{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:33:57Z","timestamp":1789605237588,"version":"build-2803163510"},"reference-count":106,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Obesity Hypoventilation Syndrome (OHS), also known as Pickwickian syndrome, is a complex disorder characterized by obesity (BMI &gt; 30 kg\/m2), daytime hypercapnia (PaCO2 \u2265 45 mmHg), and sleep-disordered breathing, primarily affecting individuals with severe obesity. Its diagnosis requires the exclusion of other causes of alveolar hypoventilation and involves comprehensive assessments, including clinical history, physical examination, pulmonary function tests, arterial blood gases, and sleep studies. The pathophysiology of OHS involves mechanical constraints from excessive adipose tissue, diminished central respiratory drive often linked to leptin resistance, mitochondrial dysfunction, and oxidative stress, all contributing to impaired ventilation and systemic inflammation. The condition often coexists with obstructive sleep apnea (OSA), exacerbating nocturnal hypoxia and hypercapnia, which can lead to severe cardiopulmonary complications such as pulmonary hypertension and right-sided heart failure. Epidemiologically, the rising global prevalence of obesity correlates with an increased incidence of OHS, yet underdiagnosis remains a significant challenge, often resulting in critical presentations like acute hypercapnic respiratory failure. Management primarily centers on non-invasive ventilation modalities like CPAP and BiPAP, with an emphasis on individualized treatment plans, continuous monitoring, and addressing comorbidities such as hypertension and diabetes. Pharmacological interventions are still evolving, focusing on supportive care and metabolic regulation. Long-term adherence, psychological factors, and complications like ventilator failure or device intolerance highlight the need for ongoing multidisciplinary management. Overall, advancing our understanding of OHS\u2019s multifactorial mechanisms and optimizing tailored therapeutic strategies are crucial for improving patient outcomes and reducing mortality associated with this increasingly prevalent syndrome.<\/jats:p>","DOI":"10.3390\/diagnostics15172120","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T07:41:45Z","timestamp":1755848505000},"page":"2120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Multidisciplinary Approach to Obesity Hypoventilation Syndrome: From Diagnosis to Long-Term Management\u2014A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1695-6990","authenticated-orcid":false,"given":"Mara Andreea","family":"Vultur","sequence":"first","affiliation":[{"name":"Pulmonology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"},{"name":"Pulmonology Clinic, Mure\u0219 County Clinical Hospital, 540011 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca Liana","family":"Grigorescu","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0882-870X","authenticated-orcid":false,"given":"Drago\u0219","family":"Hu\u021banu","sequence":"additional","affiliation":[{"name":"Pulmonology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"},{"name":"Pulmonology Clinic, Mure\u0219 County Clinical Hospital, 540011 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3558-2856","authenticated-orcid":false,"given":"Edith Simona","family":"Iano\u0219i","sequence":"additional","affiliation":[{"name":"Pulmonology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"},{"name":"Pulmonology Clinic, Mure\u0219 County Clinical Hospital, 540011 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7785-0121","authenticated-orcid":false,"given":"Corina Eugenia","family":"Budin","sequence":"additional","affiliation":[{"name":"Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1990-6767","authenticated-orcid":false,"given":"Gabriela","family":"Jimborean","sequence":"additional","affiliation":[{"name":"Pulmonology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"},{"name":"Pulmonology Clinic, Mure\u0219 County Clinical Hospital, 540011 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1097\/MS9.0000000000000665","article-title":"An indonesian adult with obesity hypoventilation syndrome: A case report","volume":"85","author":"Saka","year":"2023","journal-title":"Ann. Med. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1590\/s1806-37562017000000332","article-title":"Obesity hypoventilation syndrome: A current review","volume":"44","author":"Athayde","year":"2018","journal-title":"J. Bras. Pneumol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"210089","DOI":"10.1183\/20734735.0089-2021","article-title":"Defining obesity hypoventilation syndrome","volume":"17","author":"Shah","year":"2021","journal-title":"Breathe"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"90","DOI":"10.13078\/jsm.220013","article-title":"Air regurgitation through the nasolacrimal duct during bilevel positive airway pressure therapy in a patient with obesity hypoventilation syndrome","volume":"19","author":"Yang","year":"2022","journal-title":"J. Sleep Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.54117\/iimj.v1i1.1","article-title":"Epidemiology of adult obesity, measurements, global prevalence and risk factors","volume":"1","author":"Orukwowu","year":"2022","journal-title":"IPS Intelligentsia Multidiscip. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1080\/10408398.2020.1775546","article-title":"Obesity as a risk factor for covid-19: An overview","volume":"61","author":"Alberca","year":"2020","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1001\/jamapediatrics.2024.1576","article-title":"Global prevalence of overweight and obesity in children and adolescents","volume":"178","author":"Zhang","year":"2024","journal-title":"JAMA Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"180097","DOI":"10.1183\/16000617.0097-2018","article-title":"Obesity hypoventilation syndrome","volume":"28","author":"Masa","year":"2019","journal-title":"Eur. Respir. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"zpae033","DOI":"10.1093\/sleepadvances\/zpae033","article-title":"Obesity hypoventilation syndrome, literature review","volume":"5","author":"Gonzalez","year":"2024","journal-title":"Sleep Adv."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.5664\/jcsm.8712","article-title":"CPAP titration failure is not equivalent to long-term cpap treatment failure in patients with obesity hypoventilation syndrome: A case series","volume":"16","author":"Lastra","year":"2020","journal-title":"J. Clin. Sleep Med."},{"key":"ref_11","first-page":"2162668","article-title":"Nocturnal hypoventilation in the patients submitted to thoracic surgery","volume":"2023","author":"Majchrzak","year":"2023","journal-title":"Can. Respir. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.4187\/respcare.06901","article-title":"Acute Respiratory Failure in Obesity-Hypoventilation Syndrome Managed in the ICU","volume":"64","author":"Chebib","year":"2019","journal-title":"Respir. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1016\/j.rmed.2015.07.004","article-title":"Obesity hypoventilation syndrome: From sleep-disordered breathing to systemic comorbidities and the need to offer combined treatment strategies","volume":"109","author":"Takada","year":"2015","journal-title":"Respir. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1513\/pats.200708-122MG","article-title":"Assessment and management of patients with obesity hypoventilation syndrome","volume":"5","author":"Mokhlesi","year":"2008","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1152\/japplphysiol.00713.2009","article-title":"Big breathing: The complex interaction of obesity, hypoventilation, weight loss, and respiratory function","volume":"108","author":"Piper","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1055\/a-2591-5583","article-title":"Phenotypes of obesity hypoventilation syndrome: Characteristics and outcomes","volume":"46","author":"Masa","year":"2025","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_17","first-page":"36","article-title":"Obesity hypoventilation syndrome: New insights","volume":"6","author":"Molina","year":"2021","journal-title":"Barc. Respir. Netw."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1159\/000050505","article-title":"Acute effect of nasal continuous positive air pressure on the ventilatory control of patients with obstructive sleep apnea","volume":"68","author":"Moura","year":"2001","journal-title":"Respiration"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"160","DOI":"10.22159\/ajpcr.2019.v12i2.28760","article-title":"Endocrinological role of leptin in obesity and asthma","volume":"12","author":"Soni","year":"2019","journal-title":"Asian J. Pharm. Clin. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5137947","DOI":"10.1155\/2018\/5137947","article-title":"Leptin and leptin resistance in the pathogenesis of obstructive sleep apnea: A possible link to oxidative stress and cardiovascular complications","volume":"2018","author":"Berger","year":"2018","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e12958","DOI":"10.1111\/obr.12958","article-title":"White adipose tissue mitochondrial metabolism in health and in obesity","volume":"21","author":"Heinonen","year":"2019","journal-title":"Obes. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2563","DOI":"10.1016\/j.bbadis.2015.09.004","article-title":"Lack of cyclophilin d protects against the development of acute lung injury in endotoxemia","volume":"1852","author":"Fonai","year":"2015","journal-title":"Biochim. Biophys. Acta (BBA)-Mol. Basis Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"16","DOI":"10.61189\/619896szhnms","article-title":"Research progress on mitochondrial autophagy in sepsis-related acute lung injury","volume":"3","author":"Zhai","year":"2025","journal-title":"Perioper. Precis. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Aung, O., Amorim, M.R., Mendelowitz, D., and Polotsky, V.Y. (2024). Revisiting the role of serotonin in sleep-disordered breathing. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25031483"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e002632","DOI":"10.1136\/bmjresp-2024-002632","article-title":"Predictors of sleep-disordered breathing and chronic hypoventilation in obese women and men: A cross-sectional observational study","volume":"12","author":"Mollet","year":"2025","journal-title":"BMJ Open Respir. Res."},{"key":"ref_26","first-page":"38","article-title":"A case report of malignant obesity hypoventilation syndrome: A weighty problem in our icus","volume":"20","author":"Tatusov","year":"2017","journal-title":"Respir. Med. Case Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"181","DOI":"10.15537\/smj.2015.2.9991","article-title":"Prevalence, clinical characteristics, and predictors of obesity hypoventilation syndrome in a large sample of saudi patients with obstructive sleep apnea","volume":"36","author":"BaHammam","year":"2015","journal-title":"Saudi Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"14799731251338269","DOI":"10.1177\/14799731251338269","article-title":"Staging of obesity-associated hypoventilation in patients with morbid obesity scheduled for bariatric surgery","volume":"22","author":"Kania","year":"2025","journal-title":"Chronic Respir. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1177\/0885066612444261","article-title":"Characteristics of Patients With the \u2018Malignant Obesity Hypoventilation Syndrome\u2019 Admitted to an ICU","volume":"28","author":"Marik","year":"2012","journal-title":"J. Intensive Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2478\/jccm-2024-0034","article-title":"Endocrine Disorders in Critically Ill Patients\u2014The Smooth Criminal?","volume":"10","author":"Grigorescu","year":"2024","journal-title":"J. Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Nagappa, M., Liao, P., Wong, J., Auckley, D., Ramachandran, S.K., Memtsoudis, S.G., and Chung, F. (2015). Validation of the stop-bang questionnaire as a screening tool for obstructive sleep apnea among different populations: A systematic review and meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0143697"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"110","DOI":"10.54293\/smhj.v3i3.78","article-title":"Overview on pediatric obesity hypoventilation syndrome","volume":"3","author":"Fadl","year":"2023","journal-title":"Saudi Med. Horiz. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1210\/clinem\/dgaa247","article-title":"Rohhad(net) syndrome: Systematic review of the clinical timeline and recommendations for diagnosis and prognosis","volume":"105","author":"Harvengt","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2147\/IJGM.S293377","article-title":"Rohhad (rapid-onset obesity with hypoventilation, hypothalamic dysfunction, autonomic dysregulation) syndrome\u2014What every pediatrician should know about the etiopathogenesis, diagnosis and treatment: A review","volume":"14","author":"Lazea","year":"2021","journal-title":"Int. J. Gen. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1097\/CCM.0b013e31828a2aa1","article-title":"Body mass index is associated with hospital mortality in critically ill patients","volume":"41","author":"Pickkers","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"141","DOI":"10.5935\/0103-507X.20150025","article-title":"A gradient-boosted model analysis of the impact of body mass index on the short-term outcomes of critically ill medical patients","volume":"27","author":"Zampieri","year":"2015","journal-title":"Rev. Bras. Ter. Intensiv."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/CCM.0000000000002868","article-title":"Severity of illness scores may misclassify critically ill obese patients*","volume":"46","author":"Deliberato","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e41121","DOI":"10.1097\/MD.0000000000041121","article-title":"Apache ii-ecg scoring system: A novel and strong predictor of in-hospital mortality for patients treated in intensive care unit","volume":"103","author":"Aslan","year":"2024","journal-title":"Medicine"},{"key":"ref_39","first-page":"311","article-title":"Weaning patients with obesity from ventilatory support","volume":"27","author":"Kacmarek","year":"2021","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Aceto, P., De Cicco, R., Calabrese, C., Marusco, I., Del Tedesco, F., Luca, E., Modesti, C., Sacco, T., Sollazzi, L., and Ciccoritti, L. (2024). Obesity surgery mortality risk score as a predictor for intensive care unit admission in patients undergoing laparoscopic bariatric surgery. J. Clin. Med., 13.","DOI":"10.3390\/jcm13082252"},{"key":"ref_41","first-page":"e6498","article-title":"The predictive performance of the stop-bang questionnaire in obstructive sleep apnea screening of obese population at sleep clinical setting","volume":"11","author":"Mergen","year":"2019","journal-title":"Cureus"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1093\/bja\/aes022","article-title":"High stop-bang score indicates a high probability of obstructive sleep apnoea","volume":"108","author":"Chung","year":"2012","journal-title":"Br. J. Anaesth."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e13158","DOI":"10.1111\/jsr.13158","article-title":"A network meta-analysis of different positive airway pressure interventions in obesity hypoventilation syndrome","volume":"30","author":"Iftikhar","year":"2020","journal-title":"J. Sleep Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/bja\/aeu373","article-title":"Difficult intubation in obese patients: Incidence, risk factors, and complications in the operating theatre and in intensive care units","volume":"114","author":"Molinari","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1002\/oby.22859","article-title":"Association of obesity with disease severity among patients with coronavirus disease 2019","volume":"28","author":"Kalligeros","year":"2020","journal-title":"Obesity"},{"key":"ref_46","first-page":"13","article-title":"The association between body mass index and outcomes in patient with sepsis and acute respiratory failure","volume":"7","author":"Juarez","year":"2019","journal-title":"Southwest Respir. Crit. Care Chron."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"606","DOI":"10.37506\/mlu.v21i1.2378","article-title":"Quality of life after bariatric surgery","volume":"21","author":"Moly","year":"2021","journal-title":"Med. Leg. Update"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"94","DOI":"10.12923\/2083-4829\/2024-0020","article-title":"Oxygen therapy in the obesity hypoventilation syndrome","volume":"134","author":"Maliszewska","year":"2024","journal-title":"Pol. J. Public Health"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Castro-A\u00f1\u00f3n, O., Llano, L.P.d., S\u00e1nchez, S.d.l.F., Golpe, R., Marote, L.M., Castro-Castro, J., Gonz\u00e1lez-Quintela, A., and Atkin, S.L. (2015). Obesity-hypoventilation syndrome: Increased risk of death over sleep apnea syndrome. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0117808"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"181","DOI":"10.22543\/7674.62.P181189","article-title":"Therapeutic Alternatives with CPAP in Obstructive Sleep Apnea","volume":"6","author":"Budin","year":"2019","journal-title":"J. Mind Med. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"27","DOI":"10.51271\/JOPIC-0031","article-title":"An evaluation of noninvasive mechanical ventilation application in intensive care","volume":"2","author":"Karatepe","year":"2024","journal-title":"J. Pulmonol. Intensive Care"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1056\/NEJMsa1410639","article-title":"Driving pressure and survival in the acute respiratory distress syndrome","volume":"372","author":"Amato","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4187\/respcare.05302","article-title":"Noninvasive ventilation in obese subjects after acute respiratory failure","volume":"63","author":"Bry","year":"2018","journal-title":"Respir. Care"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.rmed.2008.03.013","article-title":"Impact of volume targeting on efficacy of bi-level non-invasive ventilation and sleep in obesity hypoventilation","volume":"103","author":"Janssens","year":"2009","journal-title":"Respir. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"146","DOI":"10.4038\/slja.v32i2.9315","article-title":"Dexmedetomidine vs. propofol: Haemodynamic changes in conscious sedation in arthroscopic shoulder surgery in the beach chair position: A randomized control trial","volume":"32","author":"Hapugoda","year":"2024","journal-title":"Sri Lankan J. Anaesthesiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/ALN.0000000000004631","article-title":"Individualized positive end-expiratory pressure titration strategies in superobese patients undergoing laparoscopic surgery: Prospective and nonrandomized crossover study","volume":"139","author":"Boesing","year":"2023","journal-title":"Anesthesiology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1378\/chest.12-2115","article-title":"Feasibility and effectiveness of prone position in morbidly obese patients with ARDS: A case-control clinical study","volume":"143","author":"Molinari","year":"2013","journal-title":"Chest"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Zhou, D., Li, T., Fei, S., Wang, C., and Lv, Y. (2022). The effect of positive end-expiratory pressure on intracranial pressure in obese and non-obese severe brain injury patients: A retrospective observational study. BMC Anesthesiol., 22.","DOI":"10.1186\/s12871-022-01934-9"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"43","DOI":"10.2478\/jccm-2023-0002","article-title":"Ramping position to aid non-invasive ventilation (niv) in obese patients in the icu","volume":"9","author":"Shirazy","year":"2023","journal-title":"J. Crit. Care Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s13054-018-2079-9","article-title":"Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the lung safe database","volume":"22","author":"Cortegiani","year":"2018","journal-title":"Crit. Care"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Dushianthan, A., Grocott, M.P.W., Murugan, G.S., Wilkinson, T.M.A., and Postle, A.D. (2023). Pulmonary Surfactant in Adult ARDS: Current Perspectives and Future Directions. Diagnostics, 13.","DOI":"10.3390\/diagnostics13182964"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1111\/crj.13359","article-title":"Heart rate variability changes by non-invasive ventilation in obesity hypoventilation syndrome","volume":"15","author":"Amra","year":"2021","journal-title":"Clin. Respir. J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"68","DOI":"10.4187\/respcare.10816","article-title":"Contribution of transcutaneous pco2 in obesity hypoventilation syndrome","volume":"69","author":"Georges","year":"2024","journal-title":"Respir. Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.5664\/jcsm.7332","article-title":"The association between adherence to positive airway pressure therapy and long-term outcomes in patients with obesity hypoventilation syndrome: A prospective observational study","volume":"14","author":"Bouloukaki","year":"2018","journal-title":"J. Clin. Sleep Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.5664\/jcsm.8766","article-title":"Ventilatory response to exercise is preserved in patients with obesity hypoventilation syndrome","volume":"16","author":"Han","year":"2020","journal-title":"J. Clin. Sleep Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.4187\/respcare.04619","article-title":"Volume-targeted versus pressure-limited noninvasive ventilation in subjects with acute hypercapnic respiratory failure: A multicenter randomized controlled trial","volume":"61","author":"Cao","year":"2016","journal-title":"Respir. Care"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Cortegiani, A., Russotto, V., Antonelli, M., Azoulay, \u00c9., Carlucci, A., Conti, G., Demoule, A., Ferrer, M., Hill, N., and Jaber, S. (2017). Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: A report of expert opinions. BMC Anesthesiol., 17.","DOI":"10.1186\/s12871-017-0409-0"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1186\/s13054-020-03214-9","article-title":"High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: A multicenter, randomized controlled trial","volume":"24","author":"Tan","year":"2020","journal-title":"Crit. Care"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/ALN.0b013e318194cac8","article-title":"High body mass index is a weak predictor for difficult and failed tracheal intubation: A cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the danish anesthesia database","volume":"110","author":"Rosenstock","year":"2009","journal-title":"Anesthesiology"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1164\/rccm.201210-1851OC","article-title":"Early identification of patients at risk for difficult intubation in the intensive care unit","volume":"187","author":"Molinari","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Noriega, N.R., Del-Rio-Navarro, B.E., Berber, A., Tapia, S.d.J.R., and D\u00edaz, D.J.M.M. (2023). Effect of obesity on lung function in the pediatric and adult populations with asthma: A review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12165385"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1111\/bcpt.12535","article-title":"Modelling of the sedative effects of propofol in patients undergoing spinal anaesthesia: A pharmacodynamic analysis","volume":"118","author":"Roh","year":"2016","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/ALN.0000000000004254","article-title":"Combination therapy of high-flow nasal cannula and upper-body elevation for postoperative sleep-disordered breathing: Randomized crossover trial","volume":"137","author":"Sakaguchi","year":"2022","journal-title":"Anesthesiology"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"458","DOI":"10.5152\/TJAR.2022.21250","article-title":"The utility of high-flow nasal oxygen therapy in a patient with pneumonia undergoing lower limb orthopaedic surgery: A case report","volume":"50","author":"Kumar","year":"2022","journal-title":"Turk. J. Anaesthesiol. Reanim."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1093\/bja\/aev262","article-title":"Optimizing oxygenation and intubation conditions during awake fibre-optic intubation using a high-flow nasal oxygen-delivery system","volume":"115","author":"Badiger","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_76","first-page":"23","article-title":"Comparison between high flow nasal cannula and non-invasive mechanical ventilation in the management of patients with acute respiratory failure: A meta-analysis","volume":"42","author":"Mahdy","year":"2024","journal-title":"Benha Med. J."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Vijitpavan, A., and Kooncharoensuk, Y. (2021). High flow versus conventional nasal cannula for oxygenation and ventilation maintenance during surgery with intravenous deep sedation by propofol: A randomized controlled study. BMC Anesthesiol., 21.","DOI":"10.1186\/s12871-021-01432-4"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1111\/anae.13607","article-title":"High-flow humidified nasal oxygenation vs. standard face mask oxygenation","volume":"71","author":"Pillai","year":"2016","journal-title":"Anaesthesia"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1159\/000510086","article-title":"Long-term mechanical ventilation: Recommendations of the swiss society of pulmonology","volume":"99","author":"Janssens","year":"2020","journal-title":"Respiration"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2298\/SARH190222130K","article-title":"Pickwickian syndrome-\u201cthe tip of the iceberg\u201d in extremely obese patients","volume":"148","year":"2020","journal-title":"Srp. Arh. Za Celok. Lek."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"e945448","DOI":"10.12659\/AJCR.945448","article-title":"Management of acute and chronic hypercapnic respiratory failure in severe obesity-hypoventilation syndrome: A case study of multi-modal therapy and long-term weight loss","volume":"25","author":"Kitamura","year":"2024","journal-title":"Am. J. Case Rep."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1513\/AnnalsATS.201412-551OC","article-title":"Prevalence of sleep-disordered breathing in obese patients with chronic hypoxemia. a cross-sectional study","volume":"12","author":"Povitz","year":"2015","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s13665-015-0108-6","article-title":"Obesity hypoventilation syndrome","volume":"4","author":"Shetty","year":"2015","journal-title":"Curr. Pulmonol. Rep."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"e140847","DOI":"10.5812\/aapm-140847","article-title":"Predictors of non-invasive ventilation failure and associated factors among the covid-19 patients admitted to intensive care unit","volume":"13","author":"Varpaei","year":"2023","journal-title":"Anesthesiol. Pain Med."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"El Solh, A.A. (2012). Drug dosing in the critically ill obese patient. Critical Care Management of the Obese Patient, John Wiley & Sons.","DOI":"10.1002\/9781119962083"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1016\/j.chest.2021.08.001","article-title":"Impact of Obesity in Critical Illness","volume":"160","author":"Anderson","year":"2021","journal-title":"Chest"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jclinane.2004.01.009","article-title":"Anesthesia in the obese patient: Pharmacokinetic considerations","volume":"17","author":"Casati","year":"2005","journal-title":"J. Clin. Anesth."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.1097\/PCC.0000000000002873","article-title":"2022 society of critical care medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the icu environment and early mobility","volume":"23","author":"Smith","year":"2022","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1177\/000313481808400646","article-title":"Elimination of routine benzodiazepine administration for nonprocedural sedation in a trauma intensive care unit is feasible","volume":"84","author":"McGinn","year":"2018","journal-title":"Am. Surg."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"91","DOI":"10.2174\/1874192401509010091","article-title":"Long-term effect of optimized sedation and pain management after sudden cardiac arrest","volume":"9","author":"Wolfertz","year":"2015","journal-title":"Open Cardiovasc. Med. J."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"301","DOI":"10.4187\/respcare.09360","article-title":"Dexmedetomidine for sedation during pediatric noninvasive ventilation","volume":"67","author":"Eidman","year":"2022","journal-title":"Respir. Care"},{"key":"ref_92","first-page":"2309","article-title":"Comparison of dexmedetomidine versus midazolam in weaning from mechanical ventilation and length of stay in icu","volume":"27","author":"Dodhy","year":"2020","journal-title":"Prof. Med. J."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1002\/jppr.1529","article-title":"Dexmedetomidine prescribing in australian intensive care units: An observational study","volume":"49","author":"Cotta","year":"2019","journal-title":"J. Pharm. Pract. Res."},{"key":"ref_94","first-page":"358","article-title":"Sedation during non-invasive ventilation and its association with intubation rate and intensive care units stay among adult patients at king abdulaziz medical city","volume":"11","author":"Ismaiel","year":"2020","journal-title":"Indian J. Public Health Res. Dev."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"38","DOI":"10.36303\/SAJAA.2021.27.1.2400","article-title":"The association between dexmedetomidine as a single or adjuvant sedative versus other sedatives and the duration of mechanical ventilation and icu stay in critically ill patients in a central south african icu","volume":"27","author":"Swart","year":"2021","journal-title":"S. Afr. J. Anaesth. Analg."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"156","DOI":"10.3892\/etm.2020.9297","article-title":"Differences in efficacy and safety of midazolam vs. dexmedetomidine in critically ill patients: A meta-analysis of randomized controlled trial","volume":"21","author":"Zhou","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s00540-017-2399-y","article-title":"Pharmacokinetic and pharmacodynamics of intravenous dexmedetomidine in morbidly obese patients undergoing laparoscopic surgery","volume":"31","author":"Xu","year":"2017","journal-title":"J Anesth."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Hasanin, A., Taha, K., Abdelhamid, B.M., Abougabal, A., Elsayad, M., Refaie, A., Amin, S., Wahba, S., Omar, H., and Kamel, M.M. (2018). Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0572-y"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"zpae016","DOI":"10.1093\/sleepadvances\/zpae016","article-title":"A comparison of two obesity-related hypoventilation disorders: Impact on sleep, quality of life and neurocognitive outcomes and the effects of positive airway pressure therapy","volume":"5","author":"Zheng","year":"2024","journal-title":"Sleep Adv."},{"key":"ref_100","first-page":"1177","article-title":"Validation of risk assessment models predicting venous thromboembolism in inpatients with acute exacerbation of chronic obstructive pulmonary disease: A multicenter cohort study in China","volume":"122","author":"Zhou","year":"2021","journal-title":"Thromb. Haemost."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"63","DOI":"10.2147\/NSS.S290349","article-title":"Long-term adherence to positive airway pressure therapy in saudi ambulatory patients with obesity hypoventilation syndrome and severe obstructive sleep apnea: A one-year follow-up prospective observational study","volume":"13","author":"Almeneessier","year":"2021","journal-title":"Nat. Sci. Sleep"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.bjae.2019.03.002","article-title":"Scoring systems in the critically ill: Uses, cautions, and future directions","volume":"19","author":"Desai","year":"2019","journal-title":"BJA Educ."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/00034894241295471","article-title":"The effect of obesity on postoperative analgesia practices and complications following endoscopic sinus surgery: A propensity score-matched cohort study","volume":"134","author":"Dhar","year":"2024","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1177\/0885066616663179","article-title":"Noninvasive ventilation in the critically ill patient with obesity hypoventilation syndrome: A review","volume":"32","author":"Sequeira","year":"2016","journal-title":"J. Intensive Care Med."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1164\/rccm.201206-1101OC","article-title":"Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease","volume":"186","author":"Carrillo","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_106","first-page":"275","article-title":"Por\u00f3wnanie wp\u0142ywu indukcji znieczulenia og\u00f3lnego, opartej na ma\u0142ej dawce opioidu, z wykorzystaniem deksmedetomidyny i indukcji znieczulenia ze standardow\u0105 dawk\u0105 opioidu na reakcj\u0119 wywo\u0142an\u0105 intubacj\u0105 tchawicy u os\u00f3b oty\u0142ych","volume":"48","author":"Czarnik","year":"2016","journal-title":"Anestezjol. Intensywna Ter."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/17\/2120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:33:29Z","timestamp":1760034809000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/17\/2120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":106,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15172120"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15172120","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,22]]}}}