{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:43:54Z","timestamp":1790120634600,"version":"4.0.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006260","name":"Technion - Israel Institute of Technology","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006260","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sleep Breath"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The natural history of untreated obstructive sleep apnea (OSA) and its cardiometabolic consequences are not fully characterized. We aimed to identify predictors of apnea severity progression and incident cardiometabolic comorbidities in untreated patients, comparing continuous and categorical measures of apnea severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively studied 538 adults (419 men, 119 women) who underwent two attended overnight polysomnographic evaluations separated by 3.8\u2009\u00b1\u20092.7 years and declined OSA treatment. Changes in apnea severity were assessed using continuous change in apnea\u2013hypopnea index (\u0394AHI) and categorical transitions across standard severity thresholds. Multivariable linear regression was used to identify predictors of \u0394AHI, and multivariable logistic regression was used to identify predictors of incident hypertension, diabetes, and cardiovascular disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Apnea severity and nocturnal hypoxemia worsened significantly over time. In linear regression, worsening \u0394AHI was independently associated with higher baseline body mass index (BMI), greater weight gain, more severe baseline hypoxemia, and longer sleep latency, whereas higher baseline AHI was associated with smaller subsequent increases. In contrast, categorical progression to moderate or severe OSA was primarily predicted by baseline BMI. Incident hypertension and diabetes were independently associated with age, baseline BMI, and duration of follow-up, but not with baseline AHI or \u0394AHI. Incident cardiovascular disease was independently associated with baseline apnea severity and lower sleep efficiency. Model discrimination ranged from acceptable to good (C-statistics 0.75\u20130.86).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In untreated patients, OSA commonly worsens over time, with progression influenced by obesity, hypoxemia, and sleep quality. Continuous measures of apnea severity capture physiologic progression more sensitively than categorical classifications. Cardiometabolic consequences differ by outcome, with obesity predominating for hypertension and diabetes and apnea severity and sleep fragmentation more closely linked to cardiovascular disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11325-026-03617-y","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T14:29:22Z","timestamp":1776781762000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predicting sleep apnea worsening and cardiometabolic risk without treatment"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6361-7210","authenticated-orcid":false,"given":"Peretz","family":"Lavie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"issue":"1","key":"3617_CR1","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.smrv.2013.01.003","volume":"18","author":"T Kendzerska","year":"2014","unstructured":"Kendzerska T, Mollayeva T, Gershon AS, Leung RS, Hawker G, Tomlinson G (2014) Untreated obstructive sleep apnea and the risk for serious long-term adverse outcomes: a systematic review. Sleep Med Rev 18(1):49\u201359. https:\/\/doi.org\/10.1016\/j.smrv.2013.01.003","journal-title":"Sleep Med Rev"},{"issue":"3","key":"3617_CR2","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1046\/j.1440-1819.2001.00843.x","volume":"55","author":"Y Inoue","year":"2001","unstructured":"Inoue Y, Nanba K, Hazama G, Takata K, Arai H (2001) Long-term follow-up study on patients with sleep apnea syndrome. Psychiatry Clin Neurosci 55(3):245\u2013246. https:\/\/doi.org\/10.1046\/j.1440-1819.2001.00843.x","journal-title":"Psychiatry Clin Neurosci"},{"issue":"5","key":"3617_CR3","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1053\/rmed.2001.1277","volume":"96","author":"D Fisher","year":"2002","unstructured":"Fisher D, Pillar G, Malhotra A, Peled N, Lavie P (2002) Long-term follow-up of untreated patients with sleep apnoea syndrome. Respir Med 96(5):337\u2013343. https:\/\/doi.org\/10.1053\/rmed.2001.1277","journal-title":"Respir Med"},{"issue":"23","key":"3617_CR4","doi-asserted-by":"publisher","first-page":"3015","DOI":"10.1001\/jama.284.23.3015","volume":"284","author":"PE Peppard","year":"2000","unstructured":"Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284(23):3015\u201321. https:\/\/doi.org\/10.1001\/jama.284.23.3015","journal-title":"JAMA"},{"issue":"10","key":"3617_CR5","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1136\/thx.52.10.872","volume":"52","author":"ST Pendlebury","year":"1997","unstructured":"Pendlebury ST, P\u00e9pin JL, Veale D, L\u00e9vy P (1997) Natural evolution of moderate sleep apnoea syndrome: significant progression over a mean of 17 months. Thorax 52(10):872\u2013878. https:\/\/doi.org\/10.1136\/thx.52.10.872","journal-title":"Thorax"},{"issue":"1","key":"3617_CR6","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1164\/ajrccm.157.1.9706079","volume":"157","author":"EO Bixler","year":"1998","unstructured":"Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A (1998) Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 157(1):144\u2013148. https:\/\/doi.org\/10.1164\/ajrccm.157.1.9706079","journal-title":"Am J Respir Crit Care Med"},{"issue":"10","key":"3617_CR7","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1183\/09031936.94.07101765","volume":"7","author":"E Sforza","year":"1994","unstructured":"Sforza E, Addati G, Cirignotta F, Lugaresi E (1994) Natural evolution of sleep apnoea syndrome: a five year longitudinal study. Eur Respir J 7(10):1765\u20131770. https:\/\/doi.org\/10.1183\/09031936.94.07101765","journal-title":"Eur Respir J"},{"issue":"6","key":"3617_CR8","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.1164\/ajrccm.159.6.9805070","volume":"159","author":"E Lindberg","year":"1999","unstructured":"Lindberg E, Elmasry A, Gislason T, Janson C, Bengtsson H, Hetta J et al (1999) Evolution of sleep apnea syndrome in sleepy snorers: a population-based prospective study. Am J Respir Crit Care Med 159(6):2024\u20137. https:\/\/doi.org\/10.1164\/ajrccm.159.6.9805070","journal-title":"Am J Respir Crit Care Med"},{"issue":"5","key":"3617_CR9","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1513\/AnnalsATS.201907-524OC","volume":"17","author":"RN Aurora","year":"2020","unstructured":"Aurora RN, McGuffey EJ, Punjabi NM (2020) Natural history of sleep-disordered breathing during rapid eye movement sleep: relevance for incident cardiovascular disease. Ann Am Thorac Soc 17(5):614\u2013620. https:\/\/doi.org\/10.1513\/AnnalsATS.201907-524OC","journal-title":"Ann Am Thorac Soc"},{"issue":"8","key":"3617_CR10","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.5664\/jcsm.7260","volume":"14","author":"A Gordon","year":"2018","unstructured":"Gordon A, Wu SJ, Munns N, DeVries A, Power T (2018) Untreated sleep apnea: an analysis of administrative data to identify risk factors for early nonadherence. J Clin Sleep Med 14(8):1303\u20131313. https:\/\/doi.org\/10.5664\/jcsm.7260","journal-title":"J Clin Sleep Med"},{"issue":"1","key":"3617_CR11","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-023-02612-3","volume":"23","author":"M Qiao","year":"2023","unstructured":"Qiao M, Xie Y, Wolff A, Kwon J (2023) Long term adherence to continuous positive airway pressure in mild obstructive sleep apnea. BMC Pulm Med 23(1):320. https:\/\/doi.org\/10.1186\/s12890-023-02612-3","journal-title":"BMC Pulm Med"},{"issue":"14","key":"3617_CR12","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1093\/eurheartj\/ehy624","volume":"40","author":"A Azarbarzin","year":"2019","unstructured":"Azarbarzin A, Sands SA, Stone KL, Taranto-Montemurro L, Messineo L, Terrill PI, Ancoli-Israel S, Ensrud K, Purcell S, White DP, Redline S, Wellman A (2019) The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J 40(14):1149\u20131157. https:\/\/doi.org\/10.1093\/eurheartj\/ehy624","journal-title":"Eur Heart J"},{"issue":"8","key":"3617_CR13","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1164\/rccm.201303-0448OC","volume":"188","author":"DJ Eckert","year":"2013","unstructured":"Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A (2013) Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 188(8):996\u20131004. https:\/\/doi.org\/10.1164\/rccm.201303-0448OC","journal-title":"Am J Respir Crit Care Med"},{"issue":"11","key":"3617_CR14","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1164\/rccm.201404-0718OC","volume":"190","author":"BA Edwards","year":"2014","unstructured":"Edwards BA, Eckert DJ, McSharry DG, Sands SA, Desai A, Kehlmann G, Bakker JP, Genta PR, Owens RL, White DP, Wellman A, Malhotra A (2014) Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea. Am J Respir Crit Care Med 190(11):1293\u2013300. https:\/\/doi.org\/10.1164\/rccm.201404-0718OC","journal-title":"Am J Respir Crit Care Med"},{"issue":"20","key":"3617_CR15","doi-asserted-by":"publisher","first-page":"2408","DOI":"10.1001\/archinte.165.20.2408","volume":"165","author":"AB Newman","year":"2005","unstructured":"Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T (2005) Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 165(20):2408\u201313. https:\/\/doi.org\/10.1001\/archinte.165.20.2408","journal-title":"Arch Intern Med"},{"issue":"12","key":"3617_CR16","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1164\/rccm.200712-1809OC","volume":"179","author":"GT O'Connor","year":"2009","unstructured":"O\u2019Connor GT, Caffo B, Newman AB, Quan SF, Rapoport DM, Redline S, Resnick HE, Samet J, Shahar E (2009) Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med 179(12):1159\u201364. https:\/\/doi.org\/10.1164\/rccm.200712-1809OC","journal-title":"Am J Respir Crit Care Med"},{"issue":"12","key":"3617_CR17","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1164\/rccm.200504-637OC","volume":"172","author":"KJ Reichmuth","year":"2005","unstructured":"Reichmuth KJ, Austin D, Skatrud JB, Young T (2005) Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med 172(12):1590\u20135. https:\/\/doi.org\/10.1164\/rccm.200504-637OC","journal-title":"Am J Respir Crit Care Med"},{"issue":"8","key":"3617_CR18","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1164\/rccm.200509-1442OC","volume":"173","author":"R Mehra","year":"2006","unstructured":"Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S, Sleep Heart Health Study (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 173(8):910\u20136. https:\/\/doi.org\/10.1164\/rccm.200509-1442OC","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"3617_CR19","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1161\/CIRCULATIONAHA.109.901801","volume":"122","author":"DJ Gottlieb","year":"2010","unstructured":"Gottlieb DJ, Yenokyan G, Newman AB, O\u2019Connor GT, Punjabi NM, Quan SF, Redline S, Resnick HE, Tong EK, Diener-West M, Shahar E (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 122(4):352\u201360. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.109.901801","journal-title":"Circulation"},{"issue":"15","key":"3617_CR20","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1164\/rccm.200911-1746OC","volume":"182","author":"S Redline","year":"2010","unstructured":"Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O\u2019Connor GT, Resnick HE, Diener-West M, Sanders MH, Wolf PA, Geraghty EM, Ali T, Lebowitz M, Punjabi NM (2010) Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 182(15):269\u201377. https:\/\/doi.org\/10.1164\/rccm.200911-1746OC","journal-title":"Am J Respir Crit Care Med"},{"key":"3617_CR21","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-024-05147-2","volume":"24","author":"F Fang","year":"2024","unstructured":"Fang F, Sun Z, Gao Y, Han J, Zhao L, Zhao Z, He Z, Zhang Z, Bian H, Liu L (2024) Effects of combined morbid insomnia and sleep apnea on long-term cardiovascular risk and all-cause mortality in elderly patients: a prospective cohort study. BMC Geriatr 24:622. https:\/\/doi.org\/10.1186\/s12877-024-05147-2","journal-title":"BMC Geriatr"},{"issue":"5","key":"3617_CR22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0090021","volume":"9","author":"MA Gupta","year":"2014","unstructured":"Gupta MA, Knapp K (2014) Cardiovascular and psychiatric morbidity in obstructive sleep apnea (OSA) with insomnia (sleep apnea plus) versus obstructive sleep apnea without insomnia: a case-control study from a Nationally Representative US sample. PLoS One 9(5):e90021. https:\/\/doi.org\/10.1371\/journal.pone.0090021","journal-title":"PLoS One"},{"issue":"2","key":"3617_CR23","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1097\/HJH.0000000000002664","volume":"39","author":"C Navarro-Soriano","year":"2021","unstructured":"Navarro-Soriano C, Torres G, Barb\u00e9 F, S\u00e1nchez-de-la-Torre M, Ma\u00f1as P, Lloberes P, Cambriles TD, Somoza M, Masa JF, Gonz\u00e1lez M, Ma\u00f1as E, de la Pe\u00f1a M, Garc\u00eda-R\u00edo F, Montserrat JM, Muriel A, Oscullo G, Garc\u00eda-Ortega A, Posadas T, Campos-Rodr\u00edguez F, Mart\u00ednez-Garc\u00eda M\u00c1 (2021) The HIPARCO-2 study: long-term effect of continuous positive airway pressure on blood pressure in patients with resistant hypertension: a multicenter prospective study. J Hypertens 39(2):302\u2013309. https:\/\/doi.org\/10.1097\/HJH.0000000000002664","journal-title":"J Hypertens"},{"issue":"22","key":"3617_CR24","doi-asserted-by":"publisher","first-page":"2407","DOI":"10.1001\/jama.2013.281250","volume":"310","author":"MA Mart\u00ednez-Garc\u00eda","year":"2013","unstructured":"Mart\u00ednez-Garc\u00eda MA, Capote F, Campos-Rodr\u00edguez F, Lloberes P, de D\u00edaz Atauri MJ, Somoza M et al (2013) Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 310(22):2407\u201315. https:\/\/doi.org\/10.1001\/jama.2013.281250","journal-title":"JAMA"},{"issue":"20","key":"3617_CR25","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.1001\/jama.2012.4366","volume":"307","author":"JM Marin","year":"2012","unstructured":"Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ et al (2012) Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 307(20):2169\u20132176. https:\/\/doi.org\/10.1001\/jama.2012.4366","journal-title":"JAMA"},{"issue":"10","key":"3617_CR26","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1056\/NEJMoa1606599","volume":"375","author":"RD McEvoy","year":"2016","unstructured":"McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X et al (2016) CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 375(10):919\u201331. https:\/\/doi.org\/10.1056\/NEJMoa1606599","journal-title":"N Engl J Med"},{"issue":"5","key":"3617_CR27","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1164\/rccm.201601-0088OC","volume":"194","author":"Y Peker","year":"2016","unstructured":"Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunstr\u00f6m E (2016) Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea: the RICCADSA randomized controlled trial. Am J Respir Crit Care Med 194(5):613\u2013620. https:\/\/doi.org\/10.1164\/rccm.201601-0088OC","journal-title":"Am J Respir Crit Care Med"},{"key":"3617_CR28","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.613452","volume":"12","author":"S Pamidi","year":"2021","unstructured":"Pamidi S, Tasali E (2021) Obstructive sleep apnea and type 2 diabetes: is there a link? Front Neurol 12:613452. https:\/\/doi.org\/10.3389\/fneur.2021.613452","journal-title":"Front Neurol"},{"key":"3617_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2022.101732","volume":"68","author":"XB Zhang","year":"2023","unstructured":"Zhang XB, Lin QC, Guo S, Chen GP, Chen HX, Tang XL (2023) Effects of continuous positive airway pressure on glucose metabolism in obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev 68:101732. https:\/\/doi.org\/10.1016\/j.smrv.2022.101732","journal-title":"Sleep Med Rev"}],"container-title":["Sleep and Breathing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11325-026-03617-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11325-026-03617-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11325-026-03617-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T14:24:46Z","timestamp":1779200686000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11325-026-03617-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":29,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["3617"],"URL":"https:\/\/doi.org\/10.1007\/s11325-026-03617-y","relation":{},"ISSN":["1520-9512","1522-1709"],"issn-type":[{"value":"1520-9512","type":"print"},{"value":"1522-1709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]},"assertion":[{"value":"17 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patients signed an informed conset before the PSG evaluations. The stydy was approved by the Faculty of Medicine Ethics Committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Ethics approval"}},{"value":"The author owns shares in SLP LtD and the Technion Sleep Center LtD.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Conflict of interest"}}],"article-number":"131"}}