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We aimed to evaluate the association between DS and IELF in patients with OSA and look for possible DS-related factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a prospective study, 220 untreated patients with mild-to-severe OSA were divided into non-smokers (Group 1,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009113), smokers without IELF (Group 2,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200969) and smokers with IELF (Group 3,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200938). Data about anthropometric characteristics, main comorbidities, spirometry, polygraphy, and DS (by Epworth Sleepiness Scale-ESS) were collected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared to other groups, patients in Group 3 had lower mean values and the lowest SpO2 (pulse oximetry oxygen saturation), with a greater ST\n                      <jats:sub>90<\/jats:sub>\n                      (sleep time with SpO\n                      <jats:sub>2<\/jats:sub>\n                      below 90%). In Group 3, DS was lower (ESS median 3) in comparison to Groups 1 (median 6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043) and 2 (median 6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005)(Kruskal-Wallis test\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021). In Group 3, particularly in patients with moderate-to-severe IELF, there was a significant association between ESS values and nocturnal lowest heart rate (LHR) (r\u00b2 = 0.436;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Finally, two multivariate linear regression-adjusted models, the second considering domiciliary treatment with bronchodilators, confirm the association between the nocturnal LHR and ESS (\u03b2 = -0.278;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 and \u03b2 = -0.260;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with OSA and IELF are less sleepy than OSA patients without it, even if they are smokers. A probable effect of autonomic alteration may explain the lower perception of sleepiness in OSA patients with IELF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11325-025-03530-w","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T06:32:06Z","timestamp":1763015526000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association between daytime sleepiness and impaired expiratory lung function due to smoking in patients with mild-to-severe OSA: an observational study"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1283-4718","authenticated-orcid":false,"given":"Giulia","family":"Sartori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5707-775X","authenticated-orcid":false,"given":"Alberto","family":"Fantin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Ferrari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7298-7084","authenticated-orcid":false,"given":"Ernesto","family":"Crisafulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"3530_CR1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.15","volume":"1","author":"P L\u00e9vy","year":"2015","unstructured":"L\u00e9vy P, Kohler M, McNicholas WT, Barb\u00e9 F, McEvoy RD, Somers VK et al (2015) Obstructive sleep apnoea syndrome. 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