{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T06:48:15Z","timestamp":1782715695685,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NCT02576587"],"award-info":[{"award-number":["NCT02576587"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Autonomic nervous system (ANS) dysfunction is implicated in sleep\u2010disordered breathing (SDB) and atrial fibrillation (AF); however, diurnal patterning of ANS function in SDB is unclear. We hypothesize diurnal variation of heart rate variability (HRV) in paroxysmal AF (PAF) in SDB and alteration by continuous positive airway pressure (CPAP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Data from the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study including 7\u201324\u2009days of electrocardiography (ECG), concomitant actigraphy and polysomnography at baseline and 3\u2009months post\u2010CPAP initiation were analyzed. Linear mixed\u2010effects models were used to assess (1) SDB: apnea hypopnea index (AHI), hypoxia (%sleep time with SaO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;\u200990% and nadir SaO\n                      <jats:sub>2<\/jats:sub>\n                      ) and (2) diurnal average HRV in 2 domains:\n                      <jats:italic>frequency domain<\/jats:italic>\n                      (\n                      <jats:italic>sympathovagal<\/jats:italic>\n                      ) with low\u2010frequency (LF) power (LFP), high\u2010frequency (HF) power (HFP), LF\/HF ratio (LHR), and\n                      <jats:italic>time domain<\/jats:italic>\n                      with mean of normal R\u2010R interval (MNN), standard deviation of NN intervals (SDNN), Poincare plot standard deviation short\u2010term and long\u2010term variability (SD1, SD2) and effect of CPAP. All results were adjusted for age, sex, race, BMI, and use of antihypertensive, antiarrhythmic, and atrioventricular nodal blockade medications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 44\u2009869 5\u2010min epochs from 109 participants with SDB and PAF, associations of AHI and LFP, nadir SaO\n                      <jats:sub>2<\/jats:sub>\n                      with sympathovagal measures (LFP, LHR) and time domain measures (SDNN, SD2) were observed during wakefulness. Sleep\u2013wake interactions were observed for multiple HRV measures, with associations generally more evident during wakefulness. From baseline to follow\u2010up after CPAP, wakefulness HRV measures showed an increase in MNN and decreases in SDNN, RMSSD, CV, SD1, and SD2. During sleep, MNN, SD2, and LHR increased.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Autonomic measures exhibited diurnal variation in moderate\u2013severe SDB and were influenced by CPAP. Association with SDB severity was more pronounced during wakefulness, providing key insights into likelihood of sustained chronobiologic electrophysiological remodeling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/joa3.70352","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T13:36:15Z","timestamp":1781098575000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep Apnea and Paroxysmal Atrial Fibrillation: Diurnal Patterning of Autonomic Dysfunction and Influence of\n                    <scp>CPAP<\/scp>\n                    Therapy"],"prefix":"10.1002","volume":"42","author":[{"given":"Sepideh","family":"Khazaie","sequence":"first","affiliation":[{"name":"Sleep Disorders Center Neurological Institute  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhad","family":"Kaffashi","sequence":"additional","affiliation":[{"name":"Institute for Smart, Secure and Connected Systems: ISSACS Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahana","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Sleep Disorders  Bakersfield California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina K.","family":"Chung","sequence":"additional","affiliation":[{"name":"The Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute Cleveland Clinic  Cleveland Ohio USA"},{"name":"Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute Cleveland Clinic Lerner College of Medicine of Case Western Reserve University  Cleveland Ohio USA"},{"name":"Lerner Research Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Heinzinger","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center Neurological Institute  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Van Wagoner","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute Cleveland Clinic Lerner College of Medicine of Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A.","family":"Loparo","sequence":"additional","affiliation":[{"name":"Institute for Smart, Secure and Connected Systems: ISSACS Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harneet K.","family":"Walia","sequence":"additional","affiliation":[{"name":"Miami Cardiac and Vascular Institute Baptist 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