"2026010701502504000_12.1.e002591.18","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.2172"},{"key":"2026010701502504000_12.1.e002591.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2010.10.007"},{"key":"2026010701502504000_12.1.e002591.20","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1159\/000323074","article-title":"Validation of a transcutaneous CO(2) monitor in adult patients with chronic respiratory failure","volume":"81","author":"Hazenberg","year":"2011","journal-title":"Respiration"},{"key":"2026010701502504000_12.1.e002591.21","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jcrc.2010.09.003","article-title":"Comparison of 3 different multianalyte point-of-care devices during clinical routine on a medical intensive care unit","volume":"26","author":"Stadlbauer","year":"2011","journal-title":"J Crit Care"},{"key":"2026010701502504000_12.1.e002591.22","doi-asserted-by":"publisher","DOI":"10.1111\/crj.12054"},{"key":"2026010701502504000_12.1.e002591.23","doi-asserted-by":"crossref","first-page":"879","DOI":"10.5664\/jcsm.2986","article-title":"Diagnostic predictors of obesity-hypoventilation syndrome in patients suspected of having sleep disordered breathing","volume":"9","author":"Macavei","year":"2013","journal-title":"J Clin Sleep Med"},{"key":"2026010701502504000_12.1.e002591.24","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-1279"},{"key":"2026010701502504000_12.1.e002591.25","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00959-2016","article-title":"Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep","volume":"49","author":"Randerath","year":"2017","journal-title":"Eur Respir J"},{"key":"2026010701502504000_12.1.e002591.26","doi-asserted-by":"crossref","first-page":"2793","DOI":"10.5664\/jcsm.10216","article-title":"Obesity-associated sleep hypoventilation and increased adverse postoperative bariatric surgery outcomes in a large clinical retrospective cohort","volume":"18","author":"Chindamporn","year":"2022","journal-title":"J Clin Sleep Med"},{"key":"2026010701502504000_12.1.e002591.27","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1177\/0300060517728857","article-title":"Detection of early nocturnal hypoventilation in neuromuscular disorders","volume":"46","author":"Trucco","year":"2018","journal-title":"J Int Med Res"},{"key":"2026010701502504000_12.1.e002591.28","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.161.1.9901057"},{"key":"2026010701502504000_12.1.e002591.29","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1080\/21678421.2020.1813309","article-title":"Heterogeneity of predictors of nocturnal hypoventilation in amyotrophic lateral sclerosis","volume":"22","author":"Crescimanno","year":"2021","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"key":"2026010701502504000_12.1.e002591.30","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01003-2019","article-title":"European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD","volume":"54","author":"Ergan","year":"2019","journal-title":"Eur Respir J"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2024-002591","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T09:50:55Z","timestamp":1767779455000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2024-002591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,6,1]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1136\/bmjresp-2024-002591"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2024-002591","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}