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Examining the relationship of EDS with features of OSA may identify physiological processes that drive increased risk for adverse health outcomes in patients with OSA and EDS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Question<\/jats:title>\n                    <jats:p>Do variations in physiological endo-phenotypes identified from polysomnography associate with EDS in a general population, and do such associations vary by sex?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>Participants in the Multi-ethnic Study of Atherosclerosis (MESA) Exam 5 Sleep Study underwent polysomnography, actigraphy, and questionnaire assessment. Among participants with an apnea\u2013hypopnea index\u2009&amp;gt;\u20095 events\/hour (n\u2009=\u20091783; mean, age 68.7\u2009\u00b1\u20099.1; 52% female), we examined associations between OSA endo-phenotypes including physiological severity measures (hypoxic burden, arousal intensity, event duration, heart rate response [\u0394 HR]), and endotypes (mechanistic traits: collapsibility, compensation, loop gain, and arousal threshold) with EDS (Epworth Sleepiness Scale, ESS\u2009&amp;gt;\u200910). Poisson regression models with robust variance were used, adjusting for demographics, smoking, and other factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>EDS was found in 14% of the sample. An interquartile increase in hypoxic burden was associated with a 28% higher prevalence ratio (PR) of EDS (PR\u2009=\u20091.28; 95% CI: 1.10, 1.51) in models adjusted for demographic factors and smoking. An increased adjusted PR of EDS was also associated with higher loop gain (1.26; 1.12, 1.42) and higher \u0394HR (1.32; 1.01, 1.73). In sex-stratified analyses, EDS was associated with shorter respiratory event duration and higher compensation in females, and with hypoxic burden and high \u0394HR in males (P value for sex interaction\u2009&amp;lt;\u2009.05 for event duration). Associations did not materially change with adjustment for short sleep duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>EDS was associated with several OSA endo-phenotypes. EDS was more strongly associated with shorter event duration in females, with trends for stronger associations for hypoxic burden and \u0394HR in males. The physiological correlates of EDS in people with OSA may contribute to differences in OSA outcomes across symptom groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag078","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T18:31:47Z","timestamp":1775759507000},"page":"1067-1076","source":"Crossref","is-referenced-by-count":1,"title":["Associations of excessive sleepiness with sleep apnea physiological endo-phenotypes: the multi-ethnic study of atherosclerosis"],"prefix":"10.1093","volume":"23","author":[{"given":"Cecilia","family":"Castro-Diehl","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women\u2019s Hospital, Harvard Medical School , Boston, MA,","place":["United States"]},{"name":"Department of Neurology, Division of Sleep and Circadian Disorders, Brigham and Women\u2019s Hospital, Harvard Medical School , Boston, MA,","place":["United 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