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September 8, 2026The Korean Journal of Internal MedicineOpen Access

Probable obesity hypoventilation syndrome shows no association with in-hospital mortality among obese ICU patients.

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Why the study?

Obesity hypoventilation syndrome is linked to morbidity and ICU utilization, but data from Asian ICUs are limited.

Does probable obesity hypoventilation syndrome affect mortality in obese patients admitted to a medical intensive care unit?

Population

531 obese adults (BMI ≥ 27 kg/m²) admitted to a MICU in Korea

Comparison

Probable OHS vs obese non-probable OHS

Design

Single-center retrospective cohort study

Key result

Probable obesity hypoventilation syndrome was identified in 3.0% of obese patients admitted to a Korean medical ICU and was not significantly associated with in-hospital mortality after adjustment (OR 0.36).

Authors

KLKyu Jin LeeHLHong Yeul LeeJLJinwoo Lee

Discussion

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Overview

Probable OHS appears underrecognized in obese medical ICU patients without mortality association; leaves open prospective studies on screening and management.

Key Points

  • To evaluate the prevalence, clinical characteristics, and outcomes of probable obesity hypoventilation syndrome among obese patients admitted to a medical intensive care unit.
  • Analyzed 531 obese adults (BMI ≥ 27 kg/m²) out of 3,660 medical intensive care unit admissions at Seoul National University Hospital in Korea between 2016 and 2023.
  • Defined probable obesity hypoventilation syndrome as obesity with chronic hypercapnia (PaCO₂ ≥ 45 mmHg and bicarbonate ≥ 27 mmol/L) without alternative causes.
  • Assessed differences in in-hospital and 90-day mortality between groups using inverse probability of treatment weighting.
  • Probable obesity hypoventilation syndrome was present in 0.4% (16/3,660) of total admissions, 3.0% (16/531) of obese patients, and 6.5% (12/186) of patients with BMI ≥ 30 kg/m².
  • Most patients meeting diagnostic criteria were clinically unrecognized during admission, despite higher rates of obstructive airway disease and longer hospital stays (40 vs. 24 days, p = 0.083).
  • Inverse probability of treatment weighting-adjusted analyses demonstrated no statistically significant differences in in-hospital or 90-day mortality.

Study Design

Type

Cohort (n=531)

Multicenter

No

Structured PICO

Does probable obesity hypoventilation syndrome affect mortality in obese patients admitted to a medical intensive care unit?

P
Population
531 obese adults (BMI ≥ 27 kg/m²) admitted to a medical intensive care unit in Korea, followed for up to 5 years to evaluate the prevalence and outcomes of probable obesity hypoventilation syndrome.
E
Exposure
Probable obesity hypoventilation syndrome (OHS), defined as obesity with chronic hypercapnia (PaCO₂ ≥ 45 mmHg and bicarbonate ≥ 27 mmol/L) without alternative causes.
C
Comparator
Obese patients without probable OHS (obese non-probable OHS group).
O
Outcome
In-hospital and 90-day mortality.hard clinical

Main Result

Odds Ratio: 0.36 (95% CI 0.09–1.4)

Absolute Event Rate: 18.8% vs 47.6%

p-value: p=0.139

Probable obesity hypoventilation syndrome is present in 3% of obese MICU patients in Korea but is frequently unrecognized, though it was not associated with increased adjusted short-term mortality.

Limitations

  • Retrospective cohort study at a single tertiary hospital with a relatively small sample size
  • Potential for unmeasured confounding and missing variables
  • Operational definition of obesity as BMI ≥ 27 kg/m² rather than the conventional ≥ 30 kg/m²
  • Use of surrogate arterial blood gas values for awake daytime hypercapnia may lead to under-recognition in critically ill patients with mixed acid-base disorders
  • single-center study
  • retrospective nature

Cite This Study

Lee et al. (2026) conducted a cohort in Probable obesity hypoventilation syndrome (OHS) (n=531). Probable obesity hypoventilation syndrome vs. Obese patients without probable OHS was evaluated on In-hospital mortality (OR 0.36, 95% CI 0.09-1.40, p=0.139). Probable obesity hypoventilation syndrome was identified in 3.0% of obese patients admitted to a Korean medical ICU and was not significantly associated with in-hospital mortality after adjustment (OR 0.36).

synapsesocial.com/papers/6a9fc6ea684b366da041e521https://doi.org/10.3904/kjim.2026.085
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A-51 | In-Hospital Outcomes of Acute Myocardial Infarction in Patients with Obesity Hypoventilation Syndrome: A Retrospective Cohort Study2024
  2. 2Obesity Hypoventilation Syndrome—A Concise Clinical Review2020
  3. 3Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study2024
  4. 4The Influence of Obesity Hypoventilation Syndrome on the Outcomes of Patients With Diabetic Ketoacidosis2022 · 2 citations
  5. 5Obesity Hypoventilation Syndrome ( <scp>OHS</scp> ) as A Chronic Inflammatory Disease: A Clinical Case2026