{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:23:37Z","timestamp":1788780217404,"version":"build-2803163510"},"reference-count":39,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/501100004921","name":"Shanghai Jiao Tong University","doi-asserted-by":"publisher","award":["YG2023LC11"],"award-info":[{"award-number":["YG2023LC11"]}],"id":[{"id":"10.13039\/501100004921","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008750","name":"Shanghai Municipal Hospital Development Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008750","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","resmedjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Medicine"],"published-print":{"date-parts":[[2026,4]]},"DOI":"10.1016\/j.rmed.2026.108759","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T07:47:28Z","timestamp":1773215248000},"page":"108759","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"special_numbering":"C","title":["Autonomic imbalance mediates sleep apnea-specific hypoxic burden and glucose metabolism in obstructive sleep apnea: A large-scale observational study"],"prefix":"10.1016","volume":"255","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2274-9998","authenticated-orcid":false,"given":"Chenyang","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenger","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianyin","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyue","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Guan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoman","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yupu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijun","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongliang","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankai","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"14","key":"10.1016\/j.rmed.2026.108759_bib1","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1001\/jama.2020.3514","article-title":"Diagnosis and management of obstructive sleep apnea: a review","volume":"323","author":"Gottlieb","year":"2020","journal-title":"JAMA"},{"issue":"3","key":"10.1016\/j.rmed.2026.108759_bib2","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1161\/CIR.0000000000000988","article-title":"Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American heart association","volume":"144","author":"Yeghiazarians","year":"2021","journal-title":"Circulation"},{"issue":"9","key":"10.1016\/j.rmed.2026.108759_bib3","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"Peppard","year":"2013","journal-title":"Am. J. Epidemiol."},{"issue":"5","key":"10.1016\/j.rmed.2026.108759_bib4","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/j.chest.2017.05.009","article-title":"Obstructive sleep apnea and diabetes: a state of the art review","volume":"152","author":"Reutrakul","year":"2017","journal-title":"Chest"},{"issue":"10","key":"10.1016\/j.rmed.2026.108759_bib5","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1513\/AnnalsATS.202111-1260OC","article-title":"Insulin resistance, hyperglycemia, and risk of developing obstructive sleep apnea in men and women in the United States","volume":"19","author":"Huang","year":"2022","journal-title":"Ann. Am. Thorac. Soc."},{"issue":"1","key":"10.1016\/j.rmed.2026.108759_bib6","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s13679-020-00369-y","article-title":"Sleep apnea, obesity, and disturbed glucose homeostasis: Epidemiologic evidence, biologic insights, and therapeutic strategies","volume":"9","author":"Pugliese","year":"2020","journal-title":"Curr. Obes. Rep."},{"issue":"8","key":"10.1016\/j.rmed.2026.108759_bib7","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.2337\/dc19-2006","article-title":"Continuous positive airway pressure treatment, glycemia, and diabetes risk in obstructive sleep apnea and comorbid cardiovascular disease","volume":"43","author":"Loffler","year":"2020","journal-title":"Diabetes Care"},{"issue":"1","key":"10.1016\/j.rmed.2026.108759_bib8","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.arbres.2022.08.005","article-title":"Hypoxic burden in obstructive sleep apnea: present and future","volume":"59","author":"Martinez-Garcia","year":"2023","journal-title":"Arch. Bronconeumol."},{"issue":"1","key":"10.1016\/j.rmed.2026.108759_bib9","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1164\/rccm.202110-2371ED","article-title":"Sleep apnea-specific hypoxic burden and not the sleepy phenotype as a novel measure of cardiovascular and mortality risk in a clinical cohort","volume":"205","author":"Mehra","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"issue":"8","key":"10.1016\/j.rmed.2026.108759_bib10","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1038\/s41569-023-00846-6","article-title":"Obstructive sleep apnoea heterogeneity and cardiovascular disease","volume":"20","author":"Redline","year":"2023","journal-title":"Nat. Rev. Cardiol."},{"issue":"7","key":"10.1016\/j.rmed.2026.108759_bib11","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1164\/rccm.202209-1808OC","article-title":"Sleep apnea physiological burdens and cardiovascular morbidity and mortality","volume":"208","author":"Labarca","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"10.1016\/j.rmed.2026.108759_bib12","doi-asserted-by":"crossref","DOI":"10.1016\/j.autneu.2019.102563","article-title":"Obstructive sleep apnea syndrome and autonomic dysfunction","volume":"221","author":"Lombardi","year":"2019","journal-title":"Auton Neurosci. Basic Clin."},{"issue":"11","key":"10.1016\/j.rmed.2026.108759_bib13","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1016\/j.sleep.2014.05.030","article-title":"Neurobehavioral and autonomic alterations in adults with obstructive sleep apnea","volume":"15","author":"Idiaquez","year":"2014","journal-title":"Sleep Med."},{"issue":"8047","key":"10.1016\/j.rmed.2026.108759_bib14","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1038\/s41586-024-08269-0","article-title":"Organ-specific sympathetic innervation defines visceral functions","volume":"637","author":"Wang","year":"2025","journal-title":"Nature"},{"issue":"12","key":"10.1016\/j.rmed.2026.108759_bib15","doi-asserted-by":"crossref","first-page":"4083","DOI":"10.2337\/db14-0477","article-title":"Central insulin administration improves whole-body insulin sensitivity via hypothalamus and parasympathetic outputs in men","volume":"63","author":"Heni","year":"2014","journal-title":"Diabetes"},{"issue":"7","key":"10.1016\/j.rmed.2026.108759_bib16","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1089\/dia.2016.0147","article-title":"Obstructive sleep apnea and diabetic nephropathy","volume":"18","author":"Misra","year":"2016","journal-title":"Diabetes Technol. Therapeut."},{"issue":"5","key":"10.1016\/j.rmed.2026.108759_bib17","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.pcd.2018.03.005","article-title":"The correlation between obstructive sleep apnea and diabetic neuropathy: a meta-analysis","volume":"12","author":"Gu","year":"2018","journal-title":"Primary care diabetes"},{"issue":"2","key":"10.1016\/j.rmed.2026.108759_bib18","doi-asserted-by":"crossref","DOI":"10.1093\/sleep\/zsae240","article-title":"The association of objective daytime sleepiness with impaired glucose metabolism in patients with obstructive sleep apnea: a multi-omics study","volume":"48","author":"Chen","year":"2025","journal-title":"Sleep"},{"key":"10.1016\/j.rmed.2026.108759_bib19","article-title":"Association between obstructive sleep apnea risk and type 2 diabetes among Emirati adults: results from the UAE healthy future study","volume":"15","author":"Taimah","year":"2024","journal-title":"Front. Endocrinol."},{"issue":"3","key":"10.1016\/j.rmed.2026.108759_bib20","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s11325-018-01779-y","article-title":"The association between obstructive sleep apnea during REM sleep and autonomic dysfunction as measured by heart rate variability","volume":"23","author":"Oh","year":"2019","journal-title":"Sleep & breathing = Schlaf & Atmung"},{"issue":"5","key":"10.1016\/j.rmed.2026.108759_bib21","doi-asserted-by":"crossref","first-page":"665","DOI":"10.5664\/jcsm.6576","article-title":"AASM scoring manual updates for 2017 (Version 2.4)","volume":"13","author":"Berry","year":"2017","journal-title":"J. Clin. Sleep Med."},{"issue":"2","key":"10.1016\/j.rmed.2026.108759_bib22","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1093\/sleep\/32.2.139","article-title":"Sleep classification according to AASM and Rechtschaffen & Kales: effects on sleep scoring parameters","volume":"32","author":"Moser","year":"2009","journal-title":"Sleep"},{"issue":"8","key":"10.1016\/j.rmed.2026.108759_bib23","article-title":"Study of serum apelin and insulin resistance in type 2 diabetes mellitus patients with or without obesity","volume":"15","author":"Mund","year":"2023","journal-title":"Cureus"},{"issue":"2","key":"10.1016\/j.rmed.2026.108759_bib24","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.clnu.2018.04.002","article-title":"Dietary inflammatory potential and risk of mortality in metabolically healthy and unhealthy phenotypes among overweight and obese adults","volume":"38","author":"Park","year":"2019","journal-title":"Clinical nutrition (Edinburgh, Scotland)"},{"issue":"19","key":"10.1016\/j.rmed.2026.108759_bib25","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.026184","article-title":"Insulin resistance is associated with heart failure with recovered ejection fraction in patients without diabetes","volume":"11","author":"Yang","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"10.1016\/j.rmed.2026.108759_bib26","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.sleep.2023.09.007","article-title":"The use of the sleep apnea-specific hypoxic burden to predict obstructive sleep apnea hypopnea syndrome: evidence from a large cross-sectional study","volume":"111","author":"Li","year":"2023","journal-title":"Sleep Med."},{"key":"10.1016\/j.rmed.2026.108759_bib27","doi-asserted-by":"crossref","first-page":"557","DOI":"10.3389\/fphys.2016.00557","article-title":"Hrvanalysis: a free software for analyzing cardiac autonomic activity","volume":"7","author":"Pichot","year":"2016","journal-title":"Front. Physiol."},{"issue":"1","key":"10.1016\/j.rmed.2026.108759_bib28","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s12933-024-02144-y","article-title":"Association between atherogenic index of plasma control level and incident cardiovascular disease in middle-aged and elderly Chinese individuals with abnormal glucose metabolism","volume":"23","author":"Min","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"issue":"17","key":"10.1016\/j.rmed.2026.108759_bib29","doi-asserted-by":"crossref","first-page":"2660","DOI":"10.1161\/CIRCULATIONAHA.105.556746","article-title":"Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome","volume":"112","author":"Ryan","year":"2005","journal-title":"Circulation"},{"key":"10.1016\/j.rmed.2026.108759_bib30","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.neubiorev.2016.03.007","article-title":"Gender differences in healthy human heart rate variability: a meta-analysis","volume":"64","author":"Koenig","year":"2016","journal-title":"Neurosci. Biobehav. Rev."},{"issue":"1","key":"10.1016\/j.rmed.2026.108759_bib31","doi-asserted-by":"crossref","DOI":"10.1111\/eci.14085","article-title":"Heart rate variability and cardiovascular diseases: a Mendelian randomization study","volume":"54","author":"Zhao","year":"2024","journal-title":"Eur. J. Clin. Invest."},{"issue":"6","key":"10.1016\/j.rmed.2026.108759_bib32","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.jelectrocard.2017.06.007","article-title":"Quantitative evaluation of heartbeat interval time series using Poincar\u00e9 analysis reveals distinct patterns of heart rate dynamics during cycles of vagus nerve stimulation in patients with heart failure","volume":"50","author":"Libbus","year":"2017","journal-title":"J. Electrocardiol."},{"issue":"1","key":"10.1016\/j.rmed.2026.108759_bib33","doi-asserted-by":"crossref","first-page":"3620","DOI":"10.1038\/s41598-021-83071-w","article-title":"Study of heart rate recovery and cardiovascular autonomic modulation in healthy participants after submaximal exercise","volume":"11","author":"Facioli","year":"2021","journal-title":"Sci. Rep."},{"key":"10.1016\/j.rmed.2026.108759_bib34","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.jad.2020.01.132","article-title":"Heart rate variability changes in patients with panic disorder","volume":"267","author":"Zhang","year":"2020","journal-title":"J. Affect. Disord."},{"issue":"3","key":"10.1016\/j.rmed.2026.108759_bib35","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1002\/j.2040-4603.2016.tb00714.x","article-title":"Overview of the anatomy, physiology, and pharmacology of the autonomic nervous system","volume":"6","author":"Wehrwein","year":"2016","journal-title":"Compr. Physiol."},{"issue":"6","key":"10.1016\/j.rmed.2026.108759_bib36","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1183\/09031936.00128412","article-title":"Effects of obstructive sleep apnoea on heart rhythm","volume":"41","author":"Rossi","year":"2013","journal-title":"Eur. Respir. J."},{"issue":"9","key":"10.1016\/j.rmed.2026.108759_bib37","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1161\/HYPERTENSIONAHA.122.19288","article-title":"Influence of obstructive sleep apnea severity on muscle sympathetic nerve activity and blood pressure: a systematic review and meta-analysis","volume":"79","author":"Maier","year":"2022","journal-title":"Hypertension (Dallas, Tex : 1979)"},{"issue":"11","key":"10.1016\/j.rmed.2026.108759_bib38","doi-asserted-by":"crossref","first-page":"E1073","DOI":"10.1152\/ajpendo.00373.2014","article-title":"Intermittent hypoxia-induced glucose intolerance is abolished by \u03b1-adrenergic blockade or adrenal medullectomy","volume":"307","author":"Jun","year":"2014","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"issue":"11","key":"10.1016\/j.rmed.2026.108759_bib39","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1111\/cns.13942","article-title":"Relationship between chronic hypoxia and seizure susceptibility","volume":"28","author":"Xu","year":"2022","journal-title":"CNS Neurosci. Ther."}],"container-title":["Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0954611126001277?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0954611126001277?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:44:21Z","timestamp":1776095061000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0954611126001277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":39,"alternative-id":["S0954611126001277"],"URL":"https:\/\/doi.org\/10.1016\/j.rmed.2026.108759","relation":{},"ISSN":["0954-6111"],"issn-type":[{"value":"0954-6111","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Autonomic imbalance mediates sleep apnea-specific hypoxic burden and glucose metabolism in obstructive sleep apnea: A large-scale observational study","name":"articletitle","label":"Article Title"},{"value":"Respiratory Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.rmed.2026.108759","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"108759"}}