Do you perform spontaneous breathing trials on higher levels of PEEP with extubation to positive pressure ventilation in patients intubated for obesity hypoventilation syndrome?

Yes. But like anything patient selection is key and the rationale for the use of higher levels of PEEP (e.g. improve oxygenation vs prevention of atelectasis for simplicity sake) factors into the decision (as do co-morbidities -heart failure, pulm HTN, etc).

The literature nor weaning guideline do ...

I typically do a regular spontaneous breathing trial with PEEP 5 and PS 5 because I don't want to distort the patient physiology during the trial (I want to know as close as possible what they would do if they were extubated). However, I do extubate to PAP much like COPD or heart failure. Increased ...